Social inequalities in childhood dental caries: the convergent roles of stress, bacteria and disadvantage

The oral microbiome is associated with HPA axis response to a psychosocial stressor

Intense psychosocial stress during early life has a detrimental effect on health-disease balance in later life. Simultaneously, despite its sensitivity to stress, the developing microbiome contributes to long-term health. Following stress exposure, HPA-axis activation regulates the "fight or flight" response with the release of glucose and cortisol. Here, we investigated the interaction between the oral microbiome and the stress response. We used a cohort of 115 adults, mean age 24, who either experienced institutionalisation and adoption (n = 40) or were non-adopted controls (n = 75). Glucose and cortisol measurements were taken from participants following an extended socially evaluated cold pressor test (seCPT) at multiple time points. The cohort´s oral microbiome was profiled via 16S-V4 sequencing on microbial DNA from saliva and buccal samples. Using mixed-effect linear regressions, we identified 12 genera that exhibited an interaction with host's cortisol-glucose response to stress, strongly influencing intensity and clearance of cortisol and glucose following stress exposure. Particularly, the identified taxa influenced the glucose and cortisol release profiles and kinetics following seCPT exposure. In conclusion, our study provided evidence for the oral microbiome modifying the effect of stress on the HPA-axis and human metabolism, as shown in glucose-cortisol time series data.

Can social adversity alter the epigenome, trigger oral disease, and affect future generations?

The nature versus nurture debate has intrigued scientific circles for decades. Although extensive research has established a clear relationship between genetics and disease development, recent evidence has highlighted the insufficiency of attributing adverse health outcomes to genetic factors alone. In fact, it has been suggested that environmental influences, such as socioeconomic position (SEP), may play a much larger role in the development of disease than previously thought, with extensive research suggesting that low SEP is associated with adverse health conditions. In relation to oral health, a higher prevalence of caries (tooth decay) exists among those of low SEP. Although little is known about the biological mechanisms underlying this relationship, epigenetic modifications resulting from environmental influences have been suggested to play an important role. This review explores the intersection of health inequalities and epigenetics, the role of early-life social adversity and its long-term epigenetic impacts, and how those living within the lower hierarchies of the socioeconomic pyramid are indeed at higher risk of developing diseases, particularly in relation to oral health. A deeper understanding of these mechanisms could lead to the development of targeted interventions for individuals of low SEP to improve oral health or identify those who are at higher risk of developing oral disease.

Relationships among Cortisol, Perceived Stress, and Dental Caries Experience in Adolescents and Young Adults

INTRODUCTION

Stress can impact mental and physical health, especially during adolescence and young adulthood, but the extent of its contribution to dental caries is poorly understood. The present study assessed the association between perceived stress, cortisol levels (in hair and saliva), and overall caries experience of adolescents and young adults aged 15-25 years.

METHODS

Hair and saliva samples were obtained from 93 participants free of periodontal disease. Cortisol in hair and saliva was determined using a competitive enzyme-linked immunosorbent assay. Participants completed a perceived stress questionnaire and underwent full-mouth oral examination by a calibrated examiner. Dental caries experience was based on the decayed, missing, and filled teeth (DMFT) index. Sociodemographic variables were also recorded.

RESULTS

There were significantly higher hair cortisol levels and perceived stress scale (PSS) scores in individuals with dental caries experience (DMFT≥1) than in those without (DMFT = 0). However, there was no significant difference in salivary cortisol concentration. A binary logistic regression revealed that higher hair cortisol levels and greater scores on the perceived stress scale were associated with increased odds of having experienced dental caries. In contrast, no significant association was found between salivary cortisol concentration and dental caries. Using multivariable regression models, caries experience was found to be significantly associated with both hair cortisol levels and PSS scores. These associations remained statistically significant even after adjusting for sociodemographic variables.

CONCLUSION

Hair cortisol levels and perceived stress have a significant association with dental caries experience, whereas salivary cortisol concentrations do not.

Examining the relationship between the oral microbiome, alcohol intake and alcohol-comorbid neuropsychological disorders: protocol for a scoping review

INTRODUCTION

Heavy alcohol use and alcohol use disorder (AUD) continues to rise as a public health problem and increases the risk for disease. Elevated rates of anxiety, depression, sleep disruption and stress are associated with alcohol use. Symptoms may progress to diagnosed neurophysiological conditions and increase risk for relapse if abstinence is attempted. Research on mechanisms connecting the gastrointestinal microbiome to neuropsychological disorders through the gut-brain axis is well-established. Less is known how the oral microbiome and oral microbial-associated biomarkers may signal to the brain. Therefore, a synthesis of research studying relationships between alcohol intake, alcohol-associated neurophysiological symptoms and the oral microbiome is needed to understand the state of the current science. In this paper, we outline our protocol to collect, evaluate and synthesise research focused on associations between alcohol intake and AUD-related neuropsychological disorders with the oral microbiome.

METHODS AND ANALYSIS

The search strategy was developed and will be executed in collaboration with a medical research librarian. Studies will be screened by two independent investigators according to the aim of the scoping review, along with the outlined exclusion and inclusion criteria. After screening, data will be extracted and synthesised from the included papers according to predefined demographic, clinical and microbiome methodology metrics.

ETHICS AND DISSEMINATION

A scoping review of primary sources is needed to synthesise the data on relationships between alcohol use, neuropsychological conditions associated with AUD and the oral microbiome. The proposed scoping review is based on the data from publicly available databases and does not require ethical approval. We expect the results of this synthesis will identify gaps in the growing literature and highlight potential mechanisms linking the oral-brain axis to addiction and other associated neuropsychological conditions. The study findings and results will be disseminated through journals and conferences related to psychology, neuroscience, dentistry and the microbiome.

A Prospective Longitudinal Study of Early Childhood Caries Onset in Initially Caries-Free Children

INTRODUCTION

Early childhood caries (ECC) is a complex oral disease that is prevalent in US children.

OBJECTIVES

The purpose of this 2-y prospective cohort study was to examine baseline and time-dependent risk factors for ECC onset in initially caries-free preschool children.

METHODS

A cohort of 189 initially caries-free children aged 1 to 3 y was recruited. At each 6-mo study visit, children were examined using the ICDAS index; salivary samples were collected to assess mutans streptococci (MS), lactobacilli, Candida species, salivary cortisol (prior and after a stressor), and salivary IgA. Diet and oral health behavior were assessed from parent report. Child and family stress exposure was assessed from measures of psychological symptoms, stressful life event exposure, family organization and violence exposure, and social support. Sociodemographic factors were also considered. A Kaplan-Meier estimator of survival function of time to ECC and a Cox proportional hazards model were used to identify predictors of ECC onset.

