The influence of sense of coherence on the relationship between childhood socioeconomic status and adult oral health-related behaviours

Abstract – Objectives: To assess the role of adulthood socioeconomic status (SES) and sense of coherence (SOC) in the relationship between childhood SES and adult oral health‐related behaviours. Methods:  This study analysed responses of 5318 dentate subjects aged 30 years and over who participated in the Finnish Health 2000 Survey. Participants provided information on their demographic characteristics (sex, age, marital status and urbanization), childhood SES (parental education), adulthood SES (years of education and household income), the SOC scale and four oral health‐related behaviours (dental attendance, toothbrushing frequency, sugar intake frequency and daily smoking). Structural equation modelling was used to test a model including adult SES and SOC as mediating factors of the relationship between childhood SES and adult oral health‐related behaviours. Multi‐group comparison was conducted to test the model within each sex and age group. Results: Childhood SES was related to adult oral health‐related behaviours (P < 0.001) but only indirectly, via adulthood SES (P < 0.001) and adult SOC (P = 0.001). However, the relationship via adulthood SES was much stronger than that via SOC (standardized path coefficients were 0.24 and 0.01 respectively). In the multi‐group comparison, the model was invariant across sex and age groups. Conclusions: The relationship between childhood SES and adult oral health‐related behaviours was mainly mediated by adulthood SES, and to a much less extent by SOC. A stronger SOC was significantly associated with better adult oral health‐related behaviours, after controlling for the effect of adulthood SES and demographic characteristics of the participants.     

Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort

OBJECTIVES: To determine whether adult oral health is predicted by (a) childhood socioeconomic advantage or disadvantage (controlling for childhood oral health), or (b) oral health in childhood (controlling for childhood socioeconomic advantage or disadvantage), and whether oral health in adulthood is affected by changes in socioeconomic status (SES). METHODS: Participants in a longstanding cohort study underwent systematic dental examination for dental caries and tooth loss at ages 5 and 26 years. The examination at age 26 years included the collection of data on periodontal attachment loss and plaque level. Childhood SES was determined using parental occupation, and adult SES was determined from each study member's occupation at age 26 years. Regression models were used to test the study hypotheses. RESULTS: Complete data were available for 789 individuals (47.4% female). After controlling for childhood oral health, those who were of low SES at age 5 years had substantially greater mean DFS and DS scores by age 26 years, were more likely to have lost a tooth in adulthood because of caries, and had greater prevalence and extent of periodontitis. A largely similar pattern was observed (after controlling for childhood SES) among those with greater caries experience at age 5 years. For almost all oral health indicators examined, a clear gradient was observed of greater disease at age 26 years across socioeconomic trajectory groups, in the following order of ascending disease severity and prevalence: 'high-high', 'low-high' (upwardly mobile), 'high-low' (downwardly mobile) and 'low-low'. CONCLUSION: Adult oral health is predicted by not only childhood socioeconomic advantage or disadvantage, but also by oral health in childhood. Changes in socioeconomic advantage or disadvantage are associated with differing levels of oral health in adulthood. The life-course approach appears to be a useful paradigm for understanding oral health disparities.     

Sense of coherence and its relationship with oral health-related behaviour and knowledge of and attitudes towards oral health

Lindmark U, Hakeberg M, Hugoson A. Sense of coherence and its relationship with oral health–related behaviour and knowledge of and attitudes towards oral health. Community Dent Oral Epidemiol 2011; 39: 542–553. © 2011 John Wiley & Sons A/S Abstract – Objective: To investigate the relationship between sense of coherence (SOC), oral health–related behaviour, knowledge of and attitudes towards oral health in an adult Swedish population. Methods: A cross‐sectional design with a stratified random sample of 910 individuals aged 20, 30, 40, 50, 60, 70 and 80 years were invited to the study, from Jönköping, Sweden. The investigation used the Swedish short version of the SOC questionnaire comprising 13 items and self‐reported questions about oral health habits and knowledge of and attitudes towards oral health. In addition, a self‐report questionnaire to elicit demographic information was included. Results: A total of 525 individuals, 261 men and 264 women, answered all the 13‐item SOC questions, which constituted the final number of the participants. After adjustment for all the sociodemographic factors included in the analysis, individuals with a stronger SOC had twice as high a chance of having healthier behaviour, including a lower frequency of snacks and drinks between meals, as well as a more positive attitude, such as the importance of having one’s own teeth as one gets older, satisfaction with their own teeth, perceiving their teeth as good and no feeling of dental fear, compared with individuals with a poorer SOC. Moreover, SOC and a good knowledge of caries were significantly associated after adjustment for age and gender. Conclusions: SOC was significantly associated with several oral health–related behaviours, attitudes towards oral health and knowledge of dental caries. When working with oral health promotion, SOC could be a way for promoting a better understanding of the behaviour and attitudes of individuals and for enabling dental personals to use that knowledge for the guidance of the individual.     

