Field: Dental Public Health/Preventative and Community Dentistry
Title of research project: Factors Related to Tooth Decay Etiology in Children in Xicotepec,
Mexico
Research Proposal
Abstract
For this Stanley project, I aim to investigate several factors that contribute to high rates of tooth
decay in children in a community in central Mexico called Xicotepec. I will do so by
administering in-person questionnaires to parents of elementary and preschool children, as well
as written surveys to local dentists and pediatricians. The community of Xicotepec has an
ongoing relationship with a service-learning course at the University of Iowa and a number of
Iowa Rotary Clubs, and the findings from this project will be used to inform and improve future
oral health promotion activities that are a part of this service-learning course. This specific
project serves my academic interests as a candidate for the certificate in Global Health Studies.
Main Research Problems
Dental caries, commonly known as tooth decay, is a substantial health issue for children in
Mexico. The town of Xicotepec de Juarez, a mid-sized town 115 miles northeast of Mexico City
in the state of Puebla, is no exception. In several elementary schools in this town, 60-70% of
children have tooth decay. In the U.S. those rates are 20-23% in the total child population and
30% among Mexican-American children in the U.S. according to the Centers for Disease Control
and Prevention.
Several factors contribute to the high burden of dental disease in children in this community:
deficiencies in knowledge about oral health, a shortage of preventive interventions addressing
childhood tooth decay, and barriers to accessing dental services. Knowledge gaps about dental
health became evident through workshops with parents of Xicotepec preschool children that
were conducted in 2012 by participants in the Xicotepec service-learning course. In these
workshops the parents identified education as the most important obstacle to optimal oral health
for their children. However, it is not fully understood what knowledge is missing or
misunderstood, nor what is commonly known and not known in this community, about factors
that affect oral health in children.
Children in much of Mexico, including Xicotepec, do not have exposure to oral disease
prevention programs to which children in the U.S. are regularly exposed. Fluoride is not
regularly added to community water systems, largely because the greater priority is to provide
water that is safe to drink. There are very limited school-based programs in which ‘pasante’
dentists (dental students in their fifth intern year) provide fluoride treatments to schoolchildren.
However, not all schools are covered every year. Additionally, brushing daily with fluoridated
toothpaste at home is not common practice. Finally, as is the case in the U.S., many children,
particularly those from families of lower socioeconomic status, are unable to access dental
services and only receive care in cases of emergency due to severe pain or infection.
These three factors – knowledge gaps, little exposure to preventive interventions, and barriers to
accessing care – are the three major etiological problems contributing to high tooth decay rates in
Xicotepec’s children. In order to change these, we must understand them at a deeper level.
Therefore, the following research questions will guide the focus of this project:
1. What are the levels of knowledge of parents in Xicotepec de Juarez about the following:
a. The etiology of tooth decay
b. Possible outcomes of tooth decay in children (pain, infection, trouble eating and speaking,
poor self-esteem)
c. Where oral health fits into the general health of children
d. Oral hygiene and dietary recommendations for children
e. The role of fluoride in preventing cavities
2. What are a) the levels of knowledge and b) attitudes of healthcare professionals (medical and
dental) about the scope of oral disease in children in Xicotepec de Juarez, and c) what
suggestions do they have to improve the situation?
Methods
I plan to develop, translate, and administer two survey instruments (one for parents and one for
healthcare providers) in Xicotepec that aim to answer the questions above. As many parents,
particularly in the more rural areas of this community, may be illiterate, I plan to enlist the help
of local university students to read the questionnaires aloud to the parents. Obviously, this will
be more time-intensive than a written survey and will result in fewer subjects, but it will provide
more detailed information, as some of the questions will be open-ended. If time allows, I plan to
perform dental screenings on a sample of preschool and primary school children at schools
where the prevalence of tooth decay is unknown, in order to provide a more comprehensive
assessment of the prevalence of tooth decay in this community. In addition, I plan to administer
written surveys to local dentists and pediatricians to investigate research question #2.
Detailed Plan for Research
Through our involvement with an ongoing annual University of Iowa service-learning course,
called International Perspectives: Xicotepec, in partnership with the Iowa City and Xicotepec
Rotary Clubs, a faculty member at the College of Dentistry, Dr. Steven M. Levy, has led dental
teams the past two years to this community and will do so again in March 2013. I served as his
unofficial graduate student assistant in 2011 after attending as a student in 2010. Oral health
activities have included several health promotion/disease prevention approaches, including
education and sustainable program development (i.e. daily toothbrushing programs, weekly
fluoride mouthrinse programs). We have also conducted screening dental exams and recorded
the rates of obvious tooth decay at these schools, which is considerably higher than caries rates
of most U.S. children.
Specifically, I plan to arrive in mid May 2013 and stay through early July. School will be in
session until early July, which will allow 4-6 weeks to complete the parent surveys. With precise
planning, I hope to be able to accomplish the above activities in six weeks. I also understand the
need to be flexible and the fact that, while planning is essential, I should not expect tasks to go
exactly as planned. In my previous experiences in Xicotepec, flexibility, patience, and problemsolving are skills that are critical for any project to be completed successfully.