RESULTS

Onset of ECC was associated with high salivary MS levels at baseline (log-rank test, P < 0.0001). Cox proportional hazards regression showed that the risk of dental caries significantly increased with salivary MS in log scale over the 6-mo period (hazard ratio, 1.08; P = 0.01). Other risk factors in the model did not reach statistical significance.

CONCLUSION

Our results provide prospective evidence that an increase in salivary MS predicts ECC onset in young, initially caries-free children, confirming that a high salivary MS count likely plays a causal role in ECC onset, independent of covariates.

KNOWLEDGE TRANSFER STATEMENT

These results suggest that we must focus on reducing salivary MS counts in young children and preventing or delaying MS colonization in infants and young children determined to be at risk for ECC.

From Mouth to Muscle: Exploring the Potential Relationship between the Oral Microbiome and Cancer-Related Cachexia

Cancer cachexia is a multifactorial wasting syndrome associated with skeletal muscle and adipose tissue loss, as well as decreased appetite. It affects approximately half of all cancer patients and leads to a decrease in treatment efficacy, quality of life, and survival. The human microbiota has been implicated in the onset and propagation of cancer cachexia. Dysbiosis, or the imbalance of the microbial communities, may lead to chronic systemic inflammation and contribute to the clinical phenotype of cachexia. Though the relationship between the gut microbiome, inflammation, and cachexia has been previously studied, the oral microbiome remains largely unexplored. As the initial point of digestion, the oral microbiome plays an important role in regulating systemic health. Oral dysbiosis leads to the upregulation of pro-inflammatory cytokines and an imbalance in natural flora, which in turn may contribute to muscle wasting associated with cachexia. Reinstating this equilibrium with the use of prebiotics and probiotics has the potential to improve the quality of life for patients suffering from cancer-related cachexia.

Social Epigenomics: Conceptualizations and Considerations for Oral Health

Advances in high-throughput technologies and the generation of multiomics, such as genomic, epigenomic, transcriptomic, and metabolomic data, are paving the way for the biological risk stratification and prediction of oral diseases. When integrated with electronic health records, survey, census, and/or epidemiologic data, multiomics are anticipated to facilitate data-driven precision oral health, or the delivery of the right oral health intervention to the right individuals/populations at the right time. Meanwhile, multiomics may be modified by a multitude of social exposures, cumulatively along the life course and at various time points from conception onward, also referred to as the socio-exposome. For example, adverse exposures, such as precarious social and living conditions and related psychosocial stress among others, have been linked to specific genes being switched "on and off" through epigenetic mechanisms. These in turn are associated with various health conditions in different age groups and populations. This article argues that considering the impact of the socio-exposome in the biological profiling for precision oral health applications is necessary to ensure that definitions of biological risk do not override social ones. To facilitate the uptake of the socio-exposome in multiomics oral health studies and subsequent interventions, 3 pertinent facets are discussed. First, a summary of the epigenetic landscape of oral health is presented. Next, findings from the nondental literature are drawn on to elaborate the pathways and mechanisms that link the socio-exposome with gene expression-or the biological embedding of social experiences through epigenetics. Then, methodological considerations for implementing social epigenomics into oral health research are highlighted, with emphasis on the implications for study design and interpretation. The article concludes by shedding light on some of the current and prospective opportunities for social epigenomics research applied to the study of life course oral epidemiology.

Effects of Early Life Adversity on Tooth Enamel Formation

In a systemic effort to survive environmental stress, organ systems fluctuate and adapt to overcome external pressures. The evolutionary drive back toward homeostasis makes it difficult to determine if an organism experienced a toxic exposure to stress, especially in early prenatal and neonatal periods of development. Previous studies indicate that primary human teeth may provide historical records of experiences related to stressors during that early time window. To assess the molecular effects of early life adversity on enamel formation, we used a limited bedding and nesting (LBN) mouse model of early life adversity (ELA) to assess changes in the enamel organ gene expression and enamel matrix mineralization. On average, postnatal day 12 (P12) ELA mice weighed significantly less than the controls. When adjusted for animal weight, ELA molar enamel volume was reduced as compared with the controls, and the relative mineral density of molar enamel was significantly increased. There were no obvious changes in enamel matrix crystal morphology or structure in ELA as compared with the control mouse enamel. RNAseq showed extracellular matrix organization to be the most significantly affected GO and reactome pathways, whereas butanote metabolism was the most significantly altered KEGG pathway. Transcripts expressing the enamel matrix proteins amelogenin (Amelx) and enamelin (Enam) were among the top 4 most differentially expressed genes. When evaluating molecular mechanisms for the changes in gene expression in ELA enamel organs, we found significantly increased expression of Dlx3, while transcripts for clock genes Per1 and Nrd1 were downregulated. These findings support the possibility that the developing enamel organ is sensitive to the pressures of early life adversity and produces molecular and structural biomarkers reflecting these challenges.

Association Between Measures Derived From Children's Primary Exfoliated Teeth and Psychopathology Symptoms: Results From a Community-Based Study

Mental disorders are among the most disabling health conditions globally. However, there remains a lack of valid, reliable, noninvasive, and inexpensive biomarkers to identify (at an early age) people who are at the greatest risk of experiencing a future mental health condition. Exfoliated primary teeth, when used in combination with established and emerging tools (e.g., family history, imaging, genetics, epigenetics), may provide important additional insights about vulnerability to mental illness. Teeth are especially promising because they develop in parallel with the brain and maintain a permanent record of environmental insults occurring during prenatal and perinatal development. Despite their potential, few empirical studies have investigated features of exfoliated teeth in relation to mental health. Here, we used micro-CT imaging to test the hypothesis that measures derived from exfoliated primary incisors associated with psychopathology symptoms in a community-based sample of children (n = 37). We found that enamel volume (β = −0.77, 95% CI, −1.35 to −0.18, P = 0.01) had large negative associations with internalizing symptoms, and enamel mineral density (β = 0.77, 95% CI, 0.18–1.35, P = 0.01) had large positive associations with internalizing behavioral symptoms, even after stringent control for multiple testing. Pulp volume (β = −0.50, 95% CI, −0.90 to −0.09, P = 0.02) had a moderately-large negative association with externalizing behavioral symptoms, though these associations did not survive multiple testing correction. These results support the ongoing investigation of teeth as potential novel biomarkers of mental health risk.

Association between social capital and oral health among adults aged 50 years and over in China: a cross-sectional study

Background

Social capital has a potential effect in protecting oral health among population. However, no study has explored the association between social capital and oral health in the Chinese context. Due to the unique culture, political, social context in China, it is important to understand their association in the Chinese context. The study aims to investigate the association between cognitive and structural dimensions of social capital with edentulism among adults aged 50 years and over in China.

