Educational gradient in dental caries

Abstract

Background: Dental health is an important aspect and a key indicator of general health. However, detailed data on dental health in the adult population in Norway is lacking. Literature indicates that people with lower socioeconomic position (SEP) have significantly poorer dental health than people with higher SEP. For example, adults in Norway with higher education report better self-reported dental health status compared with adults who have lower education. Therefore, although the inequality in dental health has been significantly reduced in Norway the last 50 years, findings may indicate that there still exists inequality in dental health among adults in Norway. These inequalities often manifest in a gradient.

Aim: This study sought to investigate if educational gradient in dental caries exists in the adult population in Tromsø municipality. The objective was to assess an association between educational level and dental caries experience among the participants of the Tromsø 7 study.

Materials and methods: The study population consisted of 3823 adults living in Tromsø municipality in northern- Norway who participated in the Tromsø 7 study. Social determinants: education, age, sex, household income, spouse, childhood financial situation, mother and fathers’ education, siblings, and intermediary determinants: smoking, alcohol consumption, exercise, soft drinks, tooth brushing, fluoride toothpaste, interdental cleaning aids, fluoride tablets, fluoride rinse, dental care and dental satisfaction was self-reported in a questionnaire. Registration of decayed, missing, filled, teeth (DMFT) score was performed after the clinical examinations by calibrated dentists using bitewing radiographs and intra-oral clinical photographs. Descriptive statistics, chi- square test and independent t-test was performed to describe the sample. Univariable and multivariable binary logistic regression models were conducted and the association between educational level and DMFT score was adjusted for selected social and intermediary covariates.

Results: After excluding participants with missing values in education and DMFT score, the data of 3752 participants aged 40- 92 years was analyzed. The median DMFT score among all participants was 19 (9), mean 18.03 (6.41). The univariable binary logistic regression analysis showed a statistically significant association between educational level and DMFT score.

The odds for higher DMFT score followed a gradient based on educational level, meaning that the odds for higher DMFT score were observed in lower education level (primary/partly secondary education level versus tertiary education level, long) and lower odds for higher DMFT score were in higher education level (upper secondary level and tertiary education, short versus tertiary education, long). When adjusted for covariates a statistically significant association remained between education level and DMFT score. However, the educational gradient was not clearly observed between the two intermediate educational levels.

Conclusion: The present cross-sectional study demonstrated an educational gradient in dental caries among the adult population in Tromsø municipality. The results call for health promotion and disease prevention initiatives to address this social determinant and thereby reduce educational inequalities in dental health.