Which life course model better explains the association between socioeconomic position and periodontal health?

Association between periodontal health and trait anxiety in Egyptian women: A cross-sectional study

OBJECTIVES

This study explored the relationship between periodontal problems and trait anxiety in a sample of Egyptian women.

MATERIALS AND METHODS

The Egyptian validated Arabic version of the State-Trait Anxiety Inventory-Trait subscale was used to measure levels of trait anxiety, and the periodontal health status of 451 Egyptian women was assessed using the Community Periodontal Index. Data were also collected on potential covariates such as age, educational level, marital status, parity, smoking, and oral healthcare-seeking behavior. Multivariate logistic regression analysis was done to evaluate the association between periodontal diseases and trait anxiety.

RESULTS

Among study participants, and after adjusting for some of the potential confounders, trait anxiety exhibited weak association with periodontal diseases (OR: 1.11; 95% CI= 1.07, 1.14; p <0.001). Also, old age (OR: 1.12; 95% CI = 1.07, 1.17; p < 0.001) as well as parity (OR: 7.26; 95% CI = 2.89, 18.27; p <0.001) were significantly associated with periodontal problems in the adjusted model.

CONCLUSION

While the study findings may implicate that personality traits, such as trait anxiety, could be linked to periodontal diseases more research is warranted to confirm or reject this association.

Contribution of individual and cumulative social determinants of health underlying gender disparities in periodontitis in a representative US population: A cross-sectional NHANES study

AIM

To examine the impact of both individual and cumulative social determinants of health (SDoH) on the likelihood of developing periodontitis, while also exploring any gender disparities in this relationship.

MATERIALS AND METHODS

Data of self-reported SDoH domains and sub-items based on Healthy People 2030 were obtained from the U.S. National Health and Nutrition Examination Surveys between 1999 and 2014. Logistic regression models, weighted by survey responses, were used to examine the relationship between SDoH (including eight sub-items and the cumulative number of unfavourable SDoH) and periodontitis. The results were further analysed by gender.

RESULTS

A total of 18,075 participants (8867 males and 9208 females) were included in the main analysis, of which 5814 (32.2%) had periodontitis. The study found that certain unfavourable SDoH were individually associated with higher odds of periodontitis, and the cumulative number of unfavourable SDoH was positively linked to the odds of developing periodontitis. Furthermore, males exposed to more unfavourable SDoH appeared to be more susceptible to developing periodontitis than females.

CONCLUSIONS

The findings suggest that unfavourable SDoH, especially when they accumulate, are associated with an increased odds of periodontitis and contribute to gender disparities within the U.S.

POPULATION

Relations between periodontal status, oral health-related quality of life and perceived oral health and oral health consciousness levels in a Turkish population

OBJECTIVES

This study aimed to evaluate the interrelationship of periodontal status, socio-demographic characteristics, perceived oral health and oral health consciousness levels as well as the impact of these factors on quality of life using a questionnaire and the Oral Health Impact Profile-14(OHIP-14) scale.

METHODS

Seven hundred and fifty systemically healthy individuals aged ≥18 years referred to a Periodontology Department were included in the study. The OHIP-14 scale and survey were applied to identify socio-demographic characteristics, oral hygiene characteristics, perceived oral health and oral hygiene consciousness levels. Three groups were established based on periodontal status (periodontally healthy [H], gingivitis [G] and periodontitis [P]) determined using periodontal indexes, and the relationship between the above-mentioned factors and periodontal status with quality of life was assessed.

RESULTS

Oral health-related quality of life differed significantly by gender, marital status, education level, oral hygiene habits and periodontal status. A statistically significant positive relationship was found between high OHIP-14 scores and unfavourable socio-demographic characteristics, increased severity of periodontal disease, and irregular dental care practices. The perceived oral health and oral health consciousness levels significantly differed due to periodontal status.

CONCLUSION

Periodontal status, gender, marital status, education level, dental care practices, perceived oral health and oral hygiene consciousness levels are important determinants of oral health-related quality of life (Clinical Trial No. NCT03549247).

Childhood socioeconomic circumstances, social status, and health in older age: Are they related in China?