Method

The study used data from the WHO SAGE (Study on Global AGEing and Adult Health) wave 1 China component. Structural social capital was operationalized as social participation. Cognitive social capital was operationalized as perceived community trust and perceived community safety. Community-level social capital was measured by aggregating individual-level social capital into community level. Oral health was measured using a final marker of oral health status, self-reported edentulism. A 2-level multilevel logistic regression was used to evaluate the association between different dimensions of social capital and oral health.

Results

In total, 12,856 individuals were included in the study, the overall prevalence of edentulism was 9.1% (95% CI 8.3–10.0). Multilevel logistic analysis revealed that individual-level social capital and community-level social capital are independently associated with edentulism. Individuals with low structural social capital and living in areas with low structural social capital have, respectively, 1.54 (95% CI 1.18–2.01) and 2.14 (95% CI 1.47–3.12) times higher odds for edentulism, after adjustment for potential confounders (age, sex, marital status, residence locality, wealth, education level, chronic conditions) and a potential mediator(smoking).

Conclusions

Living in a community with lower structural social capital and individual with low structural social capital is associated with higher risk for edentulism among adults aged 50 years and over in China.

Change of pace: How developmental tempo varies to accommodate failed provision of early needs

The interplay of genes and environments (GxE) is a fundamental source of variation in behavioral and developmental outcomes. Although the role of developmental time (T) in the unfolding of such interactions has yet to be fully considered, GxE operates within a temporal frame of reference across multiple timescales and degrees of biological complexity. Here, we consider GxExT interactions to understand adversity-induced developmental acceleration or deceleration whereby environmental conditions hasten or hinder children's development. To date, developmental pace changes have been largely explained through a focus on the individual: for example, how adversity "wears down" aging biological systems or how adversity accelerates or decelerates maturation to optimize reproductive fitness. We broaden such theories by positing shifts in developmental pace in response to the parent-child dyad's capacity or incapacity for meeting children's early, physiological and safety needs. We describe empirical evidence and potential neurobiological mechanisms supporting this new conceptualization of developmental acceleration and deceleration. We conclude with suggestions for future research on the developmental consequences of early adverse exposures.

Association of Maternal Stress and Social Support During Pregnancy With Growth Marks in Children's Primary Tooth Enamel

IMPORTANCE

Exposure to maternal psychosocial stressors during the prenatal and perinatal periods can have major long-term mental health consequences for children. However, valid and inexpensive biomarkers are currently unavailable to identify children who have been exposed to psychosocial stress and the buffers of stress exposure.

OBJECTIVE

To assess whether a growth mark in tooth enamel, the neonatal line, is associated with exposure to prenatal and perinatal maternal psychosocial factors.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study used exfoliated primary canine teeth and epidemiological survey data from 70 children enrolled in the Avon Longitudinal Study of Parents and Children, a birth cohort based in Bristol, England. Exfoliated teeth were collected from children at 5 to 7 years of age. Data were collected from January 1, 1991, to December 31, 1998, and were analyzed from January 1, 2019, to August 10, 2021.

EXPOSURES

Four types of prenatal and perinatal maternal psychosocial factors were studied: stressful life events, psychopathological history, neighborhood disadvantage, and social support. Data were collected from mailed-in questionnaires completed during and shortly after pregnancy.

MAIN OUTCOMES AND MEASURES

Neonatal line width measured within 3 portions of the tooth crown (the cuspal, middle, and innermost third) in exfoliated primary canines.

RESULTS

A total of 70 children (34 of 70 [48.7%] male; 63 of 67 [94.0%] White) were studied. Most children were born full term (57 [83.8%]) and to mothers of typical child-bearing age (60 [88.2%]). Neonatal lines were wider in the canines of children born to mothers who self-reported severe lifetime depression (β = 3.35; 95% CI, 1.48-5.23; P = .001), any lifetime psychiatric problems (β = 2.66; 95% CI, 0.92-4.41; P = .003), or elevated anxiety or depressive symptoms at 32 weeks' gestation (β = 2.29; 95% CI, 0.38-4.20; P = .02). By contrast, neonatal lines were narrower in children born to mothers who self-reported high social support shortly after birth (β = -2.04; 95% CI, -3.70 to -0.38; P = .02). The magnitude of these associations was large, up to 1.2 SD unit differences, and persisted after adjusting for other risk factors.

CONCLUSIONS AND RELEVANCE

In this cohort study, neonatal line width was associated with exposure to maternal perinatal psychosocial factors. Replication and validation of these findings can further evaluate teeth as possible new biomarkers.

Neighbourhoods and oral health: Agent-based modelling of tooth decay

This research used proof of concept agent-based models to test various theoretical mechanisms by which neighbourhoods may influence tooth decay in adults. Theoretical pathways were constructed using existing literature and tested in two study areas in Sheffield, UK. The models found a pathway between shops and sugar consumption had the most influence on adult tooth decay scores, revealing that similar mechanisms influence this outcome in different populations. This highlighted the importance of the interactions between neighbourhood features and individual level variables in influencing outcomes in tooth decay. Further work is required to improve the accuracy and reliability of the models.

The association between food insecurity, diet quality, and untreated caries among US children

BACKGROUND

The aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship.

METHODS

The authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach.

RESULTS

Food-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries.

CONCLUSIONS

Food insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries.

PRACTICAL IMPLICATIONS

Social factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.

The intergenerational interplay of adversity on salivary inflammation in young children and caregivers

Systemic inflammation links exposure to early childhood adversity to later disease. The associations among adversity and disease risk might in part operate through poor oral hygiene and subsequent periodontal inflammation, which can be measured in saliva. Few studies, however, have examined the association between adversity and salivary inflammation in young children. Further, there is a dearth of literature investigating adverse experiences and salivary inflammation in children and caregivers together, limiting our understanding of the intergenerational, dual effects of adversity on inflammation for both members of the caregiver-child dyad. This study tested child and caregiver adversity and their associations with an inflammatory composite (i.e., IL-6, IL-1β, IL-8, TNF-α) and CRP in 93 preschool-age children and their caregivers. Caregivers reported on their child's experiences of adversity, as well as on their own adverse experiences, using a comprehensive questionnaire synthesized from previous checklists for complete coverage of possible adverse events. Results showed that caregivers' salivary inflammatory markers (i.e., IL-6, IL-1β, IL-8, TNF-α, and CRP) were not significantly correlated with the same five inflammatory markers in children's saliva. Among children, adversity was associated with significantly higher levels of the inflammatory composite, though not CRP. This association was amplified among children whose caregivers also experienced more adversity during adulthood. Among caregivers, childhood adversity and adulthood adversity were each independently associated with significantly higher levels of the inflammatory composite and CRP. The association between caregivers' own childhood adversity and inflammation was amplified among caregivers whose children also experienced more adversity during their childhoods. These findings provide preliminary evidence for the possible dual role of young children's and caregivers' adverse experiences in contributing to salivary inflammation for both members of the dyad, suggesting possible implications for systemic inflammation and future disease.

