Abstract
Oral