Oral Health–Promoting School Environments and Dental Caries in Québec Children


      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 Québec children aged 8–10 years.


      This study used data from two visits (completed in 2008 and 2011) of the QUALITY (Québec 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.


      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.


      School-based oral health promotion programs combined with a favorable neighborhood can lower dental caries incidence in school children.
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        • Petersen P.E.
        • Bourgeois D.
        • Ogawa H.
        • Estupinan-Day S.
        • Ndiaye C.
        The global burden of oral diseases and risks to oral health.
        Bull World Health Org. 2005; 83: 661-669
        • Marcenes W.
        • Kassebaum N.J.
        • Bernabé E.
        • et al.
        Global burden of oral conditions in 1990–2010: a systematic analysis.
        J Dent Res. 2013; 92: 592-597
        • Gavriilidou N.N.
        Global DMFT for 12-year-olds. Malmö University Oral Health Database, 2015 ( Accessed July 15, 2015)
        • Health Canada
        Report on the Findings of the Oral Health Component of the Canadian Health Measures Survey 2007–2009.
        Health Canada, Ottawa, Ontario2010
        • Sheiham A.
        Oral health, general health and quality of life.
        Bull World Health Org. 2005; 83: 644
        • Watt R.G.
        • Marinho V.C.
        Does oral health promotion improve oral hygiene and gingival health?.
        Periodontology 2000. 2005; 37: 35-47
        • Watt R.G.
        Strategies and approaches in oral disease prevention and health promotion.
        Bull World Health Org. 2005; 83: 711-718
        • Cooper A.M.
        • O'Malley L.A.
        • Elison S.N.
        • et al.
        Primary school-based behavioural interventions for preventing caries.
        Cochrane Database Syst Rev. 2013; 5 (CD009378)
        • Watt R.G.
        • Sheiham A.
        Integrating the common risk factor approach into a social determinants framework.
        Community Dent Oral Epidemiol. 2012; 40: 289-296
        • Watt R.G.
        From victim blaming to upstream action: tackling the social determinants of oral health inequalities.
        Community Dent Oral Epidemiol. 2007; 35: 1-11
        • Källestål C.
        • Norlund A.
        • Söder B.
        • et al.
        Economic evaluation of dental caries prevention: a systematic review.
        Acta Odontol Scand. 2003; 61: 341-346
        • Petersen P.E.
        The World Oral Health Report 2003: continuous improvement of oral health in the 21st century-the approach of the WHO Global Oral Health Programme.
        Community Dent Oral Epidemiol. 2003; 31: 3-23
        • Kwan S.Y.L.
        • Petersen P.E.
        • Pine C.M.
        • Borutta A.
        Health-promoting schools: an opportunity for oral health promotion.
        Bull World Health Org. 2005; 83: 677-685
        • Kwan S.
        • Petersen P.E.
        Oral Health Promotion: An Essential Element of Health-Promoting School.
        WHO, Geneva, Switzerland2003
        • Muirhead V.E.
        • Lawrence H.P.
        Exploring school oral health outcomes and neighbourhood factors in schools participating in Ontario's "healthy schools" recognition program.
        Can J Public Health. 2011; 102: 30-34
        • Moyses S.T.
        • Moyses S.J.
        • Watt R.G.
        • Sheiham A.
        Associations between health promoting schools' policies and indicators of oral health in Brazil.
        Health Promot Int. 2003; 18: 209-218
        • Yusof Z.Y.
        • Jaafar N.
        Health promoting schools and children’s oral health related quality of life.
        Health Qual Life Outcomes. 2013; 11: 205
        • Freeman R.
        • Oliver M.
        Do school break-time policies influence child dental health and snacking behaviours? An evaluation of a primary school programme.
        Br Dent J. 2009; 206: 619-625
        • Freeman R.
        • Oliver M.
        • Bunting G.
        • Kirk J.
        • Saunderson W.
        Addressing children's oral health inequalities in Northern Ireland: a research-practice-community partnership initiative.
        Public Health Rep. 2001; 116: 617-625
        • Martin C.
        • Arcand L.
        Healthy Schools: Guide for the Education Community and its Partners.
        Gouvernement du Québec Ministère de l’Éducation, du Loisir et du Sport, Québec2005
        • Da Rosa P.
        • Nicolau B.
        • Brodeur J.-M.
        • Benigeri M.
        • Bedos C.
        • Rousseau M.-C.
        Associations between school deprivation indices and oral health status.
        Community Dent Oral Epidemiol. 2011; 39: 213-220
        • Williams J.
        • Scarborough P.
        • Matthews A.
        • et al.
        A systematic review of the influence of the retail food environment around schools on obesity-related outcomes.
        Obes Rev. 2014; 15: 359-374
        • Van Hulst A.
        • Barnett T.A.
        • Gauvin L.
        • et al.
        Associations between children's diets and features of their residential and school neighbourhood food environments.
        Can J Public Health. 2012; 103: eS48-S54
        • Lambert M.
        • Van Hulst A.
        • O'Loughlin J.
        • et al.
        Cohort profile: the Quebec adipose and lifestyle investigation in youth cohort.
        Int J Epidemiol. 2012; 41: 1533-1544
        • Pendry L.
        • Lashkari G.
        • Bewley H.
        Technical Report: 2003 Children's Dental Health Survey.
        Office for National Statistics, London2004
        • Citro C.F.
        • Michael R.T.
        Measuring Poverty: A New Approach.
        National Academies Press, Washington, DC1995
        • Greves H.M.
        • Rivara F.
        Report card on school snack food policies among the United States' largest school districts in 2004–2005: room for improvement.
        Int J Behav Nutr Phys Act. 2006; 3: 1
        • Pearlman D.N.
        • Dowling E.
        • Bayuk C.
        • Cullinen K.
        • Kelsey Thacher A.
        From concept to practice: using the School Health Index to create healthy school Environments in Rhode Island elementary schools.
        Prev Chronic Dis. 2005; 2: A09
        • Brener N.D.
        • Kann L.
        • Smith T.K.
        Reliability and validity of the School Health Policies and Programs study 2000 questionnaires.
        J Sch Health. 2003; 73: 29-37
      1. School Survey of Food and Nutrition Policies and Services in Newfoundland and Labrador.
        Newfoundland and Labrador Teachers' Association, St. Johns2001
        • Pampalon R.
        • Hamel D.
        • Gamache P.
        • Raymond G.
        A deprivation index for health planning in Canada.
        Chronic Dis Can. 2009; 29: 178-191
        • Daniel M.
        • Kestens Y.
        MEGAPHONE: Montreal Epidemiological and Geographic Analysis of Population Health Outcomes and Neighbourhood Effects.
        Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Canada2007
        • StataCorp
        Stata 12 Base Reference Manual.
        Stata Press, College Station, TX2011
        • Sheiham A.
        Impact of dental treatment on the incidence of dental caries in children and adults.
        Community Dent Oral Epidemiol. 1997; 25: 104-112
        • Amalia R.
        • Schaub R.M.
        • Widyanti N.
        • Stewart R.
        • Groothoff J.W.
        The role of school-based dental programme on dental caries experience in Yogyakarta province, Indonesia.
        Intl J Paediatr Dent. 2012; 22: 203-210
      2. Going the healthy route at school - Framework policy on healthy eating and active living. Gouvernement du Québec. Accessed July 15, 2015.

        • Morin P.
        • Demers K.
        • Gray-Donald K.
        • Mongeau L.
        Foods offered in Quebec school cafeterias: do they promote healthy eating habits? Results of a provincial survey.
        Can J Public Health. 2012; 103: e249-e254