Social, Psychological, and Behavioral Predictors of Salivary Bacteria, Yeast in Caries-Free Children

INTRODUCTION

Early childhood caries (ECC) is a complex, multifactorial oral disease that is a major public health concern because it is prevalent, profoundly alters a child's quality of life, is difficult to treat effectively, and has a distressing tendency to recur following treatment.

OBJECTIVES

The purpose of the study was to examine social, psychological, and behavioral predictors of salivary bacteria and yeast in young children at risk for ECC.

METHODS

A sample of 189 initially caries-free preschool children was assessed for child stress physiology from salivary cortisol, child and family stress exposure, diet, oral health behaviors, and sociodemographic risks. Multiple logistic regression analysis was implemented to examine the associations between these risk factors and cariogenic microorganisms: mutans streptococci (MS), lactobacilli (LB), and Candida species.

RESULTS

Higher baseline salivary cortisol (odds ratio [OR] = 6.26; 95% confidence level [CL], 1.69-23.16) and a blunted response to an acute laboratory stressor (OR = .56; 95% CL, .37-.83) were associated with an increased likelihood of elevated salivary MS (≥10⁵ colony-forming units/mL) in caries-free children. Sociodemographic risk for cariogenic microorganisms was also found. Specifically, lower education attainment of the parent/primary caregiver was associated with children being more likely to carry salivary Candida species and elevated salivary MS; in addition, children from households with an unemployed parent/primary caregiver were more likely (OR = 3.13; 95% CL, 1.2-8.05) to carry salivary Candida species and more likely (OR = 3.03; 95% CL, 1.25-7.33) to carry elevated levels of MS and/or salivary Candida and/or LB.

CONCLUSIONS

The impact of sociodemographic risk and stress physiology on cariogenic disease processes are evident prior to ECC onset. The findings provide novel data on the early onset of cariogenic processes in children and the importance of considering sociodemographic, psychosocial, and behavioral factors when judging ECC risk.

KNOWLEDGE TRANSFER STATEMENT

The findings provide valuable and novel findings that, pre-ECC onset, the caries disease process is explicable from a detailed assessment of behavioral, sociodemographic, and psychosocial stress variables.

Effect of adrenaline and noradrenaline on biofilm formation and virulence factors of Streptococcus mutans UA159

OBJECTIVES

To evaluate in vitro the effects of adrenaline and noradrenaline on the biofilm formation on orthodontic brackets, acid production and expression of virulence genes of Streptococcus mutans UA159 (S. mutans).

DESIGN

S. mutans UA159 biofilm was formed on orthodontic brackets under exposure to adrenaline (100 μM), noradrenaline (50 μM) or PBS solution (control group) in triptone-yeast extract with 1 % sucrose. After 24 h, biofilm formation was quantified through Colony Forming Units / mL (CFU/mL) and RNA was extracted to perform gene expression analysis through real-time reverse transcriptase-PCR (RT-qPCR). Evaluation of acid production was carried out on planktonic cultures for 6 h. One-way ANOVA followed by Tukey's test was carried to determine statistical difference. The level of significance was set at 5 %.

RESULTS

Catecholamines stimulated biofilm formation of S. mutans in orthodontic brackets (p < 0,05) but did not interfere with acid production (pH reduction) or the expression of the tested genes related to biofilm formation (gtfB, gtfC, gbpA, gbpB, gbpC, gbpD and brpA), aciduric (relA) and acidogenic properties (ldh).

CONCLUSIONS

The present study was the first to demonstrate that catecholamines can stimulate S. mutans UA159 biofilm formation. These findings can contribute to clarify the role of stress on bacterial metabolism and contribute to the understanding of a possible role on caries development, mainly in orthodontic patients.

Examining the Relationship between Social and School Environment and Children's Caries Experience Using Primary and Secondary Data: A Cluster Analysis

Dental caries is still prevalent worldwide, even with advances in preventive and curative measures. The aim was to examine clustering patterns of socioeconomic and environmental characteristics of schools and their associations with caries experience of schoolchildren. An epidemiological survey with cross-sectional design was conducted in 2014/2015 and included 5,213 students (aged 2-11 years) from 38 public schools of Carapicuíba (SP, Brazil). Primary data consisted of dental examinations performed at schools by 6 calibrated examiners to evaluate caries experience (dmf/DMFT index). Secondary data were extracted from the last official Demographic Census (2010) and School Census (2014 and 2015) to assess the socioeconomic and environmental characteristics of the territorial units and infrastructure of each school, respectively. Cluster analysis and ANOVA were applied to identify schools with similar social and environmental aspects and children's caries experience. A logistic regression model was used to ascertain the effects of cluster variables on the likelihood that participants have caries experience, controlling for the stage of dentition and sex. Two valid and reliable clusters were identified: cluster 1 ("advantaged group"), characterized by 33 schools with the highest percentages of children without caries experience and located in regions with better socioenvironmental indicators, and cluster 2 ("least advantaged group"), characterized by 5 schools with higher percentages of children with caries experience, lower percentages of households with sanitary sewer and water supply, higher residents/household ratio and higher percentages of families living with up to 1 minimum wage. An increase in the odds of having caries experience for each percent of houses with well water and families which live with up to 1 minimum wage was observed. By using primary and secondary data, the study draws attention to the relationship between socioeconomic and environmental indicators and caries experience, identifying least advantaged regions and helping to design strategic health plans for this target population.

Does age estimated from teeth forming in different early life periods show differential discrepancy with known age?

OBJECTIVES

The aim of this study is to explore growth discrepancies in the dentition of impoverished children and examine how dental development is impacted by environmental influences throughout childhood, thereby identifying which teeth are more sensitive to the effects of biocultural factors and are consequently less useful to predict age.

METHODS

Length measurements of developing teeth (deciduous and permanent) were taken from individuals of known age and sex (n = 61) from the Certosa collection, a 19th century skeletal assemblage representing Italian children of low socioeconomic status. Discrepancies between age estimates based on tooth length and chronological age were calculated, and the accuracy and precision of age prediction between earlier forming teeth and later forming teeth were compared.

RESULTS

Deciduous teeth produced more precise dental age estimates (mean age discrepancy -0.092 years), while discrepancies between chronological age and age based on developing permanent dentition were larger (-0.628 years). The difference between these discrepancies in age estimates for deciduous and permanent teeth was significant (p < 0.001), indicating that age prediction from deciduous tooth length is more accurate than age predicted using permanent tooth length.

CONCLUSION

An increasing variation and delay in tooth length for age reflects increasing susceptibility to biocultural factors, which impacts tooth growth during the course of childhood. Teeth whose development occurs earlier in life are less variable in their growth and provide more accurate estimations of age as a result.

