Health-risk behaviours co-occur among adults with tooth loss.

INTRODUCTION: Health-risk behaviours tend to co-occur among the same sectors of the population. The aim of this study is to examine the association between an aggregate of multiple health-risk behaviours and tooth loss among American Adults. METHODS: We used data from the Behavioural Risk Factor Surveillance System (BRFSS) 2022, a nationally representative survey of non-institutionalized American. We included participants aged 18 years and older. An aggregate variable of health-risk behaviours which included smoking, heavy alcohol consumption, lack of physical activities, overweight/obesity, infrequent dental visits and infrequent medical check-up was created. Tooth loss was indicated by losing one tooth or more. Logistic Regression analysis was conducted to test the association between the aggregate of behaviours and tooth loss adjusting for income, education, ethnicity and health insurance. RESULTS: The analysis included 326,561 participants. The mean number of health-risk behaviours was 2.13 and 1.72 among participants with tooth loss and without tooth loss, respectively. The aggregate of health-risk behaviours was significantly associated with tooth loss with odds ratios 1.23 (95% CI, 1.21, 1.26) in a model adjusting for age, gender, education, income ethnicity and health insurance. CONCLUSION: This study demonstrated that an aggregate of health-risk behaviours, with some not directly linked to oral health, is associated with tooth loss among American adults. The study highlights the importance of considering different risk factors when planning health promotion policies to tackle oral health.

Is tooth loss associated with multiple chronic conditions?

OBJECTIVES: To examine the relationship between tooth loss and co-occurrence of multiple chronic conditions (MCC) among American adults at working age. MATERIALS AND METHODS: Data was from the Behavioural Risk Factor Surveillance System 2018, a cross-sectional telephone-based, nationally representative survey of American adults. We included participants aged 25-64 years. The survey included sociodemographic data, reported diagnosis of chronic conditions, the number of missing teeth and health behaviours. An aggregate variable of chronic conditions was created which included heart attack, angina, stroke, cancer, chronic pulmonary disease, diabetes, asthma, arthritis, depression, and kidney diseases. The association between the number of missing teeth and the aggregate of chronic conditions was assessed adjusting for confounders. RESULTS: The analysis included 202,809 participants. The mean number of MCC was 0.86 (95% Confidence Interval 'CI':0.85,0.87). Tooth loss was significantly associated with MCC with rate ratio 1.18 (95% CI:1.15,1.21), 1.53 (95% CI:1.48,1.59) and 1.62 (95% CI:1.55,1.69) for those reporting losing 1-5 teeth, 6 or more but not all, and all teeth, respectively after adjusting for demographic, socioeconomic, and behavioural factors. CONCLUSION: Tooth loss could be an early marker for the co-occurrence of multiple chronic conditions among adults of working age. The association could be attributed to common risk factors for oral and general health.

Systematic review of longitudinal studies on the association between cluster of health-related behaviors and tooth loss among adults.

OBJECTIVES: To systematically review longitudinal studies on the association between cluster of/multiple health-related behaviors and tooth loss among adults. MATERIALS AND METHODS: Inclusion criteria were prospective and retrospective longitudinal studies; adults; multiple or cluster of behaviors; tooth loss, one or more tooth lost and complete tooth loss. Exclusion criteria were intervention studies; cross-sectional studies; case-control studies; children under 18 years-old; single behavior. Two reviewers searched three databases up to April 2023. Open Grey and Google Scholar were searched for grey literature. RESULTS: Twelve longitudinal studies were included in this review. Nine studies had good quality, two had poor quality, and one had fair quality according to New-Castle-Ottawa Scale. According to ROBINS-E tool, nine studies were judged as moderate risk of bias while two studies were at low risk of bias and one study had serious risk of bias. One study assessed cluster of behavior, while others examined a number of separate health-related behaviors in relation to tooth loss. Meta-analysis was not feasible because of the high heterogeneity in exposure, measure of outcomes, covariates, sample size, and follow-up time. The research found an association between tooth loss and oral hygiene practices (two studies), dental attendance (four studies), smoking (six studies), and alcohol consumption (three studies). CONCLUSION: This review provides evidence of a longitudinal association between cluster of/multiple health related-behaviors and tooth loss.

