Influence of social and behavioral variables

29-03-2010
Influence of social and behavioral variables
As discussed earlier in this chapter, the development of dental caries is a complex interaction of etiologic factors and many modifying risk and protective factors. Social factors influence behavior directly related to dental caries, such as oral hygiene, dietary habits, and dental care habits. Besides the influence of social and sociobehavioral factors on, and interaction with, sugar intake, one behavior in particular influences the caries-promoting effect of sugar intake, namely oral hygiene. 
 
It is generally accepted that caries occurs only after plaque has accumulated on susceptible tooth surfaces in individuals who eat sugar frequently. 
 
One reason for the difficulty in proving the direct relationship between oral cleanliness and dental caries in point prevalence surveys, as well as in longitudinal retrospective or even prospective studies, is the complex interaction of a number of factors. Several studies have shown an interaction between sugar intake and oral cleanliness. Kleemola-Kujala and Rasanen (1982) found, in a study of 543 Finnish children, a significant relationship between the amount of plaque and dental caries at all levels of sugar consumption. With increasing total sugar consumption, the risk of caries increased significantly only when oral hygiene was also poor. Further analysis showed that the effect estimates for the two factors in combination were always greater than the sums of the separate effects, indicating a synergistic interaction between the two caries determinants.
 
Granath et al (1976) also found an interaction between oral hygiene and dietary habits, but the significance was low in individuals with low caries prevalence. Rajala et al (1980) found, in a study of male adults, that caries experience was consistently higher for sporadic toothbrushers. Their findings indicated that the positive association between reported daily toothbrushing and low caries experience may be more pronounced in groups with higher overall risk status, for example, in the strata where education and income are low, frequency of dental visits is irregular, use of
sucrose is high, and fluoride exposure is low.
 
However, in a well-controlled longitudinal 3-year study in 12-year-old Brazilians, it was recently shown that oral hygiene habits could be improved, and caries incidence thereby reduced by more than 50%, even though test and control subjects all lived in an area with fluoridated water and were supplied with fluoride toothpaste once a month (Axelsson et al, 1994). 
 
In most of the aforementioned, the most commonly investigated social factor related to dental caries is social class or socioeconomic status, and the most commonly studied behavioral factors are oral hygiene or dietary habits. This is not surprising, because diet and oral hygiene are the factors most obviously and directly related to caries development. Socioeconomic status also has been recognized for years as one of the main factors influencing equality, or rather inequality, in both general and dental health. Because few studies have addressed the question, little is known of the caries-predictive value of other social and behavioral factors. 
 
However, there is some indirect evidence of a relationship with other social and
behavioral factors. In a major questionnaire survey in Scotland, toothbrushing was
studied in relation to a number of other health-related behaviors in 4,935 11, 13, and
15 year olds (Schou et al, 1990). Toothbrushing was shown to be significantly related
to the subjects’ health perception, smoking habits, alcohol consumption, breakfast
habits, bedtime, sweet consumption, fruit consumption, and video watching. The
minority of children who reported low toothbrushing frequency also reported
unfavorable behavior in all the other areas.
Awareness that many health-related behaviors may interact with each other and with
other environmental factors to determine individual health outcome has led to the socalled
lifestyle approach in health promotion. Dental health factors are seldom
included in analyses of the influence of lifestyle factors on health, and conversely, a
person’s lifestyle is seldom taken into account in studies of determinants and
predictors of dental health. In recent analytic epidemiologic studies in adults we found
higher caries prevalence in 35- and 50-year-old smokers than nonsmokers (Axelsson
et al, 1998). In another randomized study in almost 600 50 to 55 year olds, we found
that subjects who seldom or never exercised had significantly greater tooth loss than
those who exercised regularly (Axelsson and Paulander, 1994).
The role of social class and educational level of the parents in the dental status of
young children has already been discussed. In a randomized analytic epidemiologic
study in 35, 50, 65, and 75 year olds in the county of Varmland, Sweden, one of the
factors evaluated was the relationship between dental status and educational level.
The following clinical data were collected: the percentage of edentulous subjects, the
number of remaining teeth, masticatory function according to the modified Eichner
Index, prevalence of removable and fixed prostheses, probing attachment level,
furcation involvement, Community Periodontal Index of Treatment Needs, caries
prevalence (decayed, missing, or filled surfaces and root caries), prevalence of
endodontics and apical periodontitis, oral mucosal lesions, and Plaque Index (O’Leary
et al, 1972). The subjects also filled in a questionnaire about educational level, other
socioeconomic conditions, diseases, use of drugs, body mass index, dental care, and
oral hygiene and dietary habits. For evaluation of educational level, the subjects were
randomized into elementary school level (low) and more than elementary school level
(high) (Axelsson et al, 1990).
Figure 75, from the data collected in 1988, shows the percentage of subjects with low
and high educational levels in the four age groups. Among 35 year olds only, 22%
had a low level of education, in contrast to 69% and 72% among the 65 and 75 year
olds, respectively. However, today almost all 35 year olds are educated to
matriculation or tertiary level. For the last 20 years, Sweden has had compulsory
education to the end of secondary school (at least 12 to 14 years of education). It is
also estimated that, of the current 50 year olds, only 25% have low educational levels,
because of the continuous improvement in every cohort of age groups, and the
availability of adult education programs.
Figure 76 illustrates the dental care habits among all the subjects related to
educational level: Irregular dental attendance is much more common among subjects
with low educational levels (82.5%) than among those with higher education (17.5%).
Figure 77, from the 1988 data, shows the percentage of edentulous subjects in the four
age groups in relation to educational level: Among the well-educated subjects, except
the 75 year olds, edentulousness was extremely rare. However, the percentage of
edentulousness has declined dramatically, even among those with lower educational
standards. This can be attributed mainly to changes in indications for extraction of
teeth and the introduction in 1973 of a national dental insurance scheme that covers
all residents of Sweden. Figure 78 shows the mean numbers of teeth (excluding third
molars) in persons with low and high educational levels.
Figure 79 shows the percentage of sound and decayed, missing, or filled surfaces in
50 year olds in relation to elementary school (low), secondary school (middle), or
tertiary (high) educational level. Subjects with higher levels of education have a
greater percentage of intact surfaces and a lower percentage of missing surfaces than
do those with less education. However, the percentage of carious surfaces is almost
negligible, indicating that the available resources for provision of dental care are
adequate, at least with respect to treatment of caries.
The results of this large-scale, analytic, cross-sectional study show that low
educational level is a very significant risk indicator for tooth loss, dental caries, and
periodontal diseases, not necessarily because highly educated people are more
intelligent or wealthier. (In Sweden, there are very limited differences in net income,
after tax, between occupational categories such as poorly educated laborers and welleducated
teachers.) The difference in dental health status is attributable to the fact that
highly educated people know how to learn from written information, to seek
information about health promotion, and to apply theoretical information, for
example, to self-care.
Views: 1123 | Comments: 4 Send reply
 
