The influence of living conditions and individual behaviors on the oral‐systemic disease connection: a cross‐sectional analysis

Abstract

Objectives: To determine the extent to which living conditions and individual behaviors influence the association between oral health status and systemic disease outcomes in Ontario, Canada's most populated province. Methods: A secondary data analysis of Ontario data from the Canadian Community. Health Survey 2013/14 was undertaken. Separate analyses were conducted for participants aged 35-59 years (n = 11,858) and 60+ years (n = 11,273). A series of regression models were constructed to examine the association between self-reported oral health status and systemic disease outcomes (arthritis, diabetes, hypertension, heart disease, chronic obstructive pulmonary disease, and stroke). Models were adjusted by proxies of living conditions (income, education, ethnicity, country of birth, employment, and food security) and individual behaviors (smoking status, alcohol use, tooth brushing, life stress, physical activity, sense of belonging). Percent attenuation between models was calculated to determine the extent of the living conditionbehavior impact. Results: In both age groups, the prevalence of arthritis and high blood pressure was the highest, followed by heart disease. There was variation in percent attenuation by age group and outcome. Among participants aged 35-59 years, living conditions had a greater impact on the oral-systemic relationship, while individual behaviors played a greater role in this association among adults aged 60+ years. Conclusion:There is an association between oral and systemic diseases; however, after accounting for living conditions and individual behaviors, this relationship was attenuated. This highlights the need to address upstream and midstream factors that are common to oral and systemic conditions.

Social and economic capital as effect modifiers of the association between psychosocial stress and oral health

“…Effect measure modification showed an additive effect of indicators of social capital on the perceived life stress-oral health relationship. This effect was evident across all three age groups (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59), 60-74 yrs), with the highest attributable proportion of social and economic capital indicators in the psychosocial stress-oral health relationship in older adults (60-74 yrs).…”

“…Low economic capital may exacerbate a multitude of health barriers related to oral health. For example, individuals with low economic capital may experience: (1) worse access to adequate dental care due to unemployment or employment in a position with poor health benefits [53]; (2) greater chronic stress and stresscoping behaviours that are more damaging to oral health (e.g., tobacco use, alcohol use, sugar consumption) [52]; and/or (3) greater risk of other chronic diseases, which may impact oral disease via the oral-systemic health link [54][55][56]. Our findings that indicators of economic capital, such as household income, dental insurance, and dwelling ownership, modify the association between psychosocial stress and oral health support the hypothesis that individuals with higher economic capital can mitigate the possible impacts of psychosocial stress on poor oral health.…”

Biopsychosocial factors in oral and systemic diseases: a scoping review

“…In total, the studies in this review involved 43,472 individuals, where the weighted mean age of participants was 60.0 years (range 17–82 years) and 45.9% were female. With regard to study design, six studies were of case-control design ( 69 , 71 – 73 , 79 , 80 ), five were cross-sectional ( 67 , 74 – 76 , 81 ), three were cohort studies ( 68 , 70 , 78 ), and one was a clinical trial including baseline data comparing darapladib, a selective oral inhibitor of lipoprotein-associated phospholipase A 2 , with placebo in patients with coronary heart disease ( 77 ). There was also variation in geographical location, with four studies conducted in North America ( 67 , 70 , 74 , 76 ), four in the Middle-East ( 68 , 73 , 79 , 80 ), two in Europe ( 69 , 71 ), three in Asia ( 72 , 75 , 81 ), one in New Zealand ( 78 ), and one multi-country study ( 77 ).…”

“…Periodontal disease was the most common oral health outcome measured, included in 53% ( n = 8) of all included studies ( 69 , 71 , 72 , 74 , 75 , 78 , 79 , 81 ). The majority of studies ( n = 12) recorded oral disease using clinical examinations or diagnosis of participants (80%) ( 67 – 75 , 78 – 80 ), while the remaining three studies assessed oral health using self-report questionnaires ( 76 , 77 , 81 ). Clinically assessed outcomes included periodontal disease ( 69 , 71 , 72 , 74 , 75 , 78 , 79 , 81 ), dental caries ( 70 , 78 , 81 ), tooth loss ( 68 , 74 , 77 , 80 ), clinical attachment loss ( 68 , 72 , 74 , 78 , 79 ), burning mouth syndrome ( 73 ), and poor oral health ( 67 , 76 , 81 ).…”

“…The majority of studies ( n = 12) recorded oral disease using clinical examinations or diagnosis of participants (80%) ( 67 – 75 , 78 – 80 ), while the remaining three studies assessed oral health using self-report questionnaires ( 76 , 77 , 81 ). Clinically assessed outcomes included periodontal disease ( 69 , 71 , 72 , 74 , 75 , 78 , 79 , 81 ), dental caries ( 70 , 78 , 81 ), tooth loss ( 68 , 74 , 77 , 80 ), clinical attachment loss ( 68 , 72 , 74 , 78 , 79 ), burning mouth syndrome ( 73 ), and poor oral health ( 67 , 76 , 81 ). Self-reported outcomes included self-reported oral health ( 67 , 76 , 81 ), tooth loss ( 77 ), and bleeding gums ( 77 ).…”