Socioeconomic and behavioral factors
Early establishment of good oral hygiene and dietary habits and regular use of fluoride toothpaste are of utmost importance. Several studies in infants and toddlers have clearly shown that such habits, as well as dental status, are strongly correlated to the parents’ social class (particularly educational level), dental status, regularity of dental care (particularly preventive programs), and ethnic background (immigrants).
Organized oral health education programs at maternal and child welfare centers are therefore important strategies for reducing such inequalities. In particular, especially disadvantaged parents, such as some immigrant groups, should be identified and offered special oral health promotion programs tailored to their ethnic background, language, culture, dietary customs, oral hygiene habits, and educational level. It has also been shown that the socioeconomic and educational level of the parents is much more significantly related to caries incidence in children than, for example, the frequency of intake of sugar-containing products. On the other hand, health-related behavior that influences dental caries development, eg, dietary, oral hygiene and dental care habits, and the use of fluorides, is strongly correlated to parental socioeconomic class and particularly to educational level. Prediction of caries risk in early childhood and in schoolchildren might therefore be improved by combining data on behavioral and social factors with clinical examination, rather than analysis of behavioral or parental social variables only.
Social class, oral hygiene and dietary habits, and the use of fluorides are the variables conventionally related to caries prevalence. However, many other social and behavioral variables may also influence oral health status. The role of parental educational level on children’s dental health status has already been discussed. Even more important is the role of educational level on oral health status in the adult population. Generally, the trend in the industrialized countries is toward an acceleration in the percentage of well-educated adults, particularly among 20 to 50
year olds. There is increasing exposure to information and education about self-care, self-diagnosis, and so on from departments of health, oral health personnel, the media, and others. Such conditions favor a positive outcome for oral health promotion and a consequent improvement in oral health status in all age groups.
Other behavioral factors that have also been shown to correlate with oral health status are socalled lifestyle behaviors, such as smoking habits, regular or irregular exercise, and a vegetarian diet.
Conflicting results have been reported from studies of caries in mentally and physically handicapped people: Although prevalence is often no greater and sometimes lower than in normal children or adults, more of the caries present in handicapped people remains untreated, and more teeth are extracted. For mentally retarded children, the most important determinant of caries risk is the poor standard of oral hygiene. A mental or physical handicap does not in itself seem to be a predictor of high risk, but handicapped people need special care, and this is not always as
readily available as is routine care for the nonhandicapped population.
Multivariate predictive methods are superior to single analysis of any social and
behavioral variables. Models that include not only sociologic and behavioral but also
clinical variables are superior to those based only on sociologic or epidemiologic
variables. However, despite the relatively high sensitivity and specificity of models,
few studies have analyzed their practical application.
The decision to initiate high-risk programs is not merely an academic question: the
impact, politically and philosophically, is of far greater consequence. If a philosophy
of equality in resource allocation prevails, equality in health may never be achieved.
The high-risk strategy will probably require unequal allocation of resources to achieve
equality in health. It is hoped that application of current knowledge and the results of
ongoing research about prediction of risk groups and risk individuals will help to
advance equality in health. It is, however, more difficult to predict caries risk at that
individual level than to identify groups in the population at high caries risk. Social
and behavioral markers, although not perfect, are the best available markers for
identification of groups but less satisfactory at the individual level. Based on current
knowledge of dental disease patterns, public dental health strategies should
specifically target those in need, rather than the whole population, irrespective of
need.
