Social inequalities in oral health
Equality in adults’ oral health in Norway. Cohort and cross-sectional results over 33 years
The purpose was to assess social inequality in dental clinical parameters in adult Norwegians from 1973 to 2006. Methods.Samples from two birth-cohorts born 1929-1938 and 1959-1960, respectively, and 35-44 year olds were drawn in 1973, 1983 1994 and in 2006 in the county of Nord-Trøndelag in Norway. Standard procedures were followed all the time. The examination comprised caries and caries treatment experience by DMF criteria and a questionnaire. Length of education in years was divided into quartiles in 1983, 1994 and 2006 in order to analyse the association between social status and clinical parameters. Statistical analyses were conducted within the same study year and between the years 1983 and 2006 by descriptive statistics and ANOVA. Results. The study showed that the DMFT/S index increased in the two birth-cohorts from 1973 to 1983 where after fewer changes occurred. However, there was a great improvement in oral health among 35-44 year old during the period from 2006 to 1973. The inequalities observed in 1983 remained or decreased and there was equality in number of present teeth all the time. The DMF results from the birth-cohorts showed that if social differences appear at an early age, they will accompany persist in the cohorts the next 30 years and more. This is mainly due to the irreversibility of the DMF registrations. Conclusions. Social inequality was reduced but found in some indicators of dental status in 20068. Part of it can be explained by the insensitivity of the applied indexes. There is still a social divide in oral health that affects elderly more than younger adults.
Oral health in a life-course perspective. Born in 1929 and 77 years old in 2006.
Life course perspectives from childhood to seniority were analysed in two steps.Firstly the importance of contextual behavioral dental awareness and attention inchildhood on oral health was assessed in young and middle-aged adults in 1983.Secondly, the further development of oral health was assessed in samples drawn from the same birth-cohorts in 2006. The material consisted of data from independently selected random samples from birth-cohorts living in the counties of South- and North-Trøndelag in 1983 and in 2006. In 1983 samples were 23-24, 35-44 and 45-54 years old, respectively. Questions about the oral health environment at age 10 years tapped the parents’ awareness and behaviour with regard to their children’s oral hygiene practices and sweet consumption, the regularity of the children’s dental care and the dental status of the parents. In 1983 and 2006 birth-cohort 1959-60, 1939-48 and 1929-38 were clinically examined. Two sets of multiple regression analyses were performed. Sound, Decayed, Filled, Missing and DMF-surfaces were dependent variables and were related to oral health environment at age 10. In the¨second set of analyses the 1983 and 2006 datasets were collapsed. In the analyses the same dependent variables were regressed on adult resource variables and dental health behaviours prior to the survey. The results showed that parents’ dental health at children’s age ten was a distant but still a strong determinant of oral health. Gender and social status had a strong effect on oral health as had recent oral health behaviors and recent dental visits. The strength of the effects was weaker in younger age-groups. From 1983 to 2006 the social patterning remained stable and oral health of the birth-cohorts as measured by healthy and disease variables remained stable.