Prevalence and severity of periodontal disease in the host community and Rohingya refugees living in camps in Bangladesh.

OBJECTIVES: To assess the prevalence and severity of periodontal disease of the Rohingya refugees and host community in Bangladesh. METHODS: An unpublished pilot was conducted for the sample size calculation. Two-stage cluster sampling method was used to select 50 participants from refugee camps and 50 from the host community. Structured questionnaire and periodontal examination were completed. Composite measures of periodontal disease were based on the World Workshop (WW) and Centers for Disease Control and Prevention-American Academy of Periodontology. Linear regression models, for clinical attachment level and periodontal pocket depth (PPD) and ordered logistic regression models, for composite measures, were fitted to test the association of periodontal measures and refugee status. RESULTS: Compared to the host community, a smaller percentage of refugees reported good oral health-related behaviours. Refugees exhibited lower levels of bleeding on probing but higher PPD, hence a higher proportion had severe stages of periodontitis. As per the WW, prevalence of periodontal disease was 88% and 100% in the host and refugee groups, respectively. In the unadjusted models, refugees were three times more likely to have severe stages of periodontitis; this association was attenuated when adjusted for confounders (sociodemographic variables and oral health-related behaviours). CONCLUSIONS: Prevalence of periodontitis was high both in the host community and refugees. The refugees exhibited a more severe disease profile. The oral health of both groups is under-researched impacting the response of the health system. Large-scale research systematically exploring the oral health of both groups will inform the design and delivery of community-based interventions.

Education mediates the relationship of parental socioeconomic status with subjective adult oral health.

BACKGROUND: Evidence shows that both socioeconomic status (SES) during childhood and education are associated with adult oral health. However, whether the range of opportunities families have regarding their children's education mediate the effect of childhood disadvantage on oral health later in life remains unknown. The aim of this study was to evaluate the mediating role of education in the association between parental SES and subjective oral health status in middle adulthood. METHODS: Data from 6703 members of the British Cohort Study 1970 were analyzed. Parental SES was measured using the 7-class National Statistics Socio-Economic Classification (NS-SEC) at age 10 years. Five measures of education (type of high school, highest qualification, age left full-time education, status of institution and field of study) were obtained from ages 16 and 42 years. Subjective oral health was measured with a single global item at age 46 years. Causal mediation analysis was performed, using a weighting-based approach, to evaluate how much of the effect of parental SES on subjective oral health was mediated by the measures of education separately and jointly. RESULTS: Overall, 23.6% of individuals reported poor oral health. Parental SES was associated with every measure of education, and they were also associated with subjective oral health in regression models adjusted for confounders. The effect of parental SES on subjective oral health was partially mediated by each measure of education, with a proportion mediated of 53.2% for the institution status, 46.5% for the field of study, 42.8% for the school type, 38.9% for the highest qualification earned and 38.4% for the age when full-time education was discontinued. The proportion of the effect of parental SES on subjective oral health jointly mediated by all measures of education was 81.1%. CONCLUSION: This study found a substantial mediating role of education in the association between parental SES and subjective oral health in middle adulthood.

The intersections of socioeconomic position, gender, race/ethnicity and nationality in relation to oral conditions among American adults.

OBJECTIVE: The objective of the study was to evaluate how gender, socioeconomic position (SEP), race/ethnicity and nationality intersect to structure social inequalities in adult oral health among American adults. METHODS: Data from adults aged 20 years or over who participated in the National Health and Nutrition Examination Survey (NHANES) 2009-2018 were analysed. The outcomes were poor self-rated oral health and edentulism among all adults (n = 24 541 and 21 446 participants, respectively) and untreated caries and periodontitis among dentate adults (n = 16 483 and 9829 participants, respectively). A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted for each outcome, by nesting individuals within 48 intersectional strata defined as combinations of gender, SEP, race/ethnicity and nationality. Intersectional measures included the variance partition coefficient (VPC), the proportional change in variance (PCV) and predicted excess probability due to interaction. RESULTS: Substantial social inequalities in the prevalence of oral conditions among adults were found, which were characterized by high between-stratum heterogeneity and outcome specificity. The VPCs of the simple intersectional model showed that 9.4%-12.7% of the total variance in the presentation of oral conditions was attributed to between-stratum differences. In addition, the PCVs from the simple intersectional model to the intersectional interaction model showed that 84.1%-97.1% of the stratum-level variance in the presentation of oral conditions was attributed to the additive effects of gender, SEP, race/ethnicity and nationality. The point estimates of the predictions for some intersectional strata were suggestive of an intersectional interaction effect. However, the 95% credible intervals were very wide and the estimations inconclusive. CONCLUSIONS: This analysis highlights the value of the intersectionality framework to understand heterogeneity in social inequalities in oral health. These inequalities were mainly due to the additive effect of the social identities defining the intersectional strata, with no evidence of interaction effects.