Comparison of Some Salivary Characteristics in Iraqi Children with Early Childhood Caries (ECC) and Children without Early Childhood Caries

Background

Early Childhood Caries (ECC) is a unique form of caries that develops in temporary dentition. It has a multifactorial infectious disease. Saliva is one of the most important factors, which has an important protective effect against tooth decay when its multiple characteristics and functions are normal. The study aimed to compare some salivary characteristics in children with ECC and children without ECC.

Materials and Methods

Case-control, cross-sectional observational study. The 77 pre-schoolers aged 37 to 72 months (12 with ECC, 26 with ECC-S, and 39 without ECC) examined and we collected the stimulated saliva. The pH microelectrode was used to determine pH and buffer capacity; a formula that involves volume, collection time, and specific saliva weight was used to test the salivary flow rate. The potentiometric and phosphate methods were used to determine fluoride through spectrophotometric, colorimetric absorption techniques.

Results

The results got to show that there are no statistically significant differences in pH, buffer capacity, salivary flow rate, and levels of fluoride and phosphate, in children with ECC, ECC-S, and without ECC. The risk factors, such as mother's education, bottle use, brushing frequency, and previous dental care of the child are more important at the time of developing ECC than some salivary variables.

Conclusion

The risk factors, such as mother's education, bottle use, brushing frequency, and previous dental care of the child are more important at the time of developing ECC than some salivary variables such as pH, buffer capacity, salivary flow rate, and levels of fluoride and phosphate.

Parental stress as a predictor of early childhood caries: a systematic review

AIM

The aim of this study was to systematically review the literature to answer the question: Are parental stress associated with early childhood caries (ECC)?

METHODS

Electronic databases including MEDLINE (via Pubmed), Scopus and SciELO were searched. Cross-sectional and case-control studies that investigate the association between parental stress and ECC were included. The Newcastle-Ottawa scale was used to assess the risk of bias of the included articles.

RESULTS

Out of 498 articles identified in initial research, 7 articles met the inclusion criteria; five were cross-sectional and two were control-case in design. A statistically significant correlation between ECC and total parental stress as well as a higher level of carious activity associated with total parental stress was reported in four studies. In two studies, no significant relationship between stress and ECC was found (P > 0.05) and in one study, parental stress was inversely associated with children's ECC status with better dental outcomes significantly associated with a higher level of parenting stress.

CONCLUSION

Despite the fact that the heterogenicity of the following data precluded conclusions to be drawn, it was obvious that parenting stress or some of its domains may influence the development of carious lesions in young children.

Are parents' education levels associated with either their oral health knowledge or their children's oral health behaviors? A survey of 8446 families in Wuhan

Background

Children aged 6–7 years are in the early mixed dentition, which is a period of high prevalence of dental caries and other dental diseases and a critical period for the formation of oral health behaviors. Therefore, good oral hygiene habits of children and oral health knowledge of parents are very important. This study sought to explore the relationship between children’s oral health behaviors, parental oral health knowledge, parental choices of pit and fissure sealants, and parents’ education levels based on a large-scale sample size for the first time, and to compare the influences of parental education levels between parents.

Methods

Families of the first and second graders of primary schools in Wuhan Hongshan District were included in this study. A total of 8446 questionnaires were collected to obtain comprehensive information on children’s oral health behaviors, parents’ oral health knowledge and parents’ pit and fissure sealants-related choices. The relationship between these outcome variables and parents’ education levels were studied using logistic regression analysis and chi-square test.

Results

Parents who reported good educational background had more favorable oral health knowledge than those of other parents, and their children had better oral hygiene behaviors. Four indicators of five measures to children’s oral health behaviors were significantly associated with mother’s education level (P < 0.05), and three of them were related to father’s education level (P ≤ 0.01). Moreover, seven indicators of eight measures to parents’ oral health knowledge were significantly related to mother’s education level (P < 0.05) and four of them were affected by the father’s (P < 0.05). In addition, parents with higher educational attainments paid more attention to the completeness of medical facilities, the environment of dental practice, the distance to treatment sites, and took less concern of children’s willingness when choosing the pit and fissure sealants sites.

Conclusions

In families with children at the early mixed dentition stage, parents with higher education levels tend to have better oral health knowledge and more oral health care needs, such as pit and fissure sealants. In addition, children of parents who have better educated parents tend to perform better oral hygiene practices.

The effect of commercial functional food with probiotics on microorganisms from early carious lesions

Caries rates in school-age children are still high enough to be the cause of serious concern for health systems in different countries. The biotechnology strategies studied to decrease these rates include the consumption of probiotics—available via a variety of functional foods obtainable on the market—that are able to inhibit bacteria associated with this disease. In this vein, the purpose of this study was to determine the effect of these foods on the growth of microorganisms in early carious lesions in children aged between 6 and 12. In the first phase, an agar well diffusion method was applied to selected foods, available in supermarkets, which contain probiotics that have already been shown to inhibit Streptococcusmutans (ATCC 25175), and to lower the pH in liquid culture media. In a second phase, these foods (n = 4) were examined in terms of their ability to inhibit the microorganisms in contact with early carious lesions in children and to reduce the pH of mixed cultures combined with the food. The results revealed that, of the foods tested, three inhibit the growth of microorganisms in carious lesions and, at the same time, lower the pH of the culture by more than 2.5 units. The food with the highest inhibitory capacity (14 mm, IQR 13–14) showed a similar effect among patients (P > 0.05), which together with the fact that its sugar concentration is less than 10%, makes it an ideal candidate for clinical study.

Parenting stress as a mediator in the oral health of children and adolescents: A stress process model

OBJECTIVES

We tested hypotheses regarding socioeconomic status (SES) disparities in oral health amongst children and adolescents and the extent to which such SES disparities may be mediated by parenting stress.

METHODS

We analysed data from the 2011/2012 US National Survey of Children's Health for ages 6-11 years (n = 21 596) and 12-17 years (n = 23 584). Our models estimated associations between SES indicators (family income and parental education) and parenting stress with two oral health outcomes: parent-reported child oral health and preventive dental visits.

RESULTS

For both age groups, SES was positively associated with both oral health outcomes. Parenting stress mediated the relationship between SES and child oral health, not preventive dental visits-such that lower SES was associated with worse oral health via higher parenting stress. Amongst children, the indirect effect of parenting stress was observed for parental education and family income, whilst amongst adolescents, no indirect effect of parenting stress was observed.

CONCLUSION

Parenting stress was an important determinant of children's oral health and partially explained the SES-related oral health disparities in children. Future research is needed to explore the causal pathways in this association.

