Tooth loss prevalence and risk indicators in an isolated population of Brazil

Research Regarding Dental Mobility Phenomena in the Clinical Recognition Diagnosis of Temporomandibular Disorders

The main objective of this study is to quantify the implications of the complications of periodontal pathology and dental mobility on the pathology of dysfunctional algo syndrome, a clinical entity with profound implications for the patient's quality of life.

METHODOLOGY

Clinical and laboratory evaluation was conducted in the 2018-2022 period, on a group of 110 women and 130 men, aged between 20-69, selected from our practice venue, Policlinica Stomatologica nr. 1 Iasi, Clinical Base of Dentistry Education "Mihail Kogalniceanu" Iasi, "Grigore T. Popa" University of Medicine and Pharmacy Iasi and "Apollonia" University Iasi. Overall, 125 subjects were diagnosed with periodontal disease with complications and TMJ disorders and followed periodontal therapy in the context of oral complex rehabilitation treatments (study group); the results of their clinical evaluation were compared with the results of the evaluation of the control group, made from the other 115 patients).

RESULTS

Dental mobility and gingival recession were identified as more frequent in the study sample compared with the control sample, the differences being statistically significant in both cases. In total, 26.7% of patients had different types of TMJ disorders and 22.9% of patients had occlusal changes; the percentages are slightly increased in the study sample compared with the control one, but the recorded differences are not statistically significant.

CONCLUSIONS

Dental mobility, most of the time, is a negative consequence of periodontal disease, leading to the alteration of the mandibular-cranial relations, materializing in an important proportion as an etiopathogenic factor of the dysfunctional syndrome of the stomatognathic system.

Radiographic Assessment of Permanent First Molars Among Adults in Riyadh: A Retrospective Study

Introduction The first permanent molars (FPMs) are the first permanent teeth to emerge in the oral cavity, which have an important role in dentition, dental development, and occlusion. FPMs are the most susceptible teeth to caries due to early eruption. There are many adverse consequences related to losing FPMs. Many of the previous studies focused on younger age groups. To the best of our knowledge, there needs to be more newly updated data reported in the literature regarding the status of FPMs in adults in Saudi Arabia. The study aimed to assess the status of permanent first molars among adults in a sample of patients in Riyadh. Methods A cross-sectional retrospective study was conducted from the records of patients in the Dental University Hospital, College of Dentistry, King Saud University (KSU), after obtaining ethical approval. Panoramic images of 810 patients ages 18 and above who were seen at KSU, College of Dentistry, were examined to assess the status of FPMs. A panoramic examination was undertaken for various dental reasons in the time between the years 2017 and 2022. Patients were divided into three age groups: 18-30, 31-50, and >50 years. Data were collected in a particular form and analyzed. The prevalence of missing teeth, as well as restored and carious teeth, were recorded. In addition, further information regarding the type of restoration was recorded. Correlations of the findings regarding age, gender, side, and jaw were determined for all cases and were performed using the chi-square test. P-values less than 0.05 were considered statistically significant. Results A total of 810 patients' panoramic radiographs were studied. Panoramic male study subjects were 382 (47.2%), and females were 427 (52.8%). Three-hundred thirty-nine (339; 41.9%) of them were of less than 30 years of age, 327 (40.4%) were in the age group of 31-50 years, and the remaining 144 (17.8%) were above 50 years of age. The prevalence of missing first molar teeth was 145 (17.9%) for teeth 16, 147 (18.1%) for teeth 26, 207 (25.5%) for teeth 36, and 188 (23.2%) for teeth 46. No statistically significant association was found between the age groups and gender and the first molar missing teeth (p=0.848 & p=0.159). Nineteen point thirteen percent (19.13%) of patients had only one missing FPM, 12.3% of patients had two, and 6.29% of them had three missing FPM teeth. Five point fifty-five percent (5.55%) of patients had four missing FPMs. A total of 56.8% (242) radiographs in the overall sample did not show any missing teeth. The mandibular FPMs (35.2%) were found missing more frequently than their maxillary counterparts (14.8%), and the left mandibular quadrant showed a slightly higher rate of missing FPM (25.55%). Statistically, a significant association was seen between the number of missing FPM among different age groups, p-value <0.0001. The most restored, carious, and replaced tooth was the mandibular left molar, and tooth-color restoration was the most commonly used restoration. Conclusion A high prevalence rate of missing first permanent molars (FPMs) was found in this study population. This calls for more awareness and preventive measures to preserve such significant teeth, therefore reducing the need for complex procedures. Further prospective studies on a larger population are needed to comprehensively evaluate the status of FPMs.