Is social origin, destination or mobility what matters to adult self-rated oral health?

OBJECTIVES: To evaluate the independent contributions of parental socioeconomic position (SEP), own SEP and social mobility to explain adult self-rated oral health. METHODS: Data from 6633 participants in the 1970 British Cohort Study were analysed. Parental SEP at the age of 10 years (social origin) and own SEP at the age of 46 years (social destination) were indicated by the 7-class National Statistics Socioeconomic Classification (NS-SEC). The study outcome was self-rated oral health (SROH) at the age of 46 years. Diagonal reference models (DRMs) were used to parse out the effects of parental SEP, own SEP and intergenerational mobility from childhood to middle adulthood, after adjusting for demographic characteristics (sex, ethnicity, country and area of residence). RESULTS: Overall, 23.1% of participants reported poor SROH. A baseline DRM, with no indicators of social mobility, showed that the contribution of own SEP to explain variations in SROH was higher than that of parental SEP. However, they became almost equal after indicators of social mobility were introduced. Downward mobility was associated with poor SROH (odds ratio: 1.24, 95% CI: 1.01-1.51), but upward mobility was not (1.01, 95% CI: 0.83-1.23). Also, short-range downward mobility and long-range downward mobility (moving 1 and 2+ social classes down in NS-SEC, respectively) were associated with poor SROH (1.26, 95% CI: 1.01-1.58 and 1.39, 95% CI: 1.06-1.83, respectively) whilst short-range upward mobility (1.04, 95% CI: 0.84-1.28) and long-range upward mobility (0.88, 95% CI: 0.67-1.14) were not. CONCLUSIONS: The contributions of parental and own SEP were similar once social mobility was accounted for. Only downward mobility was associated with poor SROH, with new evidence that long-range mobility was more strongly associated with poor SROH than short-range mobility.

The Intersections of Ethnicity, Nativity Status and Socioeconomic Position in Relation to Periodontal Status: A Cross-Sectional Study in London, England.

The role of migration as a social determinant of periodontitis has been overlooked. Intersectionality theory could help understand how immigration status interacts with other social determinants of health to engender inequalities in periodontitis. The objective of the present study was to evaluate whether ethnicity, nativity status and socioeconomic position intersect to structure social inequalities in periodontal status. Data from 1936 adults in a deprived and multi-ethnic area of London were analysed. The numbers of teeth with probing depth and clinical attachment loss were determined from clinical examinations. A matrix with 51 intersectional strata, defined according to ethnicity, nativity status and education, was created. A cross-classified multilevel analysis, with participants clustered within intersectional social strata, was performed to assess the extent to which individual differences in periodontal measures were at the intersectional strata level. A complex pattern of social inequalities in periodontal status was found, which was characterised by high heterogeneity between strata and outcome-specificity. The variance partition coefficient of the simple intersectional model, which conflated additive and interaction effects, indicated that 3-5% of the observed variation in periodontal measures was due to between-stratum differences. Moreover, the percentual change in variance from the simple intersectional to the intersectional interaction model indicated that 73-74% of the stratum-level variance in periodontal measures was attributed to the additive effects of ethnicity, nativity status and education. This study found modest evidence of intersectionality among ethnicity, nativity status and education in relation to periodontal status.

Intragenerational social mobility and self-rated oral health in the british cohort study.

BACKGROUND: Most studies on social mobility and oral health have focused on movement between generations (intergenerational mobility) rather than movement within an individual's own lifetime (intragenerational mobility). The aim of this study was to investigate the association between intragenerational social mobility from early to middle adulthood and self-rated oral health. METHODS: This study used data from 6524 participants of the 1970 British Birth Cohort Study, an ongoing population-based birth cohort of individuals born in England, Scotland and Wales. Participants' socioeconomic position was indicated by occupational social class at age 26 and 46 years (the first and latest adult waves, respectively). Self-rated oral health was measured at age 46 years. The association between social mobility and adult oral health was assessed using conventional regression models and diagonal reference models, adjusting for gender, ethnicity, country of residence and residence area. RESULTS: Over a fifth of participants (22.2%) reported poor self-rated oral health at age 46 years. In conventional regression analysis, the odds ratios for social mobility varied depending on whether they were adjusted for social class of origin or destination. In addition, all social trajectories had greater odds of reporting poor oral health than non-mobile adults in class I/II. In diagonal reference models, both upward (Odds Ratio 0.79; 95% CI 0.63-0.99) and downward mobility (0.90; 95% CI 0.71-1.13) were inversely associated with poor self-rated oral health. The origin weight was 0.48 (95% CI 0.33-0.63), suggesting that social class of origin was as important as social class of destination. CONCLUSION: This longitudinal analysis showed that intragenerational social mobility from young to middle adulthood was associated with self-rated oral health, independent of previous and current social class.

