Pathways of socioeconomic inequalities in gingival bleeding among adolescents

Abstract

Objectives To explore the pathways through which the socioeconomic inequalities may influence gingival bleeding in adolescents, assessing the direct and indirect effects of material and psychosocial variables. Methods This cohort study followed a multistage, random sample of 1134 12‐year‐old adolescents from 20 public schools of Santa Maria, a city in southern Brazil. The percentage of teeth with gingival bleeding was recorded according to the Community Periodontal Index criteria (scored as healthy or bleeding) at baseline and at 2‐year follow‐up. Biological (dental plaque, caries, and dental crowding), material (socioeconomic position [SEP] operationalized as family income and parents’ education), psychosocial (parents’ religiosity, self‐rated health, and happiness) and behavioural (use of dental service by adolescents) factors were collected at baseline. Structural equation modelling (SEM) was guided by the adapted Commission on the Social Determinants of Health model linking material, psychosocial, biological, and behaviour variables to health. The SEM was employed to estimate standardized direct, indirect, and total effects of material and psychosocial factors on gingival bleeding at follow‐up. Results A total of 770 14‐year‐old adolescents were reassessed (follow‐up rate of 68%). The lower SEP at baseline had a higher direct effect (standard coefficient [SC] = −0.17, P < 0.01) than a mediated effect on percentage of teeth with gingival bleeding at 2‐year follow‐up. The lower indirect effect (SC = −0.06, P < 0.01) from SEP to gingival bleeding at follow‐up ran through biological factors—dental plaque (baseline and follow‐up) and gingival bleeding at baseline. The lower religiosity of the parents as a psychosocial aspect had only a small direct effect (SC = −0.10, P = 0.03) on gingival bleeding at follow‐up. Conclusions Material factors such as SEP contributed most to explanations on inequalities in adolescents’ periodontal health because of their higher direct effect and additional shared (indirect) effect (through biological factors) on gingival bleeding. Religious practice as a psychosocial factor only explained part of percentage of teeth with gingival bleeding at follow‐up.

The role of socioeconomic status and psychosocial factors on gingivitis in socially disadvantaged adolescents

“…Psychosocial factors have been associated with oral health‐related behaviours, and poor gingival status . The current findings are in accordance with previous research, suggesting that positive oral health beliefs and high self‐esteem are meaningful aspects related to greater oral hygiene among adolescents .…”

“…The current findings are in accordance with previous research, suggesting that positive oral health beliefs and high self‐esteem are meaningful aspects related to greater oral hygiene among adolescents . The direct effect of the religiosity, as a psychosocial condition, on gingival bleeding has been pointed out in the literature, although no indirect pathways have been identified in this association . Further, this study clarified the pathways by which psychosocial factors influence gingival status.…”

“…12 Psychosocial factors have been associated with oral healthrelated behaviours, [17][18][19] and poor gingival status. [13][14][15][16]28 The current findings are in accordance with previous research, suggesting that positive oral health beliefs and high selfesteem are meaningful aspects related to greater oral hygiene among adolescents. 17,18,29 The direct effect of the religiosity, as a psychosocial condition, on gingival bleeding has been pointed out in the literature, although no indirect pathways have been identified in this association.…”

“…17,18,29 The direct effect of the religiosity, as a psychosocial condition, on gingival bleeding has been pointed out in the literature, although no indirect pathways have been identified in this association. 28 Further, this study clarified the pathways by which psychosocial factors influence gingival status. The hypothesis that the relationship of oral health beliefs and self-esteem with gingival bleeding is mediated by toothbrushing frequency and oral hygiene effectiveness was confirmed.…”

Erosive tooth wear among South Brazilian adolescents, and its association with sociodemographic variables

“…The socioeconomic conditions in which individuals find themselves may be responsible for the greater susceptibility of some individuals to develop diseases than others. The negative influence of a poor socioeconomic background on oral health outcomes, such as dental caries 20 and gingival bleeding, 21 has been demonstrated previously. Nevertheless, the influence of socioeconomic factors on ETW has not yet been well established.…”