Tooth life expectancy and burden of tooth loss: Two cross-sectional studies in Taiwan

Background/purpose

Materials and methods

Results

Conclusion

Impact of tooth loss due to periodontal disease on the prognosis of rehabilitation

When periodontal disease is diagnosed, it is difficult to predict the clinical response of treatment of a tooth over time because the result of treatment is affected by several factors and will depend on the maintenance and support of periodontal treatment. Rehabilitation with removable dental prostheses, fixed prostheses, and dental implants makes it possible to restore the function and esthetics of patients with tooth loss due to periodontal disease. The predictive factors of tooth loss in periodontitis patients should be assessed by dentists to inform their clinical decision-making during dental treatment planning. This will provide detailed individualized information and level of risk of patients considered suitable for dental rehabilitation. Therefore, the aim of this article was to review the subject of "Impact of tooth loss due to periodontal disease on the prognosis of rehabilitation" and the effect of fixed, removable, and implant-supported prostheses in periodontal patients.

Predicting dental caries increment using salivary biomarkers in a remote Indigenous Australian child population

BACKGROUND

The burden of childhood dental caries amongst Indigenous Australians is higher than in other Australians. Because of differences in lifestyle and the evolutionary history of the oral microbiota, associated risk indicators may differ. Here, we evaluate associations between caries increment, salivary biomarkers and baseline caries among children aged 5-17 years residing in a remote rural Indigenous community.

METHODS

This study was part of a trial assessing cost-effectiveness of an intervention to prevent dental caries among children. Baseline epidemiology and application of topical caries-preventive measures was conducted in 2015, followed-up in 2016 and 2017. Children who did not consent or failed to attend the prevention visits but did attend for follow-up epidemiology constituted a natural comparison group for evaluating the intervention. Saliva flow, pH, buffering and bacterial loads were measured at all visits. Caries was scored by the International Caries Detection and Assessment system. Outcome was caries increment. Explanatory variables were sex, being in experimental or comparison group, baseline caries, saliva flowrate and buffering, pH, and salivary loads of mutans streptococci (MS), Lactobacilli (LB), and yeast. Chi Square tests compared caries incidence in relation to explanatory variables and Generalised Linear Models explored associations between explanatory and outcome variables.

RESULTS

Of 408 participants at baseline, only 208 presented at 2-year follow-up. Of caries-free children at baseline, significantly fewer had incipient (p = 0.01) and advanced (p = 0.04) caries after two years. Children in the experimental group experienced fewer tooth surfaces with advanced caries (p = 0.02) than comparison children. Having caries at baseline (p = 0.02) and low salivary flow-rates (p < 0.001) saw a significant increase in advanced caries after two years. Children with high salivary loads of MS (p = 0.03) and LB (p = 0.004) experienced more advanced carious surfaces. Multivariable analysis revealed 58% reduction (p = 0.001) in advanced caries among children with high salivary flow rates. Caries increment was 61% (p = 0.03) more for incipient and 121% (p = 0.007) more for advanced caries among children who harboured higher loads of MS.

CONCLUSION

As with other ethnicities, children with low salivary flow and those with high MS had higher incipient and advanced caries increments after two years. Such risk assessments facilitate targeted preventive interventions for such communities.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527: 3 July 2015.