Do circumstances in early life contribute to tooth retention in middle age?

The relative contributions of factors operating in fetal life, childhood, and adulthood to risk of disease in middle age have become an important research issue, though oral health has rarely been considered. This study investigated the relative impacts of risk factors operating at different stages throughout life on the number of teeth retained at ages 49-51 yrs based on data from the Newcastle Thousand Families cohort. Very little variation in tooth retention in middle age was explained by factors operating at earlier stages in life. The previously noted relationship between childhood socio-economic status and oral health in adulthood appears, with respect to tooth retention, to diminish with increasing age as adult socio-economic position and lifestyle factors have an increasing effect. Promotion of a healthier adult lifestyle and continued improvements in oral hygiene would appear to be the public health interventions most likely to increase tooth retention in middle age.     

The association between low-socioeconomic status mother's Sense of Coherence and their child's utilization of dental care

da Silva AN, Mendonça MH, Vettore MV. The association between low‐socioeconomic status mother’s Sense of Coherence and their child’s utilization of dental care. Community Dent Oral Epidemiol 2011; 39: 115–126. © 2010 John Wiley & Sons A/S Abstract – Objectives: The objective of this study was to investigate the relationship of low‐socioeconomic status mother’s Sense of Coherence (SOC) and their child’s utilization of dental care services in a city of Southeast Brazil. Methods: A cross‐sectional study was conducted on a sample of 190 schoolchildren aged 11–12 and their mothers in Sao João de Meriti‐RJ, Southeast Brazil. The outcome variables were children’s use of dental care services and visiting dentists mainly for check‐ups. Demographic and socioeconomic characteristics and data regarding children’s dental care use were collected through interviews with mothers. Children’s oral health‐related behaviours as well as dental status (DMFS index), dental pain, Visible Dental Plaque and Bleeding on Probing Index were registered. Mother’s SOC was assessed through the validated short version (13‐item) of Antonovsky’s scale. Multiple logistic regression was used in the data analysis. Results: Of the mothers, 81.1% reported on their child’s utilization of dental care services. Of them, 42.9% considered check‐ups as the main reason for taking their children to dental services. Children whose mothers had higher levels of SOC were more likely to utilize dental care services (OR = 2.08 95%CI = 1.17–3.64) and visit a dentist mainly for check‐ups (except for dental treatment) (OR = 2.02 95%CI = 1.06–3.81) than those whose mothers had lower levels of SOC. These findings were adjusted for socioeconomic status, children’s oral health‐related behaviours and oral health measures. Conclusions: Mother’s SOC was a psychosocial factor associated with their child’s pattern of use of dental care services in low‐socioeconomic status families.     

Sense of Coherence and Four-Year Caries Incidence in Finnish Adults

This study assesses whether sense of coherence (SOC) predicts incidence of tooth decay over 4 years and the role of dental behaviours in explaining the effect of SOC on incidence of tooth decay. Data from 994 adults who participated in both the Health 2000 survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed for this study. At baseline, participants provided information on demographic characteristics, education level, the SOC scale and dental behaviours (tooth brushing frequency, dental attendance and sugar intake frequency). The 4-year incidence of tooth decay was calculated using data from baseline and follow-up clinical oral examinations. Baseline SOC was significantly related to 4-year incidence of tooth decay after adjustment for demographic factors and education (relative risk: 0.79, 95% CI: 0.63-0.98). This effect was fully attenuated after further adjustment for the three dental behaviours. Tooth brushing frequency and dental attendance were the only dental behaviours significantly related to incidence of tooth decay. This prospective study suggests that SOC predicts incidence of tooth decay and that dental behaviours may help explaining why adults with strong SOC have lower risk of developing tooth decay than those with weak SOC.     

