Evaluating the role of dental behaviour in oral health inequalities

Abstract

– Objective: The aim of this study was to describe differences in dental attendance and dental self‐care behaviour between socioeconomic groups and to investigate the extent to which the socioeconomic gradient in oral health was explained by these behaviours. Methods: We used data from a representative sample of adults in Australia, surveyed by telephone interview and by self‐complete questionnaire. The dependent variables were self‐reported missing teeth and the social impact of oral conditions evaluated with the 14‐item Oral Health Impact Profile (OHIP‐14). Socioeconomic position was measured at the small‐area level. We conducted bivariate analysis using one‐way analysis of variance and 95% confidence intervals (95% CI) and adjusted for the effect of age. After adjusting for age, dental behavioural variables were entered individually into multivariate linear regression models. Results: Data were obtained for 3678 dentate adults aged 18–91 years. Missing teeth and OHIP‐14 scores followed a social gradient with poorer adults experiencing poorer outcomes. Routine dental attendance and diligent dental self‐care were associated with inverse monotonic gradients in missing teeth (P < 0.05) and OHIP‐14 scores (P < 0.05). Although adults living in areas with the least disadvantage had a preventive dental attendance orientation, no socioeconomic pattern was found for dental self‐care. In multivariate analysis, the slope of the socioeconomic gradient [β estimate for Index of Relative Socioeconomic Disadvantage (IRSD)] in missing teeth was not significantly attenuated by either dental attendance or dental self‐care. For OHIP‐14 scores, the slope of the socioeconomic gradient was significantly attenuated by dental visiting, but not by dental self‐care and not by the combined effect of both behaviours. Conclusion: The commonly held view that the poor oral health of poor people is explained by personal neglect was not supported in this study.

Fatores associados a hábitos de saúde bucal e utilização de serviços odontológicos entre adolescentes

“…A condição sócio-econômica é um fator diretamente relacionado aos cuidados com a saúde bucal. Estudos demonstram que indivíduos pertencentes a categorias sócio-econô-micas mais elevadas escovam mais seus dentes, utilizam fio dental e serviços de saúde com maior freqüência do que os de inserção sócio-econô-mica mais baixa 21,24 . Além disso, os usuários de serviços privados têm maior probabilidade de receberem instruções de higiene bucal no consultório 25 e de terem poder aquisitivo para adquirir fio dental, o que facilitaria a adoção desse hábi-to.…”

“…O padrão de utilização dos serviços é considerado elemento importante no estudo de hábi-tos de saúde, pois está relacionado à necessidade de tratamento e ao autocuidado 29 21,24 .…”

Psychometric properties of the OHIP-14 and prevalence and severity of oral health impacts in a rural riverine population in Amazonas State, Brazil

“…Sanders et al 32 described more OHIP impacts on individuals with low frequency of visits to the dentist, when compared with individuals that visited with moderate or high frequency. Another possible explanation is the higher mean age in the population sample of Lauro Sodré.…”

Inequalities in oral health: Understanding the contributions of education and income

“…This is similar to findings by Sanders et al, who reported that although there was a significant socio-economic gradient in dental visits, those individuals of low socio-economic status were not different in their oral self-care compared to the affluent, and concluded that the root of poor oral health was more likely financial limitations than neglect of self-care. 25 The contribution of income to education gradients in health is supported by Cutler and Lleras-Muney (2010); their analyses on health surveys in the United States revealed that material resources, such as income and insurance, accounted for 30% of the effect of education on health behaviours. 26 They suggest that the combination of knowledge and availability of financial resources enables healthier lifestyle choices, especially for behaviours that involve the medical care system.…”