Ethnic differences in treatment preferences among adults in East London.

Aim To explore ethnic differences in treatment preferences among adults.Methods A sample of 1,764 adults from ten ethnic groups were recruited from the adult population in Outer North East London using stratified multistage random sampling. Treatment preferences for a front tooth, a back tooth and an aching back tooth were collected via questionnaires. Ethnic differences in treatment preferences were assessed in regression models adjusting for demographic characteristics, socioeconomic indicators, dental visiting behaviour and clinical dental status.Results Ethnic differences in treatment preferences were observed, albeit only for back not front teeth. Compared to White British, Black African (odds ratio: 0.85; 95% confidence interval [CI]: 0.74-0.97), Caribbean (0.71; 95% CI: 0.51-0.98) and Other (0.73; 95% CI: 0.61-0.87) were less likely to preserve a back tooth. If the back tooth was aching, Black Others were still less likely (0.82; 95% CI: 0.71-0.93) to opt for restorative than surgical treatment. On the contrary, Bangladeshi were more likely (1.14; 95% CI: 1.06-1.22) to preserve a painful back tooth than White British.Conclusion Differences in treatment preferences were found among ethnic groups, suggesting that cultural background might influence the choices made and the value placed on dental extractions versus restorative treatment.

Is grandparents' social class associated with adult grandchildren's oral health? Analysis of two British cohorts.

OBJECTIVES: No studies have taken a multigenerational approach to the study of oral health inequalities. This study investigated whether grandparents' social class was associated with adult grandchildren's oral health. METHODS: Data from the 1958 National Child and Development Study (NCDS) and the 1970 British Cohort Study (BCS) were analysed. Cohort members' occupational social class and persistent trouble with mouth, teeth or gums in the past 12 months were reported at ages 33 years in the NCDS and 26 years in the BCS. Information on grandparents' and parents' social class was reported by the cohort members' mothers during childhood. The association between grandparents' social class and cohort members' report of persistent trouble with mouth, teeth or gums was tested in marginal structural models (MSMs). RESULTS: Data from 9853 NCDS and 6487 BCS participants were analysed. Grandparents' social class was not associated with cohort members' report of persistent trouble with teeth, gums or mouth in the NCDS sample (odds ratios of 1.25 [95% Confidence Interval: 0.95-1.65] for social class IV/V and 1.12 [95% CI: 0.76-1.64] for social class IIINM-M relative to social class I/II) or the BCS sample (odds ratios of 0.98 [95% CI: 0.68-1.43] for social class IV/V and 0.88 [95% CI: 0.67-1.16] for social class IIINM-M relative to social class I/II). CONCLUSION: This study provided no support for an independent association between grandparents' social class and adult grandchildren's oral health.

Socioeconomic inequalities in adult oral health across different ethnic groups in England.

BACKGROUND: Ethnic inequalities in oral health among British adults remain largely unexplored. This study explored the role of socioeconomic position (SEP) in explaining ethnic inequalities in oral health; and the consistency of socioeconomic inequalities in oral health across ethnic groups. METHODS: Data from 45,599 adults, aged 16 years and over, who participated in the Health Survey for England were pooled across 5 years. The seven ethnic groups included were White British, Irish, Black Caribbean, Indian, Pakistani, Bangladeshi and Chinese. Edentulousness and toothache were the outcome measures. A composite measure of SEP was developed based on education, social class, income and economic activity using confirmatory factor analysis. Ethnic inequalities in oral health were assessed in logistic regression adjusting for sex, age, survey year and SEP. RESULTS: Indian (OR: 0.55, 95%CI: 0.40-0.76), Pakistani (0.56, 0.38-0.83), Bangladeshi (0.35, 0.23-0.52) and Chinese (0.41, 0.25-0.66) were less likely to be edentulous than White British after controlling for SEP. Irish (1.22, 1.06-1.39) and Caribbean (1.37, 1.19-1.58) were more likely and Bangladeshi (0.83, 0.69-0.99) were less likely to have toothache than White British after controlling for SEP. Socioeconomic inequalities in edentulousness were consistently found across almost all ethnic groups while socioeconomic inequalities in toothache were found among White British and Irish only. CONCLUSION: This study shows that the role of SEP in explaining ethnic inequalities in oral health depended on the outcome being investigated. Socioeconomic inequalities in oral health among minority ethnic groups did not consistently reflect the patterns found in White British.

