Oral Health-Promoting School Environments and Dental Caries in Quebec Children.

INTRODUCTION: Dental caries are highly prevalent among children and have negative health consequences. Their occurrence may depend in part on school-based environmental or policy-related factors, but few researchers have explored this subject. This study aimed to identify oral health promoting school environment types and estimate their relation with 2-year dental caries incidence among Quebec children aged 8-10 years. METHODS: This study used data from two visits (completed in 2008 and 2011) of the QUALITY (Quebec Adipose Lifestyle Investigation in Youth) cohort, which recruited white children at risk of obesity and their families from Greater Montreal schools. Measures included school and neighborhood characteristics, and Decayed, Missing, Filled-Surfaces index scores. Principal component and cluster analyses, and generalized estimating equations were conducted. RESULTS: Data were available for 330 children attending 200 schools. Based on a series of statistical analyses conducted in 2016, the authors identified three distinct school environment types. Type 1 and 2 schools had strong healthy eating programs, whereas Type 3 had weak programs. Type 1 schools had favorable neighborhood food environments, whereas Type 2 and 3 had unfavorable ones. Adjusting for potential confounders, children attending Type 1 and 2 schools had 21% (incidence rate ratio=0.79, 95% CI=0.68, 0.90) and 6% (incidence rate ratio=0.94, 95% CI=0.83, 1.07) lower 2-year incidence of dental caries, respectively, compared with Type 3 schools. CONCLUSIONS: School-based oral health promotion programs combined with a favorable neighborhood can lower dental caries incidence in school children.