Factors associated with alveolar bone depth mesial to the mandibular third molars after orthodontic protraction

INTRODUCTION

The objective of this research was to study the factors associated with the alveolar bone depth mesial to the mandibular third molars (M8) after the mandibular second (M7) and third molars were protracted into the space of the mandibular first molars (M6), which were newly extracted for orthodontic treatment or extracted more than 1 year before treatment.

METHODS

This retrospective study included 57 adult patients (mean age 23.40 ± 4.40 years) in whom M6 were newly extracted for orthodontic treatment or extracted more than 1 year before treatment. The alveolar bone depth mesial to M8 was measured on posttreatment panoramic radiographs. The vertical, horizontal, and angular changes of M8 were measured on both pre- and posttreatment panoramic radiographs. Linear correlation and regression analyses were conducted to explore the factors associated with the alveolar bone depth mesial to M8.

RESULTS

The alveolar bone conditions of M6 (R= -0.391, P <0.001) and the vertical movement directions of M8 (R= -0.433, P <0.001) were significant factors associated with the alveolar bone depth mesial to M8 after orthodontic protraction.

CONCLUSIONS

Without considering the pretreatment periodontal status of M8, patients with M6 extracted exceeding 1 year before treatment and with M8 extruded after orthodontic protraction may exhibit deeper alveolar bone depth mesial to M8.

Risk factors for tooth loss with a mean follow-up period of 13.9 years in supportive periodontal therapy patients

Background

Clinical evidence indicates that there are various risk factors of tooth loss. However, the degree of this risk among other risk factors remains unclear. In this retrospective cohort study, the authors evaluated the hazard ratios of several risk factors for tooth loss.

Methods

Included patients had all been treated for dental disorders, were in the supportive phase of periodontal therapy by dental hygienists, and visited a Japanese dental office continually during a 10-year period. Periodontal parameters, tooth condition, and general status of all teeth (excluding third molars) at the initial visit and at least 10 years later were evaluated by using multiple classification analysis.

Results

The authors evaluated a total of 7584 teeth in 297 patients (average age: 45.3, mean follow-up time: 13.9 years) Non-vital pulp was the most significant predictor of tooth loss according to Cox hazards regression analysis (hazard ratio: 3.31). The 10-year survival rate was approximately 90% for teeth with non-vital pulp and 99% for teeth with vital pulp. Fracture was the most common reason for tooth loss.

Conclusions

Non-vital pulp had the most significant association with tooth loss among the parameters. Therefore, it is very important to minimize dental pulp extirpation.

Prevalence of tooth loss and associated factors in institutionalized adolescents: a cross-sectional study

This study aimed to assess the prevalence of tooth loss and associated factors in institutionalized adolescents. This cross-sectional study included 68 male adolescents incarcerated from Socio-Educational Assistance Center (CASE) aged between 15 and 19 years. Questionnaires were applied individually to assess sociodemographical, economical, medical, behavioral and oral health self-perception variables. All present teeth were evaluated by Decay, Missing, Filling (DMF) Index. The prevalence of tooth loss was analyzed in individuals with ≥1 tooth loss. Associations between tooth loss and exposure variables studied were analyzed by Poisson Regression with robust variance estimation. The prevalence of tooth loss was 47.06%. First molars in the mandible and maxilla and central incisor in the maxilla were the most absent teeth. In the multivariate model, number of decayed teeth, and those that reported daily use of medication were associated with higher tooth loss. Besides, tooth loss was associated with decayed tooth and daily use of medication. Oral health promotion and treatment should be implemented in these institutions to reduce the prevalence of dental loss in these adolescents.

Association between parity and tooth loss among northern Nigerian Hausa women

BACKGROUND

Female reproduction is associated with physiological, metabolic, and nutritional demands that can negatively affect health and are possibly cumulative when parity is high. While it is probable that maternal oral health is similarly affected, available evidence is based on fairly low parity populations and likely confounders affecting oral health status were not considered.

