Barn och ungdomar i Sverige med två utrikes födda föräldrar utgör 17% av alla barn i befolkningen. SYFTE: Syftet med denna avhandling var att inhämta kunskap om förekomst av karies och kariesassocierade variabler samt gingivit hos barn och ungdomar 3, 5, 10 och 15 år med utländsk bakgrund och jämföra dessa resultat med svenska barn i motsvarande åldersgrupper i ett tioårsperspektiv (Studie I). Syftet var vidare att med avseende på kariesprevalens och kariesassocierade faktorer jämföra 15-åringar med utländsk bakgrund med åldersmatchade ungdomar med svensk bakgrund samt att jämföra kariesförekomst hos 15-åringar med utländsk bakgrund i förhållande till ålder vid tidpunkten för immigration. (Studie II). MATERIAL OCH METOD: Under 1993 och 2003 utfördes två tvärsnittsstudier i Jönköping med ett slumpmässigt urval av individer i åldersgrupperna 3, 5, 10 och 15 år. Samtliga individers orala hälsa undersöktes kliniskt och röntgenologiskt. Barnen, eller deras föräldrar, svarade även på ett frågeformulär avseende attityder till och kunskaper om tänder samt munhälsovanor. Totalt omfattade studien 739 barn och ungdomar, 154 med två utrikes födda föräldrar (F kohort) och 585 med två svenskfödda föräldrar (S kohort) (Studie I). I en annan studie inbjöds 143 15-åringar på en kommunal skola i Jönköping att delta (Studie II). Av dessa deltog 117 personer, 51 med två utrikes födda föräldrar och 66 med två svenskfödda föräldrar. Alla ungdomar intervjuades med hjälp av ett strukturerat frågeformulär där kostfrågor förtydligades med visualisering, dvs exempel på förpackningar och varor. Information om DFS samlades in från journaler från Folktandvården, Landstinget i Jönköpings län. RESULTAT:
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Både 1993 och 2003 var fler 3- och 5-åringar med svensk bakgrund (S kohort) kariesfria jämfört med motsvarande åldersgrupper med utländsk bakgrund (F kohort). År 1993 var dfs högre bland 3- och 5-åringar i F kohorten (p<0,01) jämfört med S kohorten. År 2003 var dfs/DFS statistiskt signifikant högre bland barn och ungdomar i alla åldersgrupper i F kohorten jämfört med S kohorten. År 2003 var Odds Ratio för karies hos 10- och 15-åringar i F kohorten, justerat för kön och ålder, mer än sex gånger högre (OR=6,3, 95% CI :2.51-15 0,61; p<0,001) jämfört med S kohorten (Studie I). Proportionerna av kariesfria ungdomar var lika bland 15-åringar med utrikes födda föräldrar jämfört med 15-åringar med svenskfödda föräldrar, dock hade ungdomar med utländsk bakgrund i genomsnitt mer karies och restaureringar (p=0.03) jämfört med ungdomar med svensk bakgrund. Det var ingen skillnad i kariesförekomst mellan 15-åringar födda i Sverige av två utrikes födda föräldrar och som hade kommit till Sverige före ett års ålder. De hade en likartad kariesprevalens som ungdomar med två svenskfödda föräldrar. Däremot uppvisade barn som immigrerat till Sverige efter sju års ålder en kariesprevalens som var två till tre gånger högre (p<0,06) (Studie II). Både 1993 och 2003 var det procentuella medeltalet tandytor med plack och gingivit numerärt högre i alla åldersgrupper med utländsk bakgrund i jämförelse med individer med svensk bakgrund, utom hos 15-åringar (Studie I). Intaget av sockerhaltiga mellanmål var statistiskt signifikant högre hos 15-åringar med utländsk bakgrund än hos 15-åringar med
svensk bakgrund. SLUTSATSER: Barn och ungdomar med två utrikes födda
föräldrar uppvisade en högre kariesförekomst i ett tioårsperspektiv än barn och ungdomar med två svenskfödda föräldrar. År 2003 hade samtliga åldersgrupper med två utrikes födda föräldrar statistiskt signifikant fler kariesangrepp än barn och ungdomar med svenskfödda föräldrar. År 2003 var oddskvoten för att bli utsatt för karies nästan sex gånger högre för 10- och 15-åringar med två utrikes födda föräldrar i jämförelse med 10- och 15-åringar med två svenskfödda föräldrar. Regelbundna matvanor och goda munhälsovanor skapar nödvändiga
63
förutsättningar för en tillfredsställande oral hälsa i alla åldersgrupper oavsett svensk eller utländsk bakgrund.
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Acknowledgements
I wish to express my appreciation and sincere gratitude to:
Professor Anders Hugoson, my Assistant Supervisor and co-author, who introduced me to the area of epidemiological research and guided and encouraged me through the whole process. Without our productive discussions I had not reached this goal. It is a privilege to benefit from your friendship.
Professor Tomas Magnusson, my Supervisor and co-author, who has supported me and always has useful suggestions on my language and expressions.
Professor Lill-Kari Wendt, my co-author, and the one who introduced me to the area of children with foreign backgrounds.
Professor Göran Koch, my co-author, and the outstanding specialist in the areas of dental caries and pedodontics. Thanks you for all good advices.
Professor Ingegerd Johansson, my co-author, and the one who introduced me to SPSS and learned me the working process with a new research material and helped me to read SPSS outcome from my first article.
Assistant Professor Eleonor Fransson, my statistical supervisor. Thank you for all your enthusiasm and support in my second article.
Doctoral student Alkisti Anastassaki-Köhler, Assistant Professor Krister Bjerklin, and Senior Lecturer Malin Stensson, for your valuable comments at my final seminar.
Language Reviewer Jeanette Kliger, for excellent revision of the English language.
Librarian Stefan Carlstein, and Gunilla Brushammar, at Jönköping University Library, for all your help with EndNote and scientific articles.
65
Research co-ordinator Susanne Johannesson and University Lecturer Thomas Ehn, at School of Health Sciences, for deep friendship, help and always supporting during my work.
Marketing Director Oskar Pollack at School of Health Sciences, for all administrative help with my thesis.
My colleagues and friends at School of Health Sciences, Jönköping. Helén Jansson, for help with my first figure.
Personnel and students at Stadsgårdsskolan in Råslätt.
Last, but certainly not least, my husband Inge Jacobsson, and our children Lina and Adam, for your love and patience. You also let me know that there are more important things in life than work and you are the one that gives me an overwhelming feeling of happiness.
This thesis was supported from my employer, the School of Health Sciences, Jönköping University.
Jönköping December 2011,
66
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