It is well known that in western countries, people with disadvantaged socioeconomic circumstances during childhood are at a significantly higher risk of ill health in older age. This study further questions whether in China, individuals' different childhood socioeconomic circumstances and social status continue to affect their life-long health. Furthermore, do later-life socioeconomic circumstances affect health so that childhood conditions no longer play a significant role? The influence of social mobility and accumulation was also tested. The analysis was based on the China Health and Retirement Longitudinal Study (CHARLS) 2013 and CHARLS life history survey. Health outcomes were measured based on self-reported health, disability for activities of daily life, depression symptoms, and cognitive impairment. In addition to measurements of childhood, the analysis included current socioeconomic circumstances, current health behaviors, and demographic characteristics. Using ordered logit or logit and Ordinary Least Square (OLS) regression models, the study shows the existence of the association between childhood conditions and later health in China. After adjusting for current socioeconomic circumstances, social status was no longer related to later health. However, childhood socioeconomic circumstances still significantly influenced health at a later age. Advantaged socioeconomic circumstances in the life course (high stability) provided the best protection for later health. However, moving downward-that is, experiencing childhood socioeconomic advantage but later-life socioeconomic disadvantage-was the most detrimental to later health. Overall, this study provides new evidence from China to support the notion that health in older age is related to dynamic processes structured by the social stratification system. Thus, this study emphasizes an integrated health policy based on the premise of maximizing health over the entire life course.

Socioeconomic disadvantage across the life-course and oral health in older age: findings from a longitudinal study of older British men

Background

The influence of life-course socioeconomic disadvantage on oral health at older ages is not well-established. We examined the influence of socioeconomic factors in childhood, middle-age and older age on oral health at older ages, and tested conceptual life-course models (sensitive period, accumulation of risk, social mobility) to determine which best described observed associations.

Methods

A representative cohort of British men aged 71-92 in 2010-12 included socioeconomic factors in childhood, middle-age and older age. Oral health assessment at 71-92 years (n = 1622) included tooth count, periodontal disease and self-rated oral health (excellent/good, fair/poor) (n = 2147). Life-course models (adjusted for age and town of residence) were compared with a saturated model using Likelihood-ratio tests.

Results

Socioeconomic disadvantage in childhood, middle-age and older age was associated with complete tooth loss at 71-92 years-age and town adjusted odds ratios (95% CI) were 1.39 (1.02-1.90), 2.26 (1.70-3.01), 1.83 (1.35-2.49), respectively. Socioeconomic disadvantage in childhood and middle-age was associated with poor self-rated oral health; adjusted odds ratios (95% CI) were 1.48 (1.19-1.85) and 1.45 (1.18-1.78), respectively. A sensitive period for socioeconomic disadvantage in middle-age provided the best model fit for tooth loss, while accumulation of risk model was the strongest for poor self-rated oral health. None of the life-course models were significant for periodontal disease measures.

Conclusion

Socioeconomic disadvantage in middle-age has a particularly strong influence on tooth loss in older age. Poor self-rated oral health in older age is influenced by socioeconomic disadvantage across the life-course. Addressing socioeconomic factors in middle and older ages are likely to be important for better oral health in later life.

A public health perspective on personalized periodontics

In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk-assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio-economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach.

Marginal bone level in two Danish cross-sectional population samples in 1997-1998 and 2007-2008

OBJECTIVE

The aim of this study was to compare the marginal bone level of two randomly selected population samples from 1997/1998 and 2007/2008, with special emphasis on the role of smoking habits and gender.

MATERIALS AND METHODS

Two cross-sectional randomly selected population samples [1997/1998 (N = 616) and 2007/2008 (N = 396)] were analysed with respect to the marginal bone level. The marginal bone level was measured in full-mouth intraoral radiographs. Information on smoking was gathered using questionnaires. Multiple regression analysis was used in order to adjust for correlating factors (gender, age, smoking habits and number of teeth).

RESULTS

After adjusting for confounding factors, the population sample from 2007/2008 had on average a slightly, but statistically significantly, more reduced average marginal bone level (0.15 mm) than the population sample from 1997/1998. Men had more reduced marginal bone level than women (0.12 mm). Smokers in both population samples had more reduced marginal bone level than non-smokers (0.39 mm and 0.12 mm for 1997/1998; 0.65 mm and 0.16 mm for 2007/2008).

CONCLUSIONS

In these populations, sampled 10 years apart, the 2007/2008 population sample had a slightly more reduced marginal bone level than the 1997/1998 population sample. Men had more reduced marginal bone level than women, and smoking is considered a major risk factor for a reduced marginal bone level.