Racial Discrimination and Uptake of Dental Services among American Adults.

This study examined the relationship between racial discrimination and use of dental services among American adults. We used data from the 2014 Behavioral Risk Factor Surveillance System, a health-related telephone cross-sectional survey of a nationally representative sample of adults in the United States. Racial discrimination was indicated by two items, namely perception of discrimination while seeking healthcare within the past 12 months and emotional impact of discrimination within the past 30 days. Their association with dental visits in the past year was tested in logistic regression models adjusting for predisposing (age, gender, race/ethnicity, income, education, smoking status), enabling (health insurance), and need (missing teeth) factors. Approximately 3% of participants reported being discriminated when seeking healthcare in the past year, whereas 5% of participants reported the emotional impact of discrimination in the past month. Participants who experienced emotional impact of discrimination were less likely to have visited the dentist during the past year (Odds Ratios (OR): 0.57; 95% CI 0.44-0.73) than those who reported no emotional impact in a crude model. The association was attenuated but remained significant after adjustments for confounders (OR: 0.76, 95% CI 0.58-0.99). There was no association between healthcare discrimination and last year dental visit in the fully adjusted model. Emotional impact of racial discrimination was an important predictor of use of dental services. The provision of dental health services should be carefully assessed after taking account of racial discrimination and its emotional impacts within the larger context of social inequalities.

Ethnicity, migration status and dental caries experience among adults in East London.

OBJECTIVE: To assess the interrelationship between ethnicity, migration status and dental caries experience among adults in East London. METHODS: We analysed data from 1910 adults (16-65 years) representing 9 ethnic groups, who took part in a community-based health survey in East London. Participants completed a supervised questionnaire and were clinically examined by trained dentists. Dental caries was assessed with the number of decayed, missing and filled teeth (DMFT). The association of ethnicity, nativity status and migration history with DMFT was assessed in negative binomial regression models controlling for demographic, socioeconomic and behavioural factors. RESULTS: White migrants had greater DMFT than UK-born adults, whereas every Asian and Black migrant group had lower DMFT than adults of the same ethnic group born in the UK (albeit significant only for Black Caribbean and Asian Others). Among foreign-born adults, age at arrival (Rate Ratio: 1.03; 95% Confidence Interval: 1.01-1.05) and length of residence (1.04; 95% CI: 1.02-1.06) were positively associated with DMFT. A significant interaction between both factors was also found, with more pronounced differences between older and younger migrants at longer stay in the UK for White Others, Black Caribbean and Asian Others. CONCLUSION: Large inequalities in caries experience were found between foreign- and UK-born adults, with considerable variation across ethnic groups. Looking beyond cultural explanations, in favour of social and environmental factors, may help to explain those inequalities.

Oral impacts on quality of life and problem-oriented attendance among South East London adults.

BACKGROUND: Dental care seeking behaviour is often driven by symptoms. The value of oral health related quality of life (OHRQoL) measures to predict utilisation of dental services is unknown. This study aims to explore the association between OHRQoL and problem-oriented dental attendance among adults. METHODS: We analysed cross-sectional data for 705 adults, aged 16 years and above, living in three boroughs of Inner South East London. Data were collected during structured interviews at home. The short form of the Oral Health Impact Profile (OHIP-14) was used to assess the frequency of oral impacts on daily life in the last year. Problem-oriented attendance was defined based on time elapsed since last visit (last 6 months) and reason for that visit (trouble with teeth). The association between OHIP-14 (total and domain) scores and problem-oriented attendance was tested in logistic regression models adjusting for participants' sociodemographic characteristics. RESULTS: Problem-oriented attenders had a higher OHIP-14 total score than regular attenders (6.73 and 3.73, respectively). In regression models, there was a positive association between OHIP-14 total score and problem-oriented attendance. The odds of visiting the dentist for trouble with teeth were 1.07 greater (95% Confidence Interval: 1.04-1.10) per unit increase in the OHIP-14 total score, after adjustment for participants' sociodemographic characteristics. In subsequent analysis by OHIP-14 domains, greater scores in all domains but handicap were significantly associated with problem-oriented attendance. CONCLUSION: This study shows that oral impacts on quality of life are associated with recent problem-oriented dental attendance among London adults. Six of the seven domains in the OHIP-14 questionnaire were also associated with dental visits for trouble with teeth.