A strong sense of coherence promotes regular dental attendance in adults

OBJECTIVE: To investigate the relationship between the sense of coherence (SOC) and dental attendance pattern. It was hypothesised that the subjects with a stronger SOC have a more regular dental attendance. BASIC RESEARCH DESIGN: In the nationally representative sample including 8,028 persons aged 30, or more, 88% were surveyed. The questionnaire and home interview included information about socio-economic and demographic factors, behavioural and attitudinal variables, such as oral health behaviours (i.e. dental attendance pattern), and the SOC scale (12-item). Chi-square test, unadjusted and adjusted logistic regression models were used in the data analysis. PARTICIPANTS: The sample for this study consisted of 4,263, 30- to 64-year-old dentate, adults. RESULTS: Regular dental attendance was more common among those with a stronger SOC. Gender, education, family income and marital status, but not age, were related with dental attendance. The gender- and age-adjusted associations between the SOC and dental attendance pattern were found to be significantly stronger among those having high-, or middle level of education compared with those having a low education level. CONCLUSION: A stronger SOC is associated with regular dental attendance. This raises the possibility of achieving long-term positive effects on dental attendance in adulthood, if the SOC could be strengthened during adolescence.     

Oral health,sense of coherence and dental anxiety among middle-aged women

Abstract

Aims. The specific aims of this investigation were to analyze the relationship between sense of coherence (SOC), dental anxiety (DA) and oral health status among middle-aged women, measured both subjectively and objectively and adjusted for socioeconomic status (SES). Materials and methods. Randomly selected women, 38 (n = 206) and 50 (n = 287) years of age, were included in a cross-sectional health examination. The participants underwent a series of examination stages, including a clinical and dental radiographic examination. The women responded to questionnaires concerning SES, oral health, DA and SOC. Results. The number of teeth was significantly related to SOC, where more missing teeth revealed a lower SOC level among 50-year-olds. The variables of caries, apical periodontitis and filled surfaces were not statistically significantly associated with SOC. However, the self-reported measure of oral health was associated with SOC in both age groups. High DA was significantly related to self-perceived poor oral health regardless of age. Individuals with high DA also had fewer teeth, more filled surfaces and more approximal caries. The multivariate models showed that higher SOC levels were associated with better oral health, as estimated by objective or subjective measures, while the inverse results were seen for DA. Thus, individuals reporting high DA were more likely to have fewer teeth and poor perceived oral health, taking SES into account. Conclusions. Sense of coherence and dental anxiety are psychological aspects with respect to health- and risk-factors of oral health.     

Oral and general health behaviours among Chinese urban adolescents

Abstract – Objectives: The objectives of this study were to measure the association of general and oral health‐related behaviours with living conditions and to explore the interrelationships between general and oral health‐related behaviours in Chinese urban adolescents. Methods: A cross‐sectional survey of 2662 adolescents was conducted in eight Chinese provincial capitals. The response rate was 92%. The study population was selected through multistage cluster sampling and comprised three age groups: 11, 13 and 15 years. Data on oral and general health, lifestyles as well as living conditions were collected by means of self‐administered structured questionnaires. Several additive indices were constructed from answers to the questions on specific behaviour, and participants were categorized according to scores on each component of health‐related behaviour for statistical analyses by frequency distributions, regression analyses and factor analyses. Results: Oral health‐related behaviours among adolescents were associated with socioeconomic status of parents, school performance and peer relationships. The odds of a dental visit was 0.63 in adolescents of poorly educated parents and the corresponding figure for regular oral hygiene practices was 0.62. Odds of tobacco use was 3 for adolescents with poor performance in school while odds of consuming sugary foods/drinks was 1.3. Adolescents with high levels of preventive oral health practices also demonstrated general health‐promoting behaviours. In factor analysis of general and oral health‐related behaviours, three factors were isolated: (a) risk behaviours (loadings 0.48–0.66), (b) health‐promoting behaviours (loadings 0.60–0.64) and (c) help‐seeking behaviours (loadings 0.56–0.67). Conclusion: The findings support a multidimensional model of health behaviour. Several approaches and multiple methods should be applied in oral health education in order to modify behaviours that affect oral health.     

