Social inequality in tooth loss, the mediating role of smoking and alcohol consumption

Abstract

Objectives:The objective of the study was to investigate the mediated proportion of smoking and alcohol consumption in the association between education and tooth loss. Further, the objective was, on the additive scale, to decompose the total effect of education on tooth loss into the direct effect of education, the natural indirect effect through smoking and alcohol consumption (differential exposure) and the mediated interaction between education, smoking and alcohol consumption on tooth loss (differential susceptibility). Methods:The study was based on data from the Social Inequality in Cancer Cohort (SIC); a cohort constructed by seven pooled cohorts. The total study population comprised of 34 975 participants. With the use of natural effects models, we regarded smoking and alcohol consumption as intermediates; we investigated the role of smoking and alcohol consumption in mediating the effect of education on tooth loss. Results:In total, 4924 participants had tooth loss defined as <15 teeth present. The results of the analyses, on the additive scale, showed 1202 (95% CI: 623-1781) additional persons with tooth loss per 10 000 persons among low compared to highly educated men. Among women, the analyses showed 1159 (95% CI: 959-1359) additional persons with tooth loss per 10 000 persons. The results, on the relative scale, showed that 11% (95% CI: 8%-15%) of the social inequality in tooth loss was

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

“…This concept was expressed as the average number of teeth per capita (23.4 SD2.6 vs. 26.7 SD 1.1, p < 0.01; 36,506 participants) [ 151 , 152 ], as the average difference in number of teeth (MD −0.279 [−3.48 to −2.10] p < 0.05; 5084 participants) [ 153 ] and, in addiction, as the probability of having a reduced number of teeth in terms of mean ratio (MR 0.93 [0.93–0.94], p < 0.001; 9564 participants) [ 154 ] or risk ratio (RR0.79 [95% CI 0.75–0.83], p < 0.05) [ 155 ]. The prevalence of severe tooth loss (<10 remaining teeth) also appeared to be conditioned by a low level of education, with similar scores in both men (OR 2.71 [95% CI 2.27–3.24], p < 0.001) and women (OR 3.00 [95% CI 2.31–3.90], p < 0.001) as reported in a study involving 34,975 participants [ 156 ].…”

Early‐life course factors and oral health among young Norwegian adults

“…By contrast, Celeste et al, 29 revealed that a minor amount of 1.4% of ethnic disparity in tooth loss was explained by the combination of dental visits, marital status and alcohol consumption. Using natural effect models in a recent Danish study, Hac et al 30 showed that smoking and alcohol consumption explained about 11% and 26% of social inequality in tooth loss among adult men and women,…”

“…10,18,26 Moreover, studies have started to investigate the role of behaviours in explaining associations between oral health and early-life circumstances using various statistical methods, such as change-in-estimate regression models, structural equation modelling (SEM) and counterfactual models. 7,9,[27][28][29][30] Little is known, however, as to how unpleasant experience with dental care during childhood is associated with tooth loss and poor oral quality of life in younger adulthood.…”

Bidirectional Association between Tooth Loss and Hypertension: A Systematic Review and Meta-analysis

“…People with high income level tend to care more about their oral health which might reduce the incidence of tooth loss. Besides, the dietary patterns, smoking and alcohol consumption were all related to the oral health [44,45] . All of these might contribute to the different results of the association between hypertension and incidence of tooth loss.…”