Association of dental caries with use of internet and social media among 12 and 15-year-olds.

OBJECTIVES: To investigate the association of dental caries with use of internet and social media to gain information on oral health and to evaluate the impact of this practice on oral health inequalities among 12 and 15-year-olds. METHODS: Data from the Children's Dental Health Survey (CDHS) 2013, England Wales and Northern Ireland were used. The survey included sociodemographic, health behaviours, use of internet and social media, and clinical dental data. The association between the prevalence of caries experience (DMFT ≥ 1) and the number of untreated dental decay with use of internet and social media was assessed adjusting for age, gender, country, deprivation, toothbrushing, dental visits and consumption of sugary drinks and food. RESULTS: A total of 4414 children were included in the analysis. Children who reported using internet and social media to gain information on oral health had significantly higher odds for caries experience (1.29, 95%CI: 1.03-1.62) in the model adjusting for age, gender and country. After adjusting for behavioural and socioeconomic factors the relationship remained positive, but not statistically significant. The use of internet and social media was not significantly associated with the number of untreated caries. Social gradients in oral health remained significant after adjusting for use of internet and social media. CONCLUSIONS: The association between use of internet and social media, and dental caries could be mediated by health behaviours. Younger adults and children may be using the Internet and social media seeking information on dental caries, but longer online hours may also increase the caries risk. Internet-based health interventions should be supported by preventive strategies to promote effective and positive internet use.

Health-risk behaviours co-occur among children with untreated caries.

OBJECTIVES: The aim of this study was to examine whether an aggregate of health risk behaviours is associated with the number of untreated dental caries among 12- and 15-year-old children in England, Wales and Northern Ireland. MATERIALS AND METHODS: Data were from the Children's Dental Health Survey (CDHS) 2013, a nationally representative sample of England, Wales and Northern Ireland. The survey included assessment of oral health and data on socioeconomic, demographic and behavioural factors pertaining to children aged 12-15 years. Tooth condition (decayed, missing and filled) was assessed by NHS dentists. The survey included questions on age, sex, country, index of multiple deprivation, smoking, alcohol consumption, frequent sugar consumption and sweetened sodas, infrequent dental visit, infrequent toothbrushing and infrequent consumption of fresh fruits. Health risk behaviours were summed up to create an aggregate variable of health risk behaviour. The association between number of untreated caries and the aggregate of health risk behaviours was assessed using negative binomial regression and adjusting for age, sex, country and deprivation. RESULTS: The total number of children included in the analysis was 4414. The mean number of untreated caries was generally higher among children with health risk behaviours. The aggregate of risk behaviour was associated with greater prevalence of untreated dental caries with rate ratio (RR) 1.26 (95% confidence interval: 1.18, 1.36). CONCLUSION: This study demonstrated an association between an aggregate of health risk behaviours and untreated caries. The findings highlight the importance of addressing multiple risk factors not only those directly related to dental caries.

Complete Tooth Loss and Allostatic Load Changes Later in Life: A 12-Year Follow-Up Analysis of the English Longitudinal Study of Ageing.

OBJECTIVE: There is little evidence of the association between complete tooth loss and allostatic load (AL). We investigated, firstly, the association between complete tooth loss and changes in AL for 12 years among older English adults. A second aim was to explore the role of fruit and vegetable consumption in explaining the aforementioned association. METHODS: AL was calculated for 2430 English Longitudinal Study of Ageing cohort (2004/5-2016/17) participants 50 years and older based on nine biomarkers: systolic and diastolic blood pressures, glycated hemoglobin, high- and low-density lipoprotein cholesterol, triglycerides, fibrinogen, C-reactive protein, and waist circumference. The exposure was complete tooth loss. Participants were classified as dentate or edentulous. A linear mixed-effects model was fitted to model the 12-year change in AL score and its association with complete tooth loss after adjustments for confounders (demographic factors, socioeconomic position, and health behaviors). RESULTS: Around 11% of the participants were edentulous. Complete tooth loss was positively associated with baseline AL scores but not with its rate of change over time. The predicted mean AL scores were 3.60 (95% confidence interval [CI] = 3.53-3.68) and 3.98 (95% CI = 3.76-4.21) as well as 4·28 (95% CI = 4·18, 4·39) and 4·66 (95% CI = 4·42, 4·90) for dentate and edentulous participants, at baseline and end of follow-up, respectively. Fruit and vegetable consumption was not associated with baseline AL or its rate of change. CONCLUSIONS: Complete tooth loss was associated with baseline AL score but not with its development over time, whereas the consumption of fruit and vegetables did not help to explain this association. Both conditions may share common determinants earlier in life.