Adolescents' sense of coherence, oral health status, and oral health-related behaviours

OBJECTIVE: To investigate the relationship between sense of coherence (SOC) and oral health. It was hypothesised that subjects with better oral health status and better oral health-related behaviours have higher levels of SOC. METHODS: A cross-sectional study was conducted in Goiania-GO, Middle-West Brazil, on a sample of 664 15-year-olds randomly selected from schools. Data were collected through questionnaires, the short version of Antonovsky's SOC Scale (13-item) and clinical dental examinations. Multiple logistic regression and polytomous ordered regression were used in the data analysis. Two sets of outcome variables were selected for the analyses: oral health status (dental caries, oral cleanliness, and periodontal disease), and oral health-related behaviours (frequency of sugar intake, toothbrushing frequency, and pattern of dental attendance). RESULTS: Adolescents' SOC was associated with their caries experience in anterior teeth (OR=0.81 for 10 units increase in SOC scale; 95% CI=0.66-0.98), but the relationship did not remain significant after controlling for other factors. Adolescents with higher SOC were less likely to visit the dentist mainly when in trouble, compared with those with lower SOC (OR=0.83, 95% CI=0.71-0.98), or equivalently more likely to visit for mainly check-ups. Other measures of oral health status and behaviours were not significantly associated with SOC. CONCLUSION: SOC was identified as a psychosocial determinant of adolescents' oral health-related behaviour, particularly affecting their pattern of dental attendance.     

Oral health-related quality of life in a birth cohort of 32-year olds

Abstract – Objectives: To describe oral health‐related quality of life (OHRQoL) among New Zealand adults and assess the relationship between clinical measures of oral health status and a well‐established OHRQoL measure, controlling for sex, socioeconomic status (SES) and use of dental services. Methods: A birth cohort of 924 dentate adults (participants in the Dunedin Multidisciplinary Health and Development Study) was systematically examined for dental caries, tooth loss, and periodontal attachment loss (CAL) at age 32 years. OHRQoL was measured using the 14‐item Oral Health Impact Profile questionnaire (OHIP‐14). The questionnaire also collected data on each study member’s occupation, self‐rated oral health and reasons for seeing a dental care provider. SES was determined from each individual’s occupation at age 32 years. Results: The mean total OHIP‐14 score was 8.0 (SD 8.1); 23.4% of the cohort reported one or more OHIP problems ‘fairly often’ or ‘very often’. When the prevalence of impacts ‘fairly/very often’ was modeled using logistic regression, having untreated caries, two or more sites with CAL of 4+ mm and 1 or more teeth missing by age 32 years remained significantly associated with OHRQoL, after adjusting for sex and ‘episodic’ dental care. Multivariate analysis using Poisson regression determined that being in the low SES group was also associated with the mean number of impacts (extent) and the rated severity of impacts. Conclusions: OHIP‐14 scores were significantly associated with clinical oral health status indicators, independently of sex and socioeconomic inequalities in oral health. The prevalence of impacts (23.4%) in the cohort was significantly greater than age‐ and sex‐standardized estimates from Australia (18.2%) and the UK (15.9%).     

A life-course approach to assess psychosocial factors and periodontal disease

Background: Several models have been used to suggest the role of psychosocial factors in periodontal disease. None have adopted the life‐course approach, which emphasizes the importance of exposures over time and at critical points of a person's life. Objective: To investigate the relationship between psychosocial factors at two periods of life and periodontal diseases in Brazilian adult females. Material and Methods: The study design was a cross‐sectional survey of 330 women randomly selected from a larger sample of mothers whose children participated in a study on chronic oral disease using a life‐course framework. Each woman was clinically assessed for the presence of periodontal disease. An interview collected information on socioeconomic, behavioural and family‐related factors at two periods of the participant's life (childhood and adulthood). The main outcome variable was loss of periodontal attachment. Data analysis used logistic regression. Results: High levels of periodontal disease were predicted by <4 years of education, past and present smoking, high levels of paternal discipline in childhood and low levels of emotional support in adulthood. The influence of childhood factors was not attenuated by adulthood circumstances. Conclusion: Psychosocial factors in childhood and adulthood were associated with high levels of periodontal disease in adulthood.     