AIM

To determine the relationship between parity and tooth loss in a population with many high parity women. Contributions of age, reproductive and socioeconomic parameters, and oral health practices were considered.

MATERIALS AND METHODS

This was a cross-sectional study involving 612 Hausa women of all parity levels aged 13-65 years. Women with ≥5 children were considered high parity. Sociodemographic status and oral health practices were collected using a structured interviewer-administered questionnaire. All teeth present, (excluding third molars) and missing teeth were noted, with inquiries regarding tooth loss etiology. Associations with tooth loss were evaluated through correlations, ANOVA, post hoc analyses and Student's t tests. Effect sizes were used to interpret the magnitude of differences. Multiple regression (negative binomial model) was used to investigate predictors of tooth loss.

RESULTS

Hausa women had a low prevalence of tooth loss, despite poor oral hygiene, and limited dental care. Older, middle SES, and higher parity women experienced significantly more tooth loss. Additionally, increased duration of reproductively active years was significantly related to fewer remaining teeth.

CONCLUSION

Higher parity was related to greater tooth loss in Hausa women. Women with ≥5 children experienced more loss than lower parity age mates.

Making sense of medieval mouths: Investigating sex differences of dental pathological lesions in a late medieval Italian community

OBJECTIVES

Bioarchaeological investigations of sex-based differences in the prevalence of dental pathological lesions, particularly caries, have drawn considerable attention, and out of this work, two dominant models have emerged. Traditionally, the first model interprets sex-related patterns in caries as a product of gendered differences in diet. A more recent model interprets a generally higher propensity for caries prevalence in females in light of reproductive ecology. To test the hypothesis that females have higher risk of caries in accordance with reproductive ecology, we examined and analyzed caries prevalence and other potentially synergistic oral pathological lesions in a late medieval (A.D. 1300-1500) Italian archaeological sample.

MATERIALS AND METHODS

We examined sex- and age-related prevalence in caries and other oral pathological lesions in a late medieval Italian skeletal assemblage excavated from Villamagna consisting of 38 females and 37 males (n = 1,534 teeth). We examined age- and sex-related patterns in six dental traits: antemortem tooth loss, caries, calculus, periapical inflammation, tooth wear, and periodontitis.

RESULTS

Significant age-related increases in antemortem tooth loss, caries, calculus, and tooth wear were observed in both males and females. However, there was a lack of expected sex differences in oral pathological lesions, with instead older males exhibiting significantly more antemortem tooth loss and corrected caries than females.

DISCUSSION

Results are discussed in relation to the ethnohistoric context of medieval rural dietary practices as well as biomedical salivary literature, which suggest that dietary changes throughout the life course may have facilitated trade-offs that buffered females from higher rates of dental pathological lesions.

Comparative study of risk indicators associated with tooth loss among adult population in urban and rural areas of Muradnagar, Ghaziabad, Uttar Pradesh, India

Background:

Oral health objectives prescribed by World Health Organization for the year 2020 have expressed that there ought to be an expansion in the quantity of people with functional dentitions (at least 21 common teeth) at ages of 35–44 and 65–74 years.

Aim:

The aim of this study is to examine the prevalence of tooth loss and to evaluate and compare the risk indicators associated with tooth loss among adult population in urban and rural areas of Muradnagar, Ghaziabad.

Materials and Methods:

A cross-sectional study was led among 1200 adults aged 35–74 years in urban and rural areas of Muradnagar, India. Information was assembled by an interview followed by clinical examination (number of missing teeth). Demographic and socioeconomic factors and self-perceived oral health were the independent variables assessed. One-way analysis of variance, post-hoc test (Bonferroni), Chi-square test, Student's t-test, and logistic regression analysis were used for statistical analysis.