Teeth as Potential New Tools to Measure Early-Life Adversity and Subsequent Mental Health Risk: An Interdisciplinary Review and Conceptual Model

Early-life adversity affects nearly half of all youths in the United States and is a known risk factor for psychiatric disorders across the life course. One strategy to prevent mental illness may be to target interventions toward children who are exposed to adversity, particularly during sensitive periods when these adversities may have even more enduring effects. However, a major obstacle impeding progress in this area is the lack of tools to reliably and validly measure the existence and timing of early-life adversity. In this review, we summarize empirical work across dentistry, anthropology, and archaeology on human tooth development and discuss how teeth preserve a time-resolved record of our life experiences. Specifically, we articulate how teeth have been examined in these fields as biological fossils in which the history of an individual's early-life experiences is permanently imprinted; this area of research is related to, but distinct from, studies of oral health. We then integrate these insights with knowledge about the role of psychosocial adversity in shaping psychopathology risk to present a working conceptual model, which proposes that teeth may be an understudied yet suggestive new tool to identify individuals at risk for mental health problems following early-life psychosocial stress exposure. We end by presenting a research agenda and discussion of future directions for rigorously testing this possibility and with a call to action for interdisciplinary research to meet the urgent need for new biomarkers of adversity and psychiatric outcomes.

Oral Microbiota Development in Early Childhood

Early life determinants of the oral microbiota have not been thoroughly elucidated. We studied the association of birth and early childhood characteristics with oral microbiota composition using 16 S ribosomal RNA (rRNA) gene sequencing in a population-based Swedish cohort of 59 children sampled at 6, 12 and 24 months of age. Repeated-measurement regression models adjusted for potential confounders confirmed and expanded previous knowledge about the profound shift of oral microbiota composition in early life. These alterations included increased alpha diversity, decreased beta diversity and alteration of bacterial composition with changes in relative abundance of 14 of the 20 most common operational taxonomic units (OTUs). We also found that birth characteristics, breastfeeding and antibiotic use were associated with overall phyla distribution and/or with the relative abundance of specific OTUs. Further, we detected a novel link between morning salivary cortisol level, a physiological marker of neuroendocrine activity and stress, and overall phyla distribution as well as with decreased abundance of the most common OTU mapped to the Streptococcaceae family. In conclusion, a major part of the maturation of the oral microbiome occurs during the first two years of life, and this development may be influenced by early life circumstances.

The Biology of Social Adversity Applied to Oral Health

Biological embodiment is a concept derived from Engel's biopsychosocial model to health, theorized as the process by which adverse social exposures trigger neuroendocrine and immune responses, leading to disease and/or increased disease susceptibility. This critical review discusses the biopsychosocial model as applied to oral health and its relevance to oral health policy while deciphering some of the pathobiological processes underlying social adversity. In periodontal disease, for example, such processes can occur via the activation of the hypothalamic-pituitary-adrenal axis and the consequent release of the chronic stress hormone cortisol. The latter contributes to a proinflammatory immune state that increases the risk for periodontal inflammation. Recent research shows that cortisol relates to an elevated oral inflammatory load, demonstrated as hyperactive neutrophils that are pivotal to periodontal tissue damage. Consistent with the biopsychosocial model, this relationship is amplified in those of lower income and higher financial stress. Similarly, among children from lower socioeconomic backgrounds, cortisol is linked to a higher cariogenic bacterial load. Such findings implicate the stress pathway as key in the oral pathogenic process, particularly under social/socioeconomic adversity. Collectively, this work emphasizes the importance of addressing social factors in alleviating oral disease burden and reducing the social gaps therein.

A life course approach to total tooth loss: Testing the sensitive period, accumulation, and social mobility models in the Health and Retirement Study

OBJECTIVES

Childhood socio-economic status (SES) has long been associated with later-life oral health, suggesting that childhood is a sensitive period for oral health. Far less attention has been given to the long-term impact of childhood trauma, abuse, and smoking on later-life oral health. This study fills the gap in the literature by examining how adverse childhood experiences-social, psychological, and behavioral-shape total tooth loss over the life course, with an assessment of the sensitive period, accumulation, and social mobility models from life course research.

METHODS

Data are drawn from the 2012 Health and Retirement Study (HRS) merged with multiple HRS data sources to obtain childhood information (N = 6,427; age > 50). Adverse childhood experiences include childhood financial hardship, trauma, abuse, and smoking. Total tooth loss is measured to assess poor oral health in later life. Educational attainment and poverty status (since age 51) are measured as adult adversity. Current health conditions and health behaviors are assessed to reflect the correlates of oral health in later life.

RESULTS

The sensitive period model indicates that childhood trauma such as parental death or divorce (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.04, 1.80), physical abuse (OR = 1.17, 95% CI = 1.03, 1.34), and low educational attainment (≤ high school; OR = 1.52, 95% CI = 1.04, 2.22) are associated with higher odds of total tooth loss in later life. Poverty status was not associated with the outcome. There was a clear graded relationship between accumulation of adverse experiences and oral health, which supports the accumulation model. In the social mobility model, older adults who occupied a stable disadvantageous position were more likely to be toothless (OR = 1.77, 95% CI = 1.08, 2.90) compared to those who did not face adversity in any case. Neither upward nor downward mobility mattered.

CONCLUSIONS

Failing oral health in older adults, especially total tooth loss, may have its roots in adverse experiences such as childhood trauma, abuse, and low educational attainment. Findings also suggest that oral health in later life may be more influenced by accumulation of adversity rather than changes in social and economic position over the life course.

Is tooth loss important when evaluating perceived general health? Findings from a nationally representative study of Costa Rican adults

OBJECTIVES

Although previous studies have shown that oral diseases can impact certain systemic conditions, dental care has been historically separated from medical healthcare organizations in middle-income countries. There is a lack of research approaches which test the independent relationship between oral health and multidimensional measures of general health. This study analyses the influence of tooth loss on self-rated health (SRH), hypothesizing that, relatively to certain morbidity conditions, tooth loss is a health condition associated with SRH. This study analyses the influence of tooth loss on self-rated health (SRH), hypothesizing that, relative to certain morbidity conditions, tooth loss is a health condition associated with SRH.

METHODS

Data were obtained from the Costa Rican Longevity and Healthy Aging Study 1945-1955 Retirement Cohort, a national representative longitudinal survey including residents born between 1945 and 1955. The association between severe tooth loss and SRH was analysed cross-sectionally using the first wave of the study conducted in 2010. A multivariable logistic regression, adjusted for potential confounders, was performed on 2797 participants. A counterfactual analysis was additionally performed to illustrate the theoretical change on SRH prevalence-if all the participants were not to have had severe tooth loss.

RESULTS

Severe tooth loss was associated with poor SRH, after adjustment for smoking, morbidity, biomarkers and performance-based physical measures. The counterfactual analysis showed that severe tooth loss was the fifth most important morbidity condition in determining poor SRH. Declaring a poor SRH would have been decreased by 2.0 percentage points if those participants having severe tooth loss had shared the same risk pattern of those who had not lost the majority of their teeth.