Ethnic inequalities in periodontal disease among British adults.

AIM: To explore ethnic inequalities in periodontal disease among British adults, and the role of socioeconomic position (SEP) in those inequalities. METHODS: We analysed data on 1925 adults aged 16-65 years, from the East London Oral Health Inequality (ELOHI) Study, which included a random sample of adults living in an ethnically diverse and socially deprived area. Participants completed a questionnaire and were clinically examined for the number of teeth with periodontal pocket depth (PPD)≥4 mm and loss of attachment (LOA)≥4 mm. Ethnic inequalities in periodontal measures were assessed in negative binomial regression models before and after adjustment for demographic (gender and age groups) and SEP indicators (education and socioeconomic classification). RESULTS: Compared to White British, Pakistani, Indian, Bangladeshi and Asian Others had more teeth with PPD≥4 mm whereas White East European, Black African and Bangladeshi had more teeth with LOA≥4 mm, after adjustments for demographic and SEP measures. The association of ethnicity with periodontal disease was moderated by education, but not by socioeconomic classification. Stratified analysis showed that ethnic disparities in the two periodontal measures were limited to more educated groups. CONCLUSION: This study showed considerable ethnic disparities in periodontal disease between and within the major ethnic categories.

Ethnic inequalities in dental caries among adults in East London.

BACKGROUND: This study explored ethnic inequalities in dental caries among adults and assessed the role of socioeconomic position (SEP) in explaining those inequalities. METHODS: We analysed data on 2013 adults aged 16-65 years, from the East London Oral Health Inequality (ELOHI) Study, which included a random sample of adults and children living in East London in 2009-10. Participants completed a questionnaire and were clinically examined for dental caries at home. Dental caries was measured using the number of decayed, missing and filled teeth or DMFT index. Ethnic inequalities in dental caries were assessed in negative binomial regression models before and after adjustment for demographic (sex and age groups) and SEP measures (education and socioeconomic classification). RESULTS: White Eastern European and White Other had higher DMFT, whereas all Asian (Pakistani, Indian, Bangladeshi and Other) and all Black (African, Caribbean and Other) ethnic groups had lower DMFT than White British. Similar inequalities were found for the number of filled and missing teeth, but there were no differences in the number of decayed teeth between ethnic groups. CONCLUSIONS: This study showed considerable disparities in dental caries between and within the major ethnic categories, which were independent of demographics and SEP.

The association of depression and anxiety with dental caries and periodontal disease among Finnish adults.

OBJECTIVE: To explore the association of depression and anxiety with two oral health outcomes, dental caries and periodontal disease and assess possible mediators for any of the associations. METHODS: Secondary analysis of the Finnish Health 2000 Survey. Depression was assessed with Beck's Depression Inventory and anxiety with Composite International Diagnostic Interview. Number of decayed teeth included carious lesions reaching dentine; periodontal disease was number of teeth with periodontal pockets of 4 mm or deeper. Third molars were excluded. The association of mental disorders and oral health was tested in regression models adjusted for confounders and potential mediators. RESULTS: Depression was associated with number of decayed teeth only among 35- to 54-year-olds. The association between anxiety and the number of decayed teeth was not statistically significant. Depression and periodontal pocketing were not significantly associated. CONCLUSION: Depression was significantly associated with number of decayed teeth only among participants aged 35-54 old and not with other age groups. Neither depression nor anxiety was significantly related to periodontal disease.

Income gradients in oral health according to child age.

This study aimed to confirm whether the well-known income disparities in oral health seen over the life course are indeed absent in 9- to 11-yr-old children, and to explore the role of access to dental care in explaining the age-profile of the income gradient in child oral health. We used data from the 2007 United States National Survey of Children's Health. Income gradients in parental reports of children's decayed teeth or cavities, toothache, broken teeth, bleeding gums, and fair/poor condition of teeth were assessed in stratified analyses according to age of child (1-5, 6-8, 9-11, 12-14, and 15-17 yr), using survey logistic regression to control for family-, parental-, and child-level covariates. Health insurance status and use of preventive dental care were the indicators for children's access to dental care. The adjusted ORs for the effect of family income on having decayed teeth or cavities, toothache, and fair/poor condition of teeth were not significant in 9- to 11-yr-old children. Different age-patterns were found for broken teeth and bleeding gums. The attenuation of the income gradients in having decayed teeth or cavities, toothache, and fair/poor condition of teeth, previously seen in 9- to 11-yr-old children, was also seen in 15- to 17-, 12- to 14-, and 6- to 8-yr-old children, respectively, after controlling for children's access to dental care. This study supports the attenuation of income inequalities in oral health in 9- to 11-yr-old children. Access to dental care could attenuate income gradients in oral health in other age groups.