Results:

Low educational status, no dental check-ups, low frequency of brushing, older age, and smoking habit were independent risk factors for tooth loss. The odds of tooth loss in older adults and illiterates were higher; the odds for tooth loss among those who expressed their desire for replacement of missing teeth were 1.3 times lower than their counterparts.

Conclusion:

The experiences gained up showed that tooth loss was very pervasive in Muradnagar populace and the critical hazard indicators identified were age, education, socioeconomic status, and cigarette smoking.

Tooth loss in middle-aged adults with diabetes and hypertension: Social determinants, health perceptions, oral impact on daily performance (OIDP) and treatment need

BACKGROUND

This study aimed to explore the association between tooth loss and social determinants, health self-perceptions, OIDP and self-concept of dental treatment need in middle-aged adults with diabetes and hypertension.

MATERIAL AND METHODS

A cross-sectional study was developed with 212 hypertensive and diabetic middle-aged adults (50-65 years). Data were collected from clinical examinations (DMFT) and a questionnaire regarding socioeconomic status, dental health assistance, self-perceptions of oral and general health, OIDP, and the self-concept of dental treatment need. Tooth loss was dichotomized considering the cutoff point of 12 (Model I) or 24 missing teeth (Model II). Data were analyzed using Chi-square, Fisher's exact test and logistic regression (p≤0.05).

RESULTS

Tooth loss was significantly associated with variables such as last dental visit, reason for dental visit, OIDP, perception of dental treatment need, and general self-perception (Model I). Schooling, last dental visit, oral health self-perception and perception of dental treatment need were significantly associated with tooth loss in the Model II. When Model 1 and 2 were adjusted, they demonstrated that last dental visit and perception of dental treatment need were predictor variables.

CONCLUSIONS

The annual dental visit and the self-concept of dental treatment need were associated with tooth loss, demonstrating that these variables reduce the tooth loss prevalence.

[Tooth loss classification: factors associated with a new classification in an adult population group]

This study evaluated tooth loss and factors associated with a new classification, which considers not only the number of teeth lost, but also the number and position that they occupied in the mouth. In Piracicaba, State of São Paulo, Brazil, 248 adults (20-64 year-olds) were examined using a household probability sample. The oral examinations followed the WHO criteria for caries and periodontal disease. Socioeconomic, demographic and dental service use data were collected. The tooth loss outcome, based on tooth position and number of missing teeth, was analyzed by hierarchical multinomial logistic regression using a conceptual model. The mean number of missing teeth was 8.52 (DP = 9.24). For those who had lost up to 12 posterior teeth, age (PR = 1.1) and low social class (PR = 2.6) were significant; for those who lost up to 12 including anterior teeth, age (PR = 1.1) and clinical attachment loss>4mm (PR = 2.9); and for tooth loss in excess of 13 teeth, age (PR = 1.3), low social class (PR = 3.8), and visiting a dentist due to emergency (PR = 9.4) were significant. Age was associated with tooth loss. The classification made it possible to differentiate variables in accordance with position or the number of teeth lost.

[Prospective study on tooth loss in a cohort of dentate elderly]

The aim of this study was to assess factors associated with tooth loss in elderly 60 years or older during a four-year observation period. A representative cohort of dentate elderly from the city of São Paulo, Brazil, participated in the study. The outcome was teeth loss incidence from 2006 to 2010. Demographic and socioeconomic characteristics, health services access and use, behavior, reported diseases, cognitive status, functional status, state of dentition, and use of dental prosthesis were recorded as independent variables in 2006 and the outcome was measured in 2010. Negative binomial regression models were used. Participation included 440 dentate elderly. Increased likelihood of tooth loss was associated with use of two removable prostheses (RR = 1.57; 95%CI: 1.02-2.41), fair self-rated oral health (RR = 1.62; 95%CI: 1.11-2.36), bad/very bad self-rated oral health (RR = 1.87; 95%CI: 1.11-3.17), male gender (RR = 1.74; 95%CI: 1.28-2.37), and living alone (RR = 2.03; 95%CI: 1.11-3.72).