The relationship among sense of coherence, socio-economic status, and oral health-related behaviours among Finnish dentate adults

This study assessed the independent and interactive associations between sense of coherence (SOC) and socio-economic status (SES) with oral health-related behaviours. Data from 5,399 dentate adults regarding their demographic characteristics, years of education, SOC score, and oral health-related behaviours were analysed. Household income was obtained from tax authorities. Logistic regression was used to test the adjusted association of SOC with each behaviour and to test the statistical interaction between each SES indicator and the SOC score. Subjects were 1.20 [95% confidence interval (95% CI): 1.11–1.28] and 1.22 (95% CI: 1.12–1.32) times more likely to visit dentists regularly for check-ups and to brush their teeth twice daily or more often, respectively, and were 1.11 (95% CI: 1.03–1.20) and 1.21 (95% CI: 1.12–1.32) times less likely to be daily smokers and to consume sugar-added products on a daily basis, respectively, for every unit increase in SOC score. The findings provide strong support for an association between higher levels of SOC and more favourable oral health-related behaviours, independently of current SES and demographic characteristics of the participants and across the four behaviours assessed. By contrast, the findings give limited support for the moderating role of SOC on the relationship between SES and oral health-related behaviours.     

Caries in adolescence - influence from early childhood

Alm A, Wendt LK, Koch G, Birkhed D, Nilsson M. Caries in adolescence – influence from early childhood. Community Dent Oral Epidemiol 2012; 40: 125–133. © 2011 John Wiley & Sons A/S Abstract – Objective: To analyse the relationship between caries determinants in early childhood and caries prevalence in proximal surfaces in adolescents at the age of 15 years. Methods: The present longitudinal study is part of a series of surveys of oral health in 671 children followed from 1 to 15 years of age. Data were selected from examinations, interviews and questionnaires at 1, 3 and 6 years and bitewing radiographs at 15 years of age. Uni‐ and multivariable logistic regression analyses were performed to identify caries‐related determinants. The outcome variable was carious lesions and fillings (DFa) in approximal tooth surfaces at 15 years of age. Statistical comparisons were made between caries‐free teenagers, DFa = 0 and teenagers with DFa > 0, DFa ≥ 4 and DFa ≥ 8, respectively. Results: In the final logistic regression analyses, caries experience at 6 years and mother’s self‐estimation of her oral health care as being less good to poor remained statistically significant and were related to caries in all three caries groups (i.e. DF > 0, ≥4 and ≥8) at 15 years of age. The consumption of sweets at 1 year remained statistically significant, with a caries experience of DF ≥ 4 and ≥ 8. The variables ‘parents born abroad’ and female gender were statistically significantly associated with DFa ≥ 4 and DFa ≥ 8, respectively. Furthermore, infrequent toothbrushing habits at 3 years of age and failure to attend the examination at 1 year were statistically significantly associated with caries at 15 years in the univariable analyses. Conclusion: Early caries experience, consumption of sweets at an early age and mother’s self‐estimation of her oral health care as being less good to poor are associated with approximal caries in adolescents. The study indicates that caries determinants identified during early childhood have a strong impact on approximal caries in adolescence.     

Oral health inequalities in a national sample of Australian children aged 2-3 and 6-7 years

Background: While inequalities in oral health are generally well documented, it is less clear whether such patterns are evident from early childhood. Using four measures of potential inequality, this study examined patterns in oral health for Australian children at ages 2–3 and 6–7 years. Methods: Cross‐sectional data from two cohorts of children in the Longitudinal Study of Australian Children (LSAC) were used to explore associations between reported oral health and four indicators of social disadvantage: socio‐economic position (SEP), residential remoteness, Indigenous status and non‐English speaking background. Results: For both cohorts, lower SEP and Indigenous status were associated with higher odds of poor oral health on all three indicators, and less accessible location was associated with increased odds for caries. Non‐English speaking background was associated with increased odds for caries experience in 2–3 year olds and non‐use of dental services in the older cohort. Inequalities were larger in the older cohort for socio‐economic position and toothbrushing. Conclusions: Marked social disparities in oral health appear as early as 2 years of age and remain evident in school‐age children. Interventions to reduce such disparities should start as early as possible.     

