Is Dental Caries a Risk Factor for Acute Rheumatic Fever in New Zealand?

Abstract

Background Although largely preventable, acute rheumatic fever (ARF) is still a public health problem in New Zealand, mainly among Māori and Pacific children. In addition, sugar consumption, and prevalence of dental caries (from sugar consumption) are also high in Māori and Pacific children. Studies have observed that many childhood ARF cases have severe tooth decay, suggesting an association of ARF with dental caries, and an indirect association with sugar. Aim To examine the association between ARF and dental caries in children from the Auckland region of New Zealand. Methods This study used the Auckland region’s (Auckland, Counties Manukau and Waitemata) community oral health register to identify 97,548 children aged 3-12 years old registered between 2007 and 2014. Cases of ARF were identified from the National Minimum Dataset. Time to event analysis was used to examine the relationship between ARF and caries experience (decayed, missing and filled teeth of primary and permanent teeth (dmft and DMFT), as well individual numbers of d, m, f and D, M, F) of a child, adjusting for gender, ethnicity and the deprivation status. Results During the study period, 144 were diagnosed with ARF, the majority (96.5%) in Māori and Pacific island children. Among them, around 91 percent (131) had some degree of caries in their teeth. The incidence of ARF was 4.3 times higher in children with dental caries (95% CI: 2.4-8.3). Cox proportional hazards regression was restricted to Māori and Pacific children as the ARF is confined to them. The regression analysis showed that decayed primary teeth is a risk factor for the incidence of ARF. The ARF hazard ratio per decayed primary tooth (d) was 1.26 (95%CI: 1.17-1.36; p-value < 0.001) after controlling for gender, ethnicity and socio-economic deprivation (NZDep2006). Discussion This research sheds new light on the understanding of ARF pathogenesis. The incidence of ARF is greater in children with dental caries than children with good oral health. Cost-effective and practical prevention programmes of caries in order to reduce the incidence of ARF are recommended. Moreover, as sugar consumption is an important causal factor for caries, control of sugar content in the diet of children may prevent both ARF and dental caries.