Impact of tooth loss related to number and position on oral health quality of life among adults

Background

The objective of this study was to evaluate the impact of tooth loss on oral health-related quality of life (OHRQoL) in adults with emphasis on the number of teeth lost and their relative position in the mouth.

Methods

The study population was a cross-sectional household probability sample of 248, representing 149,635 20–64 year-old residents in Piracicaba-SP, Brazil. OHRQoL was measured using the OHIP-14. Socioeconomic, demographic, health literacy, dental services use data and clinical variables were collected. Oral examinations were performed using WHO criteria for caries diagnosis, using the DMFT index; that is, the sum of decayed, missing and filled teeth (DMFT). An ordinal scale for tooth loss, based on position and number of missing teeth, was the main explanatory variable. The total OHIP score was the outcome for negative binomial regression and OHIP prevalence was the outcome for logistic regression at 5% level. A hierarchical modeling approach was adopted according to conceptual model.

Results

OHIP score was 10.21 (SE 1.16) with 48.1% (n=115) reporting one or more impacts fairly/very often (OHIP prevalence). Significant prevalence rate ratios (PRRs) for OHIP severity were observed for those who had lost up to 12 teeth, including one or more anterior teeth (PRR=1.63, 95%CI 1.06–2.51), those who had lost 13–31 teeth (PRR=2.33, 95%CI 1.49–3.63), and the edentulous (PRR=2.66, 95%CI 1.55–4.57) compared with fully dentate adults. Other significant indicators included those who only sought dental care because of dental pain (PRR=1.67, 95%CI 1.11–2.51) or dental needs (PRR=1.84, 95%CI 1.24–2.71) and having untreated caries (PRR=1.57 95%CI 1.09–2.26). Tooth loss was not significantly associated with OHIP prevalence; instead using dental services due to dental pain (PR=2.43, 95%CI 1.01–5.82), having untreated caries (PR=3.96, 95%CI 1.85–8.51) and low income (PR=2.80, 95%CI 1.26–6.42) were significant risk indicators for reporting OHIP prevalence.

Conclusion

Our analyses showed OHRQoL gradients consistent with the number and position of teeth missing due to oral disease. These findings suggest that the quantity of teeth lost does not necessarily reflect the impact of tooth mortality on OHRQoL and that future studies should take this into consideration.

The neolithic demographic transition and oral health: The Southeast Asian experience

The purpose of this article is to present new oral health data from Neolithic An Son, southern Vietnam, in the context of (1) a reassessment of published data on other Neolithic, Bronze, and Iron Age Southeast Asian dental series, and (2) predictions of the Neolithic Demographic Transition (NDT). To this end, frequencies for three oral conditions (caries, antemortem tooth loss, and alveolar lesions) were investigated for seven Southeast Asian adult dental series from Thailand and Vietnam with respect to time period, age-at-death and sex. A clear pattern of elevated rates for oral disease in the Neolithic followed by a marked improvement in oral health during the Bronze and Iron Ages was observed. Moreover, rates of caries and antemortem tooth loss for females were almost without exception higher than that for males in all samples. The consensus view among Southeast Asian bioarchaeologists that oral health did not decline with the adoption/intensification of agriculture in Southeast Asia, can no longer be supported. In light of evidence for (1) the low cariogenicity of rice; (2) the physiological predisposition of females (particularly when pregnant) to poorer oral health; and (3) health predictions of the NDT model with respect to elevated levels of fertility, the most plausible chief explanation for the observed patterns in oral health in Southeast Asia is increased levels of fertility during the Neolithic, followed by a decline in fertility during the subsequent Bronze and Iron Ages.