Comments
Гость:
Works well! It is not obvious, toughh. Will new users know to click on the yellow bubble or time stamp?Within the thread itself, perhaps you can put the same yellow bubble next to the title of the thread to keep things consistent? Maybe a yellow bubble with a down arrow?

Гость:
To me nothing is more frtiarutsng than not having enough time to educate my patients! At the end of my already too-short appt, I ask if patients have any questions and panic when they say yes! That means I’m going to be even further behind to do what should already be included in each appointment. I can’t wait until ADHP comes to my state. I would love to start my own business going to care facilities, schools, medical offices, ect., to provide people with the education they deserve.

Гость:
I work in one office where 1 hour is aloewld for all recall aptients. This is great in case a patient is a few minutes late or extra time is needed for perio charting ,explaining treatments,oral hygiene instructions.This helps create a more relaxed appontment time ,since you are not always rushing.

Гость:
I tell my patients their mouth is the widonw to their soul. What goes in your mouth goes in your whole body. Hundreds of bacteria live in your mouth and when your gums bleed they go into your system and to all your vital organs. http://trnqriwlr.com [url=http://rbwzzriu.com]rbwzzriu[/url] [link=http://gaxlhx.com]gaxlhx[/link]

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Articles for theme “caries”:
Influence of socioeconomic status – Social class
29-03-2010
Influence of socioeconomic statusSocial classThe relationship between parents’ social status and children’s dental health has been demonstrated in numerous studies. Many studies in Western industrialized countries have also shown a relationship between on the one hand, the parents’ dental health status, dental knowledge, and dental care habits and on the other, the prevalence and incidence of dental caries in their children (Martinsson, 1973; Martinsson and Petersson, 1972).
Role of Socioeconomic and Behavioral Factors – Introduction
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Role of Socioeconomic and Behavioral FactorsIntroductionAt group and population level, socioeconomic factors, particularly educational levels, are emerging as the most important external factors related to dental caries today. History has clearly shown a relationship between social characteristics and dental disease patterns and, in particular, how social changes have influenced those patterns.  Wartime, urbanization, and industrialization, to mention a few, have affected caries prevalence.
Influence of other risk factors on diet-related caries – Certain conditions may predispose people to risk for diet-related dental caries.
29-03-2010
Influence of other risk factors on diet-related cariesCertain conditions may predispose people to risk for diet-related dental caries. Systemic diseases and regular medication may affect caries risk. The disease or medication per se might increase caries risk, but sometimes the increased risk is related to treatment. The increased need for energy and nutrients during a disease episode is often not met, and the patient may be undernourished. Intake of medicines containing sucrose must be noted, eg, fiber supplements for constipation, cough mixtures, and antibiotics.
Dietary recommendations for general health promotion General recommendations
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Dietary recommendations for general health promotionGeneral recommendationsGeneral guidelines for energy and nutrient intake are given in the Nordic recommendations from 1989, and in recommendations specific for each Scandinavian country. They give age- and sex-specific recommendations for daily energy and nutrient intake as well as minimal daily required amounts for healthy individuals older than 3 years. It is recommended that energy intake be at a level that does not cause obesity and that there be five or six daily intakes of food at even intervals throughout the day.
Evaluation of dietary factors
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Evaluation of dietary factorsThe human longitudinal studies described earlier showed that, in individuals with little or no plaque control and no use of fluoride, frequent intake of sugar-containing products is a significant risk factor or prognostic risk factor for dental caries. In addition, in vivo plaque pH measurements have shown that the drop in pH and sugar clearance time in undisturbed plaque (more than 2 days old) is related to the sugar concentration and consistency of the food item being evaluated (see Figs 63, 64, 65, 66, 67, 68, and 69).
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