Hospital admissions for dental disorders in patients with severe mental illness in Southeast London: A register-based cohort study.

In people with mental disorders, adverse general health is well recognized but dental diseases remain underinvestigated. The objective of this study was to investigate risk factors for hospital admissions for dental disorders in patients with severe mental illness (SMI) and/or depressive disorder. De-identified electronic mental health records from the South London and Maudsley NHS Foundation Trust (SLaM) were linked to national Hospital Episode Statistics (HES) data for analysis. Data were extracted for adults with a diagnosis of SMI (schizophrenia, schizoaffective disorder, bipolar disorder) and/or depression, who had received care at SLaM between 1 January 2010 and 31 March 2017. In the cohort of 18,999 patients thus obtained, the following factors were independently associated with hospital admission for dental disorders: female gender [odds ratio (OR) = 1.48, 95% CI: 1.31-1.68)], Health of the Nation Outcome Scales (HoNOS) problem drinking/drug taking (OR = 1.12, 95% CI: 1.05-1.19), HoNOS physical illness/disability (OR = 1.18, 95% CI: 1.12-.25), diabetes (OR = 1.24, 95% CI: 1.06-1.43), recorded current/past smoking (OR = 1.35, 95% CI: 1.06-1.43), treatment with antidepressant medication (OR = 1.48, 95% CI: 1.31-1.68), and depressive disorder (OR = 1.36, 95% CI: 1.11-1.68). Building on previous research in this population, which indicated a relatively high risk of acute care hospitalizations with dental disorders as discharge diagnoses, a number of demographic and clinical characteristics were found to be independent predictors over a 7-yr period. Further research into these predictors would facilitate a better understanding of how adverse dental outcomes might be prevented.

Functional dentition and changes in dietary patterns among older adults in Thailand.

OBJECTIVE: To investigate the relationship between functional dentition (FD) and changes in dietary patterns (DP) in older adults. DESIGN: This was a 12-month prospective study, with dental examinations at baseline and questionnaires at baseline and follow-up. Dentition was classified as FD (containing ≥10 occlusal contacts), non-FD with dentures and non-FD without dentures. A 154-item FFQ assessed dietary intake in the previous month. Food items (servings/d) were combined into twenty-two food groups based on their similar nutrient profile, culinary use and previous studies in Thailand. DP were identified through factor analysis of baseline intake and applied scores were used to estimate changes in DP scores. The association between baseline FD (exposure) and change in each DP score (outcome) was tested in linear regression models adjusting for baseline socio-demographic factors, behaviours, chronic conditions, medications, total energy intake and DP score. SETTING: Phetchaburi, Thailand. PARTICIPANTS: Totally, 788 community dwellers aged ≥ 60 years. RESULTS: In total, 651 participants were retained after 12 months (82·6 % retention rate), of whom 14·1 % had FD. Having an FD was positively associated with larger increases in vegetable intake. Three DP were identified. Participants with FD had larger increases in healthy (0·13; 95 % CI: -0·13, 0·39) and carbohydrate-rich diets intake (0·12; 95 % CI: -0·17, 0·40) as well as larger reductions in meat-rich diet intake (-0·12; 95 % CI: -0·45, 0·21) than those with neither FD nor dentures. However, these differences were not significant. CONCLUSION: There was little support for an association between baseline FD and changes in DP.

Effectiveness of School Dental Screening to Reduce Untreated Caries: A Cluster-Randomized Controlled Trial.