Caries and background factors in Norwegian and immigrant 5-year-old children

Wigen TI, Wang NJ. Caries and background factors in Norwegian and immigrant 5‐year‐old children. Community Dent Oral Epidemiol 2010; 38: 19–28. © 2009 John Wiley & Sons A/S Abstract – Objectives: The purpose of this study was to assess the caries status of 5‐year‐olds in a low caries area, and study associations between dental caries and parent‐related factors: parents’ education, national origin, oral health behaviours and attitudes. Methods: The material consisted of 523 children and was a stratified random sample. Clinical and radiographic examination was performed in 2007. Enamel and dentine caries were recorded at surface level. Parents filled in questionnaires regarding socioeconomic status, their own oral health behaviours and attitudes. Results: Most participants (66%) had no caries experience and 16% had enamel caries only. Dentine caries experience was present in 18% of the children, and 5% had dentine caries experience in five or more teeth. Surfaces with enamel caries constituted half of all surfaces with caries experience. In multiple logistic regression, statistically significant risk indicators for the child having dentine caries experience at the age of five were: having one or both parents of non‐western origin (OR = 4.8), both parents (OR = 3.0) or one parent (OR = 2.1) with low education, parental laxness about the child’s tooth brushing (OR = 2.8), parents’ brushing their own teeth less than twice a day (OR = 2.2) and having parents with frequent sugar intakes (OR = 1.8). Conclusion: Caries prevalence in 5‐year‐olds was strongly associated with parent‐related factors signifying that information on parents’ socioeconomic status, dental behaviours and attitudes should be considered when planning dental services for young children. Our results suggest that the real high risk group is non‐western children whose parents have low education.     

Trends in oral health from childhood to early adulthood: a life course approach

Lu HX, Wong MCM, Lo ECM, McGrath C. Trends in oral health from childhood to early adulthood: a life course approach. Community Dent Oral Epidemiol 2011; 39: 352–360. © 2011 John Wiley & Sons A/S Abstract – Objectives: The aims of this study were to investigate trends in oral health in a cohort from late childhood through adolescence to early adulthood and to describe how the oral health of young adults was affected by their family sociodemographic characteristics, oral health status, and utilization of dental services during adolescence using life course approach. Methods: A cohort of 638 students was followed from late childhood (12 years old) through adolescence (15 years old) to early adulthood (18 years old) in Hong Kong. Dental examinations included the assessment of caries experience (DMFT score) and periodontal conditions (Community Periodontal Index, CPI) according to WHO criteria. Information on utilization of dental services, parental education attainment, and monthly household income was collected. Path analyses were performed to investigate oral health trends and the relationships between oral health (DMFT scores and highest CPI values) at age 18 years and the sociodemographic characteristics at age 12 years, oral health, and utilization of dental services during adolescence. Results: In 2004 and 2007, 395 (62%) and 324 (51%) subjects of the original sample were followed up when they reached the age of 15 and 18 years, respectively. The mean DMFT score gradually increased from 0.62 at age 12 to 1.52 at age 18 (P < 0.001). The proportion of subjects with calculus or shallow periodontal pockets (highest CPI score 2 or 3) also increased with age, from 58% at age 12 to 96% at age 18 (P < 0.001). The oral health trend path models showed that DMFT score and highest CPI value at age 18 years were positively associated with DMFT score and highest CPI value at younger ages (P < 0.05). Results of the two extended path models showed that household income had positive effect on the utilization of dental services (β > 0.29, P < 0.05) and the utilization of dental services had positive effect on DMFT score (β > 0.12, P < 0.05) but not for highest CPI value (P > 0.05). However, parental education attainment had no significant effect on either DMFT score or highest CPI value (P > 0.05). Conclusions: Oral health status had become worse from childhood to early adulthood in the study cohort. Economic circumstance of the subjects was found to be positively related to their utilization of dental services and through this contributed to the subjects’ caries experience. Oral health at younger ages was positively associated with succeeding oral health conditions.     

