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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    ABSTRACT: During the past two decades, increasing recognition has been given to a relationship between oral health and systemic diseases. Associated systemic conditions include cardiovascular disease, diabetes, low birth weight and preterm births, respiratory diseases, rheumatoid arthritis, obesity, osteoporosis, and, in particular among oral conditions, periodontal disease. Low-grade inflammation is a common denominator linking these disorders. Applying an anecdotal approach and an integrative view, the medical and dental histories of two women document increasing ill health subsequent to incidences of maltreatment and sexual abuse, including oral penetration, at an early age. Comprehensive oral rehabilitation was required in both cases. These cases open for medical insight with regard to their implicit patho-physiology, when integrated with current evidence from neuroscience, endocrinology, and immunology, converging in the concepts of allostasis and allostatic load. In cases such as those presented in this paper, primary care physicians (family doctors, General Practitioners) and dentists may be the first to identify an etiological pattern. This report underlines the importance of increased and enhanced multidisciplinary research cooperation among health professionals. Our hypothesis is that childhood adversity may affect all aspects of human health, including adult oral health. Copyright © 2015. Published by Elsevier Ltd.
    Medical Hypotheses 04/2015; DOI:10.1016/j.mehy.2015.04.020 · 1.07 Impact Factor
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    • "Within the measurement of family functioning the aspects of family conflict and communication have been recognized as dominant (Ballash et al. 2006), while low income is related to family stress (Sharam 2007). In relation to dental health, stress has been hypothesized to increase the risk of dental caries via a biochemical pathway involving cortisol and its chemical impacts on tooth enamel structure and another pathway increasing the levels of cariogenic bacteria (Boyce et al. 2010). Other recognized risk factors for poor oral health related to both income and family functioning are nutritional quality of the diet and dental care. "
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    Child Care Health and Development 03/2013; DOI:10.1111/cch.12053 · 1.83 Impact Factor
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    • "In this context, the virtual lack of carious lesions in Near Eastern Neandertals should not be related to the low-sugar diet, but rather to the absence of most cariogenic bacterial species in Neandertal oral flora, assuming that the vulnerability was similar or even higher in Neandertals than in modern humans due to higher environmental stress, comparable to modern Inuits (Boyce et al., 2010; Guatelli- Steinberg et al., 2004). Such an explanation seems to be supported by research on genetic diversity of S. mutans. "
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    Homo: internationale Zeitschrift fur die vergleichende Forschung am Menschen 03/2012; 63(2):110-3. DOI:10.1016/j.jchb.2012.02.001 · 0.96 Impact Factor
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