CONCLUSION

Individuals consider their oral health status to a similar extent as other morbidity conditions when evaluating their general health. A stronger focus on oral health, and its impact on general health, could lead to better planning of national resources, thereby improving accessibility to health care and modifying prevailing conceptions of health care in low- and middle-income countries.

Review: modulation of the oral microbiome by the host to promote ecological balance

The indivisible relationship between the human host and its oral microbiome has been shaped throughout the millennia, by facing various changes that have forced the adaptation of oral microorganisms to new environmental conditions. In this constant crosstalk between the human host and its microbiome, a bidirectional relationship has been established. The microorganisms provide the host with functions it cannot perform on its own and at the same time the host provides its microbes with a suitable environment for their growth and development. These host factors can positively affect the microbiome, promoting diversity and balance between different species, resulting in a state of symbiosis and absence of pathology. In contrast, other host factors can negatively influence the composition of the oral microbiome and drive the interaction towards a dysbiotic state, where the balance tilts towards a harmful relationship between the host and its microbiome. The aim of this review is to describe the role host factors play in cultivating and maintaining a healthy oral ecology and discuss mechanisms that can prevent its drift towards dysbiosis.

Does poverty cause dental caries?

Dental caries generates significant health, financial and social costs to individuals and communities, but risk factors are not spread randomly and evenly throughout populations. People from lower socio-economic status (SES) and disadvantaged groups suffer a disproportionately greater disease burden. Clinicians and public health experts view this problem through a different lens. Dentists at the clinical coalface consider individual risk factors and behaviours, for example sugar consumption, cariogenic bacteria and poor oral hygiene, as major causes of dental caries. However, considerable evidence suggests that low SES, via traditional individual risk factors as mediators and through additional independent pathways, is another significant cause. Progressive clinical practice uses education, prevention and treatment to reduce the impact of individual risk factors. Policy-makers and health administrators use population-based approaches to improve the health of societies. The authors use literature review to argue for both a greater awareness of the upstream socio-economic causes of dental caries, and action from key community sectors to redress the societal inequalities contributing to dental health inequalities.

Development of a prognostic model for caries onset and progression from early childhood caries incidence in urban preschool children

AIM

Of this prospective cohort study was to assess early childhood caries (ECC) incidence and, based on the data, build a model that not only predicts future ECC onset in clinically caries-free children, but also is prognostic for children with ECC.

METHODS

ECC incidence was assessed at the 12-month follow-up examination on a cohort of 291 preschool children. Weighted general estimation equation (WGEE) was used to estimate the effects of covariates on ds (decayed primary tooth surfaces) and dfs (decayed and filled primary tooth surfaces).

RESULTS

The mean dfs at the baseline examination was 0.81. Of the 116 children who completed the study, approximately 22% examined at baseline had ECC (dfs > 0). At 12-months, 36% had ECC with a mean dfs of 2.22. Children with dfs = 0 at baseline had 2.95 fewer ds in the primary dentition at the end of the study than children who had ECC at the baseline examination (dfs > 0) (p < 0.0001). Children with dfs = 0 at baseline had 5.49 fewer ds and dfs in the primary dentition at the end of the study than children who had ECC at the baseline examination (dfs > 0) (p < 0.0001).

CONCLUSIONS

ECC incidence at 1 year was 14%. The prevalence of ECC at the 12-month follow-up examination was approximately 36%. The model developed from these data strongly indicate that past caries experience in the primary dentition is a significant predictor of future caries activity and severity, as well as a predictor of future caries onset in clinically caries-free children.

'One tooth one child': evaluating the effects of diet and fertility on the oral health of women from archaeological sites in South America

Women from ancient societies have shown a higher prevalence of dental caries in comparison with men. Recent research has shown that the relationship between increased oestrogen production during pregnancy and decreased salivary flow is a possible cause for the higher levels of caries in women, which is in contrast to the traditional view of sexual division of labour resulting in unequal access to cariogenic food. In order to test these two hypotheses, individuals exhumed from 12 South American archaeological sites were examined for markers of oral health (caries, ante mortem tooth loss, deep caries, and enamel hypoplasia) and compared in terms of fertility (Crude Birth Rate) and subsistence systems. Our results suggest that diet and other cultural practices remain the most important factors affecting oral health and that the effects of hormones can be masked by them. Such findings add to the discussion regarding the availability of micronutrients in such societies affecting caries experience in pregnant women, because of their special nutritional requirements.

The association of the Bolsa Familia Program with children's oral health in Brazil

Background

Several studies have demonstrated that Conditional Cash Transfer (CCT) programs reduce poverty/inequity and childhood mortality. However, none of these studies investigated the link between CCT programs and children’s oral health. This study examines the association between receiving the Brazilian conditional cash transfer, Bolsa Familia Program (BFP), and the oral health of five-year-old children in the Northeast of Brazil.

Methods

We conducted a cross-sectional study with 230 caregivers/children randomly selected in primary health care clinics in the city of Fortaleza in 2016. Interviews and oral health examinations were performed. Descriptive statistics and multiple logistic regression analyses were conducted to identify factors associated with dental caries among five-year-old children enrolled in the BFP.

Results

Around 40% of children enrolled in the BFP had dental caries. However, those who received Bolsa Familia (BF) for a period up to two years (OR = 0.13, 95% CI 0.05–0.35) had substantially lower adjusted odds of having dental caries than those who had never received BF. In addition, the association of BF and dental caries was more prominent among extremely poor families (OR = 0.05, 95% CI 0.01–0.28).

Conclusions

Although initial enrolment in the BFP predicted low dental caries among five-year-old children, the prevalence of dental caries in this population is still high, thus, public health programs should target BF children’s oral health. An ongoing effort should be made to reduce oral health inequalities among children in Brazil.

Effect of a coating material containing surface reaction-type pre-reacted glass-ionomer filler on prevention of primary enamel demineralization detected by optical coherence tomography

We used optical coherence tomography to examine the effect of a coating material containing surface reaction-type pre-reacted glass-ionomer (S-PRG) filler on primary enamel demineralization in 18 extracted human primary teeth. The pulp was removed, and each tooth was ultrasonically cleaned with distilled water. Six teeth were treated with 0.1-M lactic acid buffer solution (De group). In the second group (n = 6), a thin film of coating material was applied before demineralization (PRG group). A third group (Control group; n = 6) was maintained in artificial saliva. Using optical coherence tomography, we measured peak signal intensity (dB) and width at 1/e² (µm) at predetermined locations on the enamel surface and calculated integrated values. All data were analyzed with ANOVA and the Tukey-Kramer test (α = 0.05). Although changes in integrated values differed between groups, there was a small but significant increase in the Control group and a small but significant decrease in the De group. In the PRG group, integrated values were significantly higher at 7 days after the start of the experiment and significantly increased thereafter. Our findings indicate that a coating material containing S-PRG fillers may prevent primary enamel demineralization.