The independent contribution of neighborhood disadvantage and individual-level socioeconomic position to self-reported oral health: a multilevel analysis

OBJECTIVES: To examine the association between neighborhood disadvantage and individual-level socioeconomic position (SEP) and self-reported oral health. METHODS: A population-based cross-sectional study conducted in 2003 among males and females aged 43-57 years. The sample comprised 2915 individuals and 60 neighborhoods and was selected using a stratified two-stage cluster design. Data were collected using a mail survey (69.4% response rate). Neighborhood disadvantage was measured using a census-based composite index, and individual-level SEP was measured using education and household income. Oral health was indicated by self-reports of the impact of oral conditions on quality of life (0 = none or minor, 1 = severe), self-rated oral health (0 = excellent-good, 1 = fair/poor) and missing teeth (measured as a quantitative outcome). Data were analyzed using multilevel modeling. RESULTS: After adjusting for age, sex, education, and household income, residents of socioeconomically disadvantaged neighborhoods were significantly more likely than those in more advantaged neighborhoods to indicate negative impacts of oral conditions on quality of life, to assess their oral health as fair or poor, and to report greater tooth loss. In addition, respondents with low levels of education and those from a low income household reported poorer oral health for each outcome independent of neighborhood disadvantage. CONCLUSIONS: The socioeconomic characteristics of neighborhoods are important for oral health over and above the socioeconomic characteristics of the people living in those neighborhoods. Policies and interventions to improve population oral health should be directed at the social, physical and infrastructural characteristics of places as well as individuals (i.e. the traditional target of intervention efforts).     

Pregnancy,parity and periodontal disease

Many women believe that their dental condition deteriorated during pregnancy or as a result of having children. Epidemiological studies have reported an association between higher parity and tooth loss, and higher parity and periodontal attachment loss. Several possible explanations for this association exist. First, hormonal changes during pregnancy affect the immune response to bacterial plaque and drive vascular and gingival changes that may contribute to heightened gingival inflammation. These changes are transient, without irreversible loss of periodontal attachment, and post‐partum resolution can be expected for most women. For women with destructive periodontal disease, the effects of pregnancy and parity are unclear. Second, it is also plausible that parity and socioeconomic position (SEP) have shared risk factors, increasing the incidence of disease or influencing its management. Education, one aspect of SEP, is an important determining factor for women's fertility rate, with a gradient of fewer children with higher educational attainment. Higher levels of education are also favourably associated with behaviours conducive to oral health, and a lower incidence of damaging health behaviours. Thus, the potential for confounding is considerable. This review examines the literature on the association between pregnancy, parity and periodontal health, and explores sociobehavioural mechanisms for the observed association.     

Instability of self-esteem, self-confidence, self-liking, self-control, self-competence and perfectionism: associations with oral health status and oral health-related behaviours

To cite this article:
Int J Dent Hygiene 10 , 2012; 22–29
DOI: 10.1111/j.1601‐5037.2011.00519.x
Dumitrescu AL, Zetu L, Teslaru S. Instability of self‐esteem, self‐confidence, self‐liking, self‐control, self‐competence and perfectionism: associations with oral health status and oral health‐related behaviours. Abstract: Aim: Our aim was to explore whether instability of self‐esteem, self‐confidence, self‐liking, self‐control, self‐competence and perfectionism each has an independent contribution to the self‐rated oral health and oral health‐related behaviours. Material and methods: A cross‐sectional study design was used. Data were collected between November 2008 and May 2009. The sample consisted of 205 Romanian adults (mean age: 29.84 years; 65.2% women; 40% married) who were a random population drawn consecutively from the registry file of two private dental practices in the Iasi area. The questionnaire included information about demographic, psychological, self‐reported oral health and oral health‐related behaviour items. Results: The comparison of participants who never flossed their teeth with those who flossed everyday showed statistically significant lower levels of self‐confidence (P < 0.05), self‐liking (P = 0.001), self‐competence (P < 0.0001), self‐control (P < 0.05) and Perfectionism Scores (P < 0.05). Significant higher levels of self‐competence were scored in persons who used weekly mouthrinses comparing with never users (P = 0.012). Also patients who visited the dentist mainly when treatment is needed or when pain presented lower levels of self‐competence and self‐control comparing with those who visited the dentist mainly for check‐up or for tooth cleaning and scaling (P < 0.05). Oral health behaviours (toothbrushing and mouthrinse frequencies) were predicted by multiple regression analyses using sociodemographic (age, gender), self‐competence and perfectionism variables. Conclusions: Our study showed that instability of self‐esteem, self‐confidence, self‐competence, self‐liking, self‐control and perfectionism was associated not only with self‐rated dental health but also with oral health behaviours. Understanding the psychological factors associated with oral hygiene can further the development and improvement in therapeutic strategies to be used in oral health‐improving programs, as well as of programs aimed at prevention and education.