The aim of the study was to evaluate the effectiveness of dental screening plus referral to a specific treating facility (intervention arm) against screening plus advice letter to see a dentist (traditional screening, and control arm) on changes in untreated caries among primary schoolchildren. A cluster-randomized, assessor-blinded, controlled trial was conducted in 16 public schools in Riyadh city, Saudi Arabia. Children aged 6-11 years without any compromising medical condition were eligible for inclusion. Children were examined for dental caries at baseline and 12 months later. Parents reported their socio-demographic characteristics and their child use of dental services at baseline and follow-up. Differences in the number of decayed primary and permanent teeth between trial arms were assessed using 3-level mixed-effects models to account for the clustering of children within schools and baseline demographic differences between arms. Data from 1,098 children (537 in the intervention and 561 in the control arm) were analysed. In the mixed-effect model, no differences in the increment of decayed primary and permanent teeth were found between the intervention and control arms (rate ratio: 0.88; 95% CI: 0.53-1.06). No differences between arms were found in the proportion of children visiting the dentist either (secondary outcome). The findings of this trial provided no support for the effect of post-screening referral to a specific dental hospital, compared to traditional screening, on changes in untreated dental caries among primary schoolchildren.

Self-rated oral health and frailty index among older Americans.

OBJECTIVE: To assess the association between self-rated oral health and frailty index among older American adults aged 60 years and over. MATERIALS AND METHODS: Data from the National Health and Nutrition and Examination Survey from 2011 to 2014 were used. Self-rated oral health was assessed based on a single question "rate the health of your teeth and gum". A frailty index of 49-items covering multiple systems was created. Age, gender, ethnicity, poverty-income ratio, education, poor nutritional intake and smoking were used as covariates. Weighted negative binomial regression was used to test the association between self-rated oral health and frailty index adjusting for the covariates. RESULTS: A dose response relationship was observed between self-rated oral health and frailty index. The rate ratios (RR) of frailty index were 1.03 (95% CI 0.95-1.13), 1.15 (95% CI 1.05-1.25), 1.30 (95% CI 1.17-1.45) and 1.41(95% CI 1.28-1.54) for participants who rated their oral health very good, good, fair or poor, respectively, compared with those who rated their oral health excellent after adjusting for covariates. CONCLUSION: Poorer self-rated oral health is associated with higher rates of frailty index. This highlights the importance of oral health as a predictor of frailty and the adequacy of using self-rated oral health in health surveys and clinical practices when conducting a comprehensive clinical oral examination is not feasible.

Severe dental caries is associated with incidence of thinness and overweight among preschool Chinese children.

Objective: To examine the association of incidence and baseline prevalence of severe dental caries with incidences of thinness and overweight among pre-school Chinese children.Materials and methods: A longitudinal study design was used. A total of 772 children recruited from 15 kindergartens in Liaoning Province who completed baseline and follow-up assessments were included. The age range of children at baseline was 24.6-71.1 months. BMI-for-age z-score was calculated to estimate incidence of thinness and overweight. Severe dental caries was indicated by pulpal involvement, ulceration, fistula or abscess (pufa). Baseline prevalence of severe caries included children with pufa ≥1, incidence included those who changed from pufa = 0 to ≥1 at follow-up. Logistic regression was constructed to assess the association of baseline prevalence and incidence of severe caries with each of incidence thinness and overweight.Results: Children with incidence of severe caries had higher odds for incidence thinness (OR: 4.08; 95% CI: 1.08, 15.41). Baseline prevalence of severe caries was not significantly associated with incidence thinness. Participants with severe caries at baseline had higher odds for incidence overweight (OR: 2.33; 95% CI: 1.17, 4.63). The relationship between incidence of severe caries and incidence overweight was insignificant.Conclusions: The findings suggest a U-shaped relationship between severe dental caries and both ends of anthropometric measures among pre-school Chinese children. The findings highlight the importance of integrating oral and general health promotion policies. Primary health care providers are encouraged to incorporate dental screening, counselling and referral for treatment for severe caries to promote appropriate growth and overall health of children.

The association between number of teeth and physical function limitation among older adults in the USA.

