Explaining sex differences in dental caries prevalence: Saliva, hormones, and “life‐history” etiologies

Abstract

When dental caries rates are reported by sex, females are typically found to exhibit higher prevalence rates than males. This finding is generally true for diverse cultures with different subsistence systems and for a wide range of chronological periods. Exceptions exist, but are not common. In this paper, we present new data for sex differences in dental caries rates among the Guanches (Tenerife, Canary Islands), summarize results of meta-analyses of dental caries prevalence, and emphasize new research that stresses the critical role of female hormones and life-history events in the etiology of dental caries. Among the Guanches, corrected tooth-count caries rates for females (8.8%, 158/1,790) are approximately twice the frequency of caries among males (4.5%, 68/1,498). Higher caries prevalence among females is often explained by one of three factors: 1) earlier eruption of teeth in girls, hence longer exposure of girls' teeth to the cariogenic oral environment, 2) easier access to food supplies by women and frequent snacking during food preparation, and 3) pregnancy. Anthropologists tend to favor explanations involving behavior, including sexual division of labor and women's domestic role in food production. By contrast, the causal pathways through which pregnancy contributes to poorer oral health and higher caries rates are deemphasized or discounted. This paper presents recent research on physiological changes associated with fluctuating hormone levels during individual life histories, and the impact these changes have on the oral health of women. The biochemical composition of saliva and overall saliva flow rate are modified in several important ways by hormonal fluctuations during events such as puberty, menstruation, and pregnancy, making the oral environment significantly more cariogenic for women than for men. These results suggest that hormonal fluctuations can have a dramatic effect on the oral health of women, and constitute an important causal factor in explaining sex differences in caries rates.

Dental markers of poverty: Biocultural deliberations on oral health of the poor in mid‐nineteenth‐century Ireland

“…A higher caries frequency in female dentitions is consistent with the well‐known biological bias, relating to hormonal differences during puberty, pregnancy, and menopause in particular. Hormonal fluctuations during these periods have negative effects on the composition and flow of saliva which creates an increased risk of dental caries (Lukacs & Largaespada, 2006). …”

“…As stated above, there is a known biological bias toward higher rates of caries and tooth loss in females compared to males due to hormonal factors (Lukacs & Largaespada, 2006). The relationship between parity and a decline in oral health has also been examined but studies have yielded contrasting results (e.g., Russell, Ickovics, & Yaffee, 2010; Scheutz, Baelum, Matee, & Mwangosi, 2002).…”

Dental diseases of human skeletal remains from the early-modern period of Kumejima Island, Okinawa, Japan

“…Many biological and cultural factors may produce this sexual difference. Lukacs and Largaespada (2006) reviewed three main causative factors of the higher rates of dental caries in females: (1) earlier eruption of permanent teeth and longer life expectancy of females; (2) higher intake of carbohydrates; (3) pregnancy, menopause and other hormonal influences, suggesting that biomedical factors are more important than expected. The higher rate of older females in the early-modern Kumejima series may indicate that incidences of dental caries were influenced by adult female-specific events, such as pregnancy and menopause.…”

Sociodemographic, Socio-economic, Clinical and Behavioural Factors Modifying Experience and Prevalence of Dental Caries in the Permanent Dentition

“…In contrast, other studies have found that gender has an effect on the prevalence of caries in permanent teeth with BLR (30). Some authors attribute this, among other things, to the eruption age and the early hormonal fluctuation in girls, compared with boys (16,31). The cariogenic process seems to also be associated with economic factors, regardless of the indicator used.…”