Risk indicators for tooth loss in adult workers

Tooth loss continues to be a prevalent condition in Brazilian adults and elderly individuals. The aim of this cross-sectional study, conducted among workers in a wholesale grocery chain in the State of São Paulo, was to identify risk indicators for tooth loss in adults. The presence of caries and periodontal status were examined in 387 adults aged 20-64 years, according to World Health Organization criteria. Two outcomes were analyzed: loss of one or more teeth, and loss of four or more teeth. Independent variables analyzed were demographic and socioeconomic factors, clinical conditions, use of dental services, and self-perceived oral health. Poisson regression models were used for multivariate statistical analysis. Participants were missing a mean of 5.38 teeth, and 76.9% (n = 297) had lost at least one tooth; the most frequently lost teeth were permanent molars. Older age and the presence of visible dental biofilm were associated significantly with the two tooth loss outcomes (p < 0.05). Individuals who had visited the dentist 3 or more years previously showed a lower prevalence of tooth loss (prevalence ratio = 0.79; 95% confidence interval, 0.68-0.91). Those with lower household incomes were significantly more likely to have lost four or more teeth (prevalence ratio = 1.35; 95% confidence interval, 1.07-1.70). Study results indicated that age and dental biofilm were risk indicators for tooth loss, independently of socioeconomic factors. These risk indicators should be considered when planning oral health programs for adults.

Gender differences in oral health in South Asia: metadata imply multifactorial biological and cultural causes

OBJECTS

This study was designed to examine the magnitude and etiology of gender differences in oral health. South Asia was selected for study because sex differences in caries rates exist in prehistory here, great cultural diversity provides context, and clinical reports document caries by gender.

METHODS

A literature survey yielded extensive data on caries rates in India, Nepal, Bangladesh, and Sri Lanka. The percentage of individuals with caries (prevalence) and the mean number of decayed, missing, and filled teeth (experience) comprise the data. Statistical tests for gender differences come from published sources or were independently computed.

RESULTS

Higher caries rates were found more often among females than males. The data show that: (a) in male children caries rates are greater than, or equal to, female rates, (b) the gender bias reverses (F > M caries rates) from adolescence through the reproductive years, (c) mature adults typically exhibit significant differences, with higher caries rates in females, (d) a male gender bias in adults is rare, and (e) though some studies find no significant gender difference in caries, a female bias dominates. Tooth loss is also greater in women than men and often results from caries (vs. periodontal disease).

CONCLUSIONS

The gender gap in oral health exists in South Asia and results from genetic, hormonal, and cultural influences. Three cultural factors contribute to this gender gap South Asia: (a) the relative value of sons and daughters, (b) frequent fasting among Hindu women, and (c) the belief that dietary restrictions result in easier childbirth.

Sex differences in dental caries experience: clinical evidence, complex etiology

A sex difference in oral health has been widely documented through time and across cultures. Women's oral health declines more rapidly than men's with the onset of agriculture and the associated rise in fertility. The magnitude of this disparity in oral health by sex increases during ontogeny: from childhood, to adolescence, and through the reproductive years. Representative studies of sex differences in caries, tooth loss, and periodontal disease are critically reviewed. Surveys conducted in Hungary, India, and in an isolated traditional Brazilian sample provide additional support for a significant sex bias in dental caries, especially in mature adults. Compounding hormonal and reproductive factors, the sex difference in oral health in India appears to involve social and religious causes such as son preference, ritual fasting, and dietary restrictions during pregnancy. Like the sex difference in caries, tooth loss in women is greater than in men and has been linked to caries and parity. Results of genome wide association studies have found caries susceptible and caries protective loci that influence variation in taste, saliva, and enamel proteins, affecting the oral environment and the micro-structure of enamel. Genetic variation, some of which is X-linked, may partly explain how sex differences in oral health originate. A primary, but neglected, factor in explaining the sex differential in oral health is the complex and synergistic changes associated with female sex hormones, pregnancy, and women's reproductive life history. Caries etiology is complex and impacts understanding of the sex difference in oral health. Both biological (genetics, hormones, and reproductive history) and anthropological (behavioral) factors such culture-based division of labor and gender-based dietary preferences play a role.