AIM: To examine the association between the number of teeth and physical function limitation (PFL), as an indicator of frailty, among older adults in the USA. BACKGROUND: Physical function limitation is common among the elderly and potentially associated with oral health, particularly the number of extracted teeth. MATERIALS AND METHODS: Data from the Behavioral Risk Factor Surveillance System 2014 (BRFSS, 2014), a cross-sectional national interview survey of US population, were analyzed. The number of participating older adults aged 65 and over was 158 962. The association between PFL, outcome and number of extracted teeth, demographic data, socio-economic status, smoking, general health, comorbidity conditions and body mass index (BMI) was assessed using logistic regression analyses. RESULTS: The prevalence of PFL was 28%. In the fully adjusted model, the number of extracted teeth had a significant association with PFL: edentulous older adults had higher odds for PFL, (odds ratio [OR]:1.36; 95%CI: 1.22, 1.52). Similarly, those who lost 6 teeth or more but not all were likely to have PFL (OR 1.35: 95% CI: 1.23, 1.48). CONCLUSIONS: There was a significant association between the number of extracted teeth and PFL among US older adults aged 65 and more, based on the data from BRFSS 2014. The findings indicate that losing teeth may be a potential risk for PFL.

The association between periodontal disease and root/coronal caries.

OBJECTIVES: To examine whether there is an association between periodontal disease and each of root caries and coronal caries among adults (aged 35 and over), using a nationally representative sample of adults in England, Northern Ireland and Wales. MATERIAL AND METHODS: In this cross-sectional study, data from the Adult Dental Health Survey 2009 were used. Adults aged 35 years or older who had periodontal and caries assessment were included. Two sets of negative binomial regression were conducted for each of coronal caries and root caries adjusting for periodontal diseases, dental visits, country, sex, age, education, job classification, oral hygiene and smoking. RESULTS: Overall, 4738 were included in the analysis. Periodontal disease was significantly associated with each of coronal and root caries. In the fully adjusted model, those with PD/ LoA ≥ 4 mm had 1.03 rate ratio (RR) for coronal caries (95% CI: 1.01-1.05). In the model pertaining to root caries, the RR for those with periodontitis was 1.23 (95% CI: 1.16-1.30). Smoking, sex, age and oral hygiene were the variables that showed a consistent and significant association with coronal and root caries. CONCLUSION: Individuals with periodontal diseases appeared to be at higher risk of coronal and root caries. While root exposure could be a plausible explanation for the relationship between periodontitis and root caries, the association with coronal caries could be attributed to the irritation of carious cavities, or common risk factors such as poor oral hygiene, or co-occurrence of different health risk behaviours related to both caries and periodontitis and socioeconomic conditions.

Is there socioeconomic inequality in periodontal disease among adults with optimal behaviours.

OBJECTIVE: To examine if socioeconomic inequalities exist in periodontal disease among adult with optimal oral health behaviours. MATERIALS AND METHODS: Data were from the Adult Dental Health Survey 2009, a national survey of England, Wales and Northern Ireland. Overall, 4738 participants aged 35 years and older were included in the analysis. Periodontal disease indicated by pocket depth or loss of attachment ≥4 mm, and gingival bleeding were used as periodontal outcomes. Education and deprivation indicated socioeconomic position. Behavioural factors were dental visits, toothbrushing and smoking. The subset of adults with and without optimal health related behaviours included 2916 and 1822 participants, respectively. The associations between periodontal disease and socioeconomic position were tested adjusting for demographic and behavioural factors. Additional models stratifying the sample to those with and without optimal behaviour subgroup were constructed. RESULTS: Education and deprivation were significantly associated with periodontal disease in the partially adjusted models. In the analysis of those with optimal behaviours, only deprivation and highest level of education showed significant association with periodontitis (PD), but not with gingival bleeding. Among those without optimal behaviours, all socioeconomic factors were associated with all outcomes except deprivation and PD. CONCLUSIONS: Oral health behaviours marginally contributed to inequalities in gingival bleeding and periodontal disease. Socioeconomic inequalities were attenuated among those with optimal behaviours and persisted among those without optimal behaviours. Behaviours appeared to be an effect modifier for the relationship between periodontal outcomes and socioeconomic factors.

Association between oral health and frailty: A systematic review of longitudinal studies.

