Sense of coherence and oral health in dentate adults: findings from the Finnish Health 2000 survey.

AIM: To assess the relationship between sense of coherence (SOC) and oral health, and the role of oral health-related behaviours in this relationship. MATERIALS AND METHODS: This is a cross-sectional study of 5401 dentate adults who participated in the nationally representative Health 2000 Survey in Finland. The survey gathered information on SOC, demographic characteristics, education, income, pre-existing diabetes, daily smoking, dental attendance, toothbrushing frequency and sugar intake frequency. Oral health was assessed through clinical outcomes, such as number of teeth, number of decayed teeth and extent of periodontal pockets and perceived oral health. RESULTS: A strong SOC was related to having more teeth, fewer decayed teeth, lower extent of periodontal pockets and good perceived oral health after adjustment for confounders, such as demographic and socioeconomic factors (all p0.003). These associations were attenuated but remained significant after further adjustment for potential mediators (oral health-related behaviours), except for the association of SOC with the extent of periodontal pockets, which was fully accounted for by pre-existing diabetes, oral health-related behaviours and dental plaque (p=0.549). CONCLUSION: SOC is positively associated with various aspects of adult oral health, in part because of the better oral health-related behaviours among people with a strong SOC.

The influence of sense of coherence on the relationship between childhood socioeconomic status and adult oral health-related behaviours.

OBJECTIVES: To assess the role of adulthood socioeconomic status (SES) and sense of coherence (SOC) in the relationship between childhood SES and adult oral health-related behaviours. METHODS: This study analysed responses of 5318 dentate subjects aged 30 years and over who participated in the Finnish Health 2000 Survey. Participants provided information on their demographic characteristics (sex, age, marital status and urbanization), childhood SES (parental education), adulthood SES (years of education and household income), the SOC scale and four oral health-related behaviours (dental attendance, toothbrushing frequency, sugar intake frequency and daily smoking). Structural equation modelling was used to test a model including adult SES and SOC as mediating factors of the relationship between childhood SES and adult oral health-related behaviours. Multi-group comparison was conducted to test the model within each sex and age group. RESULTS: Childhood SES was related to adult oral health-related behaviours (P < 0.001) but only indirectly, via adulthood SES (P < 0.001) and adult SOC (P = 0.001). However, the relationship via adulthood SES was much stronger than that via SOC (standardized path coefficients were 0.24 and 0.01 respectively). In the multi-group comparison, the model was invariant across sex and age groups. CONCLUSIONS: The relationship between childhood SES and adult oral health-related behaviours was mainly mediated by adulthood SES, and to a much less extent by SOC. A stronger SOC was significantly associated with better adult oral health-related behaviours, after controlling for the effect of adulthood SES and demographic characteristics of the participants.

The T-Health index: a composite indicator of dental health.

The aim of this study was to determine the most appropriate set of weights with which to calculate the number of sound-equivalent teeth (T-Health index) against perceived oral health, which was used as a proxy of oral health status. This study used data from 5,057 dentate subjects, > or = 30 yr of age, who ere participating in the Finnish Health 2000 Survey. Subjects provided information on socio-demographic characteristics, behaviours and perceived oral health, and had a clinical examination. The T-Health index was calculated by assigning different weights to missing, decayed, filled, and sound teeth. Thirty-six alternative sets of weights were evaluated. The most appropriate set of weights was judged by the strength of the adjusted association between the T-Health index and levels of perceived oral health in ordinal logistic regression models and by the invariance of this association according to the extent of restorative treatment (non-significant statistical interaction). Among the 36 sets of weights used to calculate the T-Health index, assigning twice the weight of a decayed tooth to a filled tooth whilst keeping the weight for a filled tooth < or = 0.20 provided the strongest association with levels of perceived oral health and did not vary according to the extent of restorative treatment.

The relationship among sense of coherence, socio-economic status, and oral health-related behaviours among Finnish dentate adults.

This study assessed the independent and interactive associations between sense of coherence (SOC) and socio-economic status (SES) with oral health-related behaviours. Data from 5,399 dentate adults regarding their demographic characteristics, years of education, SOC score, and oral health-related behaviours were analysed. Household income was obtained from tax authorities. Logistic regression was used to test the adjusted association of SOC with each behaviour and to test the statistical interaction between each SES indicator and the SOC score. Subjects were 1.20 [95% confidence interval (95% CI): 1.11-1.28] and 1.22 (95% CI: 1.12-1.32) times more likely to visit dentists regularly for check-ups and to brush their teeth twice daily or more often, respectively, and were 1.11 (95% CI: 1.03-1.20) and 1.21 (95% CI: 1.12-1.32) times less likely to be daily smokers and to consume sugar-added products on a daily basis, respectively, for every unit increase in SOC score. The findings provide strong support for an association between higher levels of SOC and more favourable oral health-related behaviours, independently of current SES and demographic characteristics of the participants and across the four behaviours assessed. By contrast, the findings give limited support for the moderating role of SOC on the relationship between SES and oral health-related behaviours.

Structure of the sense of coherence scale in a nationally representative sample: the Finnish Health 2000 survey.

OBJECTIVE: To examine the structure of the sense of coherence (SOC) scale in a general population. METHODS: This study analysed the responses of 6,217 subjects aged 30 years and over who participated in the Finnish Health 2000 survey (response rate 77.4%). Participants completed an abbreviated 12-item version of the SOC scale. Two alternative structures were tested using confirmatory factor analysis: a one-factor model, with all scale items loaded onto a single latent factor representing the SOC construct, versus a second-order factor model, with scale items loaded onto their corresponding latent factors representing the three SOC components (comprehensibility, manageability and meaningfulness), which are, in turn, dependent on one single higher-order SOC construct. RESULTS: The one-factor model was fitted to the data after allowing the errors of comprehensibility item 5 and manageability item 6 to correlate, as was done in previous studies among Finnish adults. The comparative fit index (CFI), Tucker-Lewis index (TLI) and root mean square error of approximation (RMSEA) for the one-factor model were, respectively, 0.97-0.98, 0.96-0.97 and 0.05-0.09 across both sexes and three age groups. The second-order factor model had correlations between latent factors higher than 1, even after alternative model modifications, casting doubts on this more complex structure. CONCLUSION: These data suggest that the components of comprehensibility, manageability and meaningfulness should be merged when measuring SOC with the 12-item SOC scale in the Finnish general population.