What are the possible associations between socioeconomic position and caries?
F. Schwendicke, C.E. Dörfer, P. Schlattmann, L. Foster Page,W.M. Thomson, and S. Paris
- Dental caries is the most prevalent disease worldwide, with the majority of caries lesions being concentrated in few, often disadvantaged social groups.
- A growing number of studies have found the distribution of caries lesions to be increasingly skewed, with a small fraction of (usually) disadvantaged individuals experiencing the majority of lesions or restorations.
- It has therefore been hypothesized that socioeconomic position (SEP) predicts or even causally affects caries, as has been reported for many other diseases.
- However, it remains unclear to which degree different socioeconomic parameters, such as educational background, income, or occupation, are associated with the presence of caries lesions or caries experience.
Purpose of the Study
- To systematically review and synthesize the available evidence for a possible association between SEP and caries.
- The review should be suitable to identify gaps or weaknesses in current knowledge or methods used and could allow an assessment of the influence of confounders such as study design, quality or country, or the size or age of the population examined on the magnitude of the association.
- This review found lower SEP to be significantly associated with greater risk of having any caries lesions or any caries experience.
- Despite included studies being very heterogeneous with regard to study design and used measures for SEP and caries, as well as evidence levels being low due studies’ risk of bias, the large number of included studies, the nearly unequivocal direction of reported findings, and the precision and magnitude of our estimates strongly support the existence of such association.
- Own or parental educational background frequently determines income, thus controlling access to home or professional preventive means such as toothpastes, dental floss, low caloric sugar-reduced diets, or privately paid dental sealants.
- Besides, educational background also affects nonmaterial characteristics, such as health literacy and behavior, including dietary and tooth cleaning habits, or health service utilization frequency and patterns.
- Social position is further known to determine social participation, support, stability, and cohesion, which positively affect health and health behavior as well.
- The study revealed that caries experience to be more unequally distributed in highly developed countries with low income inequality than in underdeveloped, more unequal countries. Caries experience itself is a function of both caries prevalence and utilization of dental services. While such services are universally available in most highly developed countries, access to them might be limited to a few, usually privileged groups in developing countries.