OBJECTIVE: To systematically review longitudinal studies on the association between oral health and frailty indicated by any validated scale or index. BACKGROUND: Frailty and poor oral health are common among ageing populations; however, evidence from longitudinal studies is scarce. METHODS: Three databases (MEDLINE, EMBASE and LILACS) were searched for published literature up to July 2018 using prespecified search strategy. Grey literature was searched using OpenGrey and Google Scholar. Quality of included studies was checked using the Newcastle-Ottawa Quality Assessment Scale (NOS) for longitudinal studies. RESULTS: Five longitudinal studies from three countries (Mexico, Japan, and UK) that examined the association between oral health and frailty were identified. All studies used Fried's frailty phenotype criteria for measuring frailty. Oral health indicators were number of teeth, periodontal disease, oral functions (functional dentition with occluding pairs and maximum bite force), use of removable dentures, accumulation of oral health problems and dry mouth symptoms. The studies showed significant association of number of teeth (two studies), oral functions (two studies), accumulation of oral health problems and number of dry mouth symptoms with frailty incidence, whereas periodontal disease showed inconsistent associations. CONCLUSION: This systematic review identified significant longitudinal associations between oral health indicators and frailty that highlight the importance of oral health as a predictor of frailty in older age. There is a need for further research exploring the role of nutrition as a mediator of the relationship between oral health and frailty.

Functional dentition, dietary intake and nutritional status in Thai older adults.

OBJECTIVES: To explore the relationship between functional dentition and nutritional status among Thai older adults, and the role of nutrient intake in this association. BACKGROUND: Evidence on the interplay between tooth retention, diet and nutritional status is still inconclusive, with most evidence coming from Western countries. METHODS: Seven hundred and eighty-eight Thai adults, aged 60+ years, living in Phetchaburi Province, Thailand, participated in this cross-sectional study. Data were collected through questionnaires, body measurements and dental examinations. Being underweight (Body Mass Index < 18.5) and overweight/obese (BMI > 25) were the two outcome measures. Functional dentition was defined as having 10+ functional tooth units. The association of functional dentition with each outcome was assessed in regression models adjusted for sociodemographic factors, behaviours, chronic conditions and total energy intake. The role of various nutrients in explaining the above associations was quantified via the per cent attenuation in the coefficient for functional dentition. RESULTS: Functional dentition was associated with being underweight but not with being overweight/obese. After adjustments, participants with functional dentition were 61% (prevalence ratio: 0.39, 95% CI: 0.16, 0.95) less likely to be underweight than those with neither functional dentition nor dentures. In addition, participants with functional dentition had significantly greater intake of dietary fibre and thiamine (Vitamin B1 ) than those with neither functional dentition nor dentures. The two nutrients explained a small part of the association between functional dentition and being underweight. CONCLUSION: Having a functional dentition was negatively associated with being underweight. The consumption of dietary fibre and thiamine explained a small part of this association.

Epidemiological survey of early childhood caries in Cambodia.

BACKGROUND: The Southeast Asian Forum for Early Childhood Caries identified the need for more epidemiological surveys involving preschool children. To date, the only data on Early Childhood Caries in Cambodia come from convenience samples and only using the basic dmft index without measurement of the early signs of disease. METHODS: A cross-sectional survey on an epidemiological sample of Cambodian preschool children was conducted in conjunction with the fourth follow-up of the Cambodian Health and Nutrition Monitoring Study. Children were examined in a field setting using both the South East Asian Index for Early Childhood Caries as well as the 'pulpally involved, ulcerated, fistula, abscess' (pufa) index. Caregivers also participated in a short questionnaire covering dietary habits, oral health knowledge and behaviors, as well as the Family Impact Scale (FIS) for Oral-Health-Related Quality-of-Life. RESULTS: The sample included 3985 participants between birth and 4-years of age, across three provinces. There was an even sex distribution (50.7% male). Overall 56.6% of participants had one or more carious lesions and 5.4% had one or more pulpally-involved teeth. There were some significant differences by age and location. Among those in the 3-year-old age group 84.9% had at least one decayed tooth, and 16.1% had one or more pulpally-involved teeth. There were differences in oral health knowledge and behaviors by province; those in Phnom Penh reported more favorable responses. Consumption of non-nutritious foods also differed between provinces with those in Phnom Penh consuming a higher mean number of sweet beverages per day. Those children with at least one pulpally involved tooth had a ten times greater chance of realizing an impact across the FIS. CONCLUSIONS: Cambodian preschool children have a severe burden of dental caries and a high proportion of families are impacted by this problem. There were differences in oral health knowledge and behaviors according to province and this translated into differences in caries experience. The data from this study support the need for urgent action to address the issue of ECC in Cambodia.

Stress, allostatic load, and periodontal diseases.

Psychosocial stress plays an important role in periodontal disease through biological and behavioral pathways. In this paper we review studies that examine the relationship between stress and periodontal diseases, and discuss the different measures used to assess stress. Self-reported measures, such as the Perceived Stress Scale and the Stress Appraisal Measure, have traditionally been used to assess stress. Frequent and repeated exposure to stressor(s) leads to wear and tear of the body's systems, resulting in what is known as allostatic load. In recent years, few studies examining the relationship between stress and periodontal diseases have used an aggregate variable, including primary and secondary markers of allostatic load, as a biological marker of stress. While research on the relationship between allostatic load and periodontal disease is still developing, as most of the studies used cross-sectional data, this line of research presents a good opportunity for establishing a composite biological indicator as a risk factor for periodontal disease. Such an indicator is also potentially beneficial for personalized periodontics as it will help to target intervention to specific levels of risk and will help in integrating oral and general health promotion policies.

The role of healthcare and education systems in co-occurrence of health risk behaviours in 27 European countries.

Background: Contextual factors play an important role in health and related behaviours. This study aims to examine the association of co-occurrence of five health-risk behaviours with healthcare and education contextual factors using nationally representative samples from 27 European countries. Methods: Data were from Eurobarometer 72.3, 2009. The outcome was a count variable ranging from 0 to 5 indicating co-occurrence of five health-risk behaviours, namely smoking, excessive alcohol consumption, non-frequent fresh fruit consumption, physical inactivity and non-dental check-ups. Public expenditures on healthcare and education as a percentage of GDP and quality of healthcare and education at a country-level were used as contextual factors. A set of multilevel Poisson regression models were conducted to examine the associations between co-occurrence of health-risk behaviours and each of the contextual factors considering age, gender, marital status, urbanisation, individual socioeconomic positions (education, subjective social status or difficulty in paying bills) and GDP per capita. Results: The total population was 23 842. Greater expenditures on healthcare and education, and better quality of healthcare systems had negative associations with co-occurrence of health-risk behaviours in the model adjusted for all individual demographic indicators. However, statistical significance disappeared after adjusting for socioeconomic indicators and GDP per capita. Conclusion: While the study highlights the importance of developing high-quality healthcare and education systems generously supported by public fund in relation to co-occurrence of health-risk behaviours, the influence of contextual factors in adopting health-related behaviours is probably attenuated by individual socioeconomic factors.

Do Socioeconomic Conditions Explain Ethnic Inequalities in Tooth Loss among US Adults?

Objective: To assess whether there are ethnic differences in tooth loss among adult Americans aged <40 years and whether socioeconomic position attenuates these differences if they exist. Methods: Data were from the 2014 Behavioral Risk Factor Surveillance System, a health-related telephone cross-sectional survey of a nationally representative sample of US adults. Tooth loss (one tooth or more) was used as the outcome variable. Ethnicity was the main explanatory variable. Family income, education and health insurance were also used in the analysis. Logistic regression models for tooth loss were constructed adjusting for demographic (age, sex, and ethnicity), socioeconomic indicators (income and education), health insurance, dental visits, smoking and diabetes. Results: A total of 76,273 participants were included in the analysis. The prevalence of tooth loss was highest among Blacks (33.7%). Hispanics and other ethnic groups had a higher prevalence of tooth loss than Whites, 29.1% (95%CI: 27.7-30.6), 22.0% (95%CI: 20.3-23.8), and 20.8% (95%CI: 20.2-21.4), respectively. Blacks had odds ratios (OR) 1.98 (95%CI: 1.81-2.16) for tooth loss compared with Whites. After adjusting for socioeconomic positions (SEP), the relationship attenuated but remained significant with OR 1.71 (95%CI: 1.55-1.90). Conclusions: Despite recent changes in the health care system in the United States, ethnic inequalities in tooth loss still exist. Income and education partially explained ethnic differences in tooth loss among Americans aged <40 years.