Article

Social inequalities in childhood dental caries: The convergent roles of stress, bacteria and disadvantage

University of British Columbia, Vancouver, BC, Canada.
Social Science [?] Medicine (Impact Factor: 2.56). 11/2010; 71(9):1644-52. DOI: 10.1016/j.socscimed.2010.07.045
Source: PubMed

ABSTRACT The studies reported here examines stress-related psychobiological processes that might account for the high, disproportionate rates of dental caries, the most common chronic disease of childhood, among children growing up in low socioeconomic status (SES) families. In two 2004-2006 studies of kindergarten children from varying socioeconomic backgrounds in the San Francisco Bay Area of California (Ns = 94 and 38), we performed detailed dental examinations to count decayed, missing or filled dental surfaces and microtomography to assess the thickness and density of microanatomic dental compartments in exfoliated, deciduous teeth (i.e., the shed, primary dentition). Cross-sectional, multivariate associations were examined between these measures and SES-related risk factors, including household education, financial stressors, basal and reactive salivary cortisol secretion, and the number of oral cariogenic bacteria. We hypothesized that family stressors and stress-related changes in oral biology might explain, fully or in part, the known socioeconomic disparities in dental health. We found that nearly half of the five-year-old children studied had dental caries. Low SES, higher basal salivary cortisol secretion, and larger numbers of cariogenic bacteria were each significantly and independently associated with caries, and higher salivary cortisol reactivity was associated with thinner, softer enamel surfaces in exfoliated teeth. The highest rates of dental pathology were found among children with the combination of elevated salivary cortisol expression and high counts of cariogenic bacteria. The socioeconomic partitioning of childhood dental caries may thus involve social and psychobiological pathways through which lower SES is associated with higher numbers of cariogenic bacteria and higher levels of stress-associated salivary cortisol. This convergence of psychosocial, infectious and stress-related biological processes appears to be implicated in the production of greater cariogenic bacterial growth and in the conferral of an increased physical vulnerability of the developing dentition.

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    • "All these associations can be explained in terms of chronic activation of the HPA-axis resulting in inflammatory responses, in increased receptivity to infection, including oral infections, and in increased vulnerability to having otherwise minor infections become severe and protracted. Pediatrician Thomas Boyce and colleagues studying 5-year old children have demonstrated how psychosocial , infectious, and stress-related processes seem to converge in the development of caries and thus contribute to increasing the risk that future, overall dental health be impaired [13]. The highly acknowledged, prospective Dunedin Study from New Zealand, which followed the impact of psychosocial distress on children over a period of years, has shown a clear correlation between the dental health of the children and that of their parents, reflecting social gradients [88]. "
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