Investigating the association between stress, saliva and dental caries: a scoping review

BACKGROUND

This scoping review addressed the question 'what do we know about stress-related changes in saliva and dental caries in general population?'

METHODS

The review was conducted using electronic searches via Embase, MEDLINE, PsycINFO, CINAHL and WoS. All published human studies with both observational and experimental designs were included. Two reviewers independently reviewed eligible articles and extracted the data. The studies' quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool.

RESULTS

Our search identified 232 reports, of which six were included in this review. All six studies were conducted in children and used salivary cortisol as stress marker. The studies varied by design, types of stressors, children's caries experience, methods of saliva collection. Four studies reported a positive association between saliva cortisol levels and caries (p < 0.05) while the other two reported no association (p > 0.05). The quality of the included studies was weak to moderate.

CONCLUSIONS

There is lack of evidence about an association between stress-related changes in saliva and caries. Well-designed longitudinal studies with rigorous measurement technics for stress, saliva and dental caries are necessary. This will help to generate new insights into the multifactorial etiology of caries and provide evidence for a rational method for its control.

Early socioeconomic conditions and severe tooth loss in middle-aged Costa Ricans

OBJECTIVE

A wide literature shows a strong social gradient in tooth loss according to income, education and occupation, in both developed and developing countries. It has been shown associations between tooth loss and parental education and occupation, independently of adult conditions. To explore the role of early socioeconomic circumstances on tooth loss, we used a lifecourse model. We analysed the direct and indirect links between early socioeconomic conditions and severe adult tooth loss.

METHODS

We used the Costa Rican Longevity and Healthy Aging Study 1945-1955 Retirement Cohort, a nationally representative longitudinal survey of Costa Rican residents born between 1945 and 1955. We used imputed data on 2796 individuals. Principal component analyses were run to integrate measures approaching the material circumstances during childhood and adulthood. We additionally examined the role of adult health behaviours and education level as potential mediators in the multivariable regression.

RESULTS

Early socioeconomic conditions were found strongly associated with severe tooth loss; 72.4% of the people who experienced the most deprived socioeconomic conditions during childhood (quartile 1) had severe tooth loss at the time of the interview; vs 43.3% in quartile 4 (most advantaged). This link diminished after adjustment for adult mediators. However, it remained a significant determinant of severe tooth loss in the final model.

CONCLUSION

The lifecourse model allowed to highlight that early socioeconomic conditions could have long-term consequences on severe tooth loss in middle ages via both direct and indirect mechanisms.

Social capital and oral health: The association of social capital with edentulism and chewing ability in the rural elderly

OBJECTIVE

The association between social capital and oral health had been reported in various ways, but still remains unclear. We investigated the association between the social capital of the elderly living in a rural region and their edentulism and chewing ability.

METHODS

A total of 241 elderly aged≥70years living in a rural city of Korea participated in this cross-sectional study. Their social capital was surveyed by questionnaire assessing its network and trust dimensions. Their edentulism and chewing ability were assessed by oral examination and chewing gum whose color changes based on the mastication performance.

RESULTS

The mean age of the participants was 82.7 (ranged 71 to 101) years and 68.8% of them were female. In the binomial regression analysis, the general network aspect of the network dimension was significantly associated with chewing ability, of which the prevalence ratio was 1.88 (95% CI: 1.16-3.06) in the age, sex, education and marital status-adjusted model.

CONCLUSION

Our findings suggest that social capital, such as a poor social network, is associated with poor chewing ability in the elderly living in rural areas.

Type 2 diabetes as a risk indicator for dental caries in Korean adults: the 2011-2012 Korea national health and nutrition examination survey

OBJECTIVES

The associations between type 2 diabetes (T2D) and untreated dental caries was examined. This study hypothesized that there would be a positive association between T2D and the prevalence of decayed permanent teeth (DT) in representative Korean adults.

METHODS

The information was derived from the Korea National Health and Nutrition Examination Survey conducted in 2011-2012. Sociodemographic and lifestyle variables, anthropometric and biochemical status, metabolic health and glucose tolerance status, oral health behaviors, and dental caries index were evaluated.

RESULTS

The number of DT had a positive association with degree of fasting plasma glucose (FPG) level, and glycated hemoglobin (HbA1c) (p-value = 0.045 and 0.007, respectively). The levels of FPG and HbA1c increased with the number of DT (p for trend = 0.009 and 0.004, respectively). The prevalence of untreated caries uncontrolled T2D participants was about 26% higher than those with normal glucose tolerance levels after adjusting for potential confounders including diets and socioeconomic status (OR [95% CI] = 1.26 [1.02, 1.56]).

CONCLUSIONS

T2D is an independent risk indicator for untreated caries in Korean adults.

Social inequalities in children's oral health-related quality of life: the Generation R Study

Purpose

Oral health-related quality of life (OHRQoL) is the most important patient-reported outcome measure in oral health research. The purpose of the present research was to study the association of family socioeconomic position (SEP) with children’s OHRQoL.

Methods

This cross-sectional study was embedded in the Generation R Study, a population-based cohort study conducted in Rotterdam, The Netherlands. For the present study, OHRQoL was assessed of 3871 ten-year old children. Family SEP was assessed with the following indicators: maternal/paternal education level, maternal/paternal employment status, household income, benefit dependency, and family composition. Linear regression analyses were performed to evaluate the (independent) associations of family SEP indicators with OHRQoL.

Results

The median (90% range) OHRQoL score of the participating children was relatively high [50.0 (43.0–53.0)]; however, OHRQoL was consistently lower in children with low family SEP. Positive associations were found for all SEP indicators (p-values <0.05) except maternal employment status and family composition. Benefit dependency, paternal employment, and household income were the most strongly associated with OHRQoL. No family SEP indicator was significantly associated with OHRQoL independent of the other indicators.

Conclusions

Based on the present findings, interventions and policies promoting good oral health and oral well-being should target children from low socioeconomic position. More research is needed, however, to understand the pathways of social inequalities in children’s OHRQoL especially for the effects of material resources on subjective oral health measures.

Electronic supplementary material

The online version of this article (doi:10.1007/s11136-017-1679-1) contains supplementary material, which is available to authorized users.

Social Determinants of Pediatric Oral Health

Social determinants of health are defined as conditions in which people are born and live and the role these conditions play on health outcomes. Research indicates that risk factors and their interactions are far more complex than originally thought. This article outlines social determinant constructs and their role in understanding oral health promotion. Due to the complex interactions, oral health must be promoted using a multilevel chronic disease model or common risk factor approach. An understanding of social determinants is particularly important for the pediatric population because optimum oral health and general health in adulthood are heavily influenced by childhood.