Graduates' satisfaction with and attitudes towards a master programme in dental public health.

BACKGROUND: Monitoring graduates' views of their learning experiences is important to ensure programme standards and further improvement. This study evaluated graduates' satisfaction with and attitudes towards a Master programme in Dental Public Health. METHODS: An online questionnaire was sent to individuals who completed successfully the Master of Science programme in Dental Public Health at King's College London Dental Institute and had a valid email address. Participants provided information on demographic characteristics, satisfaction with and attitudes towards the programme. Satisfaction and attitudes scores were compared by demographic characteristics using multiple linear regression models. RESULTS: Satisfaction scores with the programme were high, with 92% of respondents reporting the programme had met or exceeded their expectations. Learning resources and quality of teaching and learning were the aspects of the programme graduates were most satisfied with. The main motivations for taking the programme were to progress in career path and improve employment prospects. As for attitudes, 70.7% of respondents would recommend this course to a colleague or a friend. There were no significant differences in satisfaction and attitude scores by graduates' demographic background. CONCLUSION: Graduates were satisfied with most aspects of the programme and reported positive attitudes towards it. This study highlights the value of using graduates' views for programme's improvement and the need for a regular monitoring of the programme.

Intergenerational mobility and adult oral health in a British cohort.

OBJECTIVES: This study aimed to characterize trajectories of intergeneration mobility from birth to age 33 years and to assess the influence of these trajectories on adult oral health. METHODS: Repeated data on occupational social class (birth and 7, 11, 16, 23 and 33 years) and two subjective oral health indicators (lifetime and past-year prevalence of persistent trouble with gums or mouth) measured at age 33 years, from the 1958 National Child Development Study, were used for this analysis. Latent class growth analysis (LCGA) was used to identify different trajectories of exposure to manual social class over time. Binary logistic regression was then used to explore the association between these trajectories and each oral health indicator, adjusting for participants' sex. RESULTS: Latent class growth analysis showed that a four trajectory model provided the best fit to the data. The four trajectories that emerged were identified as stable manual, stable nonmanual, late steep increase (those who were likely to be in the manual social class until age 16 years but ended up in the nonmanual social class afterwards) and steady increase (those whose likelihood of leaving the manual social class increased gradually over time). Lifetime and past-year prevalence of persistent trouble with gums or mouth was significantly higher in the stable manual trajectory than in all other trajectories. No differences were found between the stable nonmanual, late steep increase and steady increase trajectories. CONCLUSION: Although four distinctive trajectories were identified in the 1958 NCDS, only those who remained in the manual social class over time reported worse oral health by age 33 years. Proximal socioeconomic experiences may be more relevant to adult oral health than early life experiences.

Daily smoking and 4-year caries increment in Finnish adults.

OBJECTIVES: Although the harmful effects of smoking on periodontal disease and oral cancer are now indisputable, its effect on dental caries is less well known. This study assessed whether daily smoking predicts caries increment in adults over 4 years. METHODS: Data from 955 adults who participated in both the Health 2000 Survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed. At baseline, participants provided information on demographic characteristics, education and dental behaviours. The 4-year net increment in the numbers of decayed (DT), filled (FT) and missing (MT) teeth and the DMFT index were calculated using the data from baseline and follow-up clinical oral examinations. RESULTS: Daily smoking was not associated with net DMFT increment. In subsequent analysis by components, daily smoking was associated with net DT increment, but not with net FT or MT increments. When daily smokers were split into two groups by consumption level (1-19 and 20+ cigarettes/day) and compared to nondaily smokers, a significant dose-response relationship was additionally found between levels of tobacco consumption and net DT increment. Although daily smokers reported less favourable behaviours than nonsmokers, these associations only explained partially the effect of daily smoking on net DT increment. CONCLUSIONS: Daily smoking was independently related to caries development (net DT increment) in adults over 4 years, but not to caries treatment (net FT and MT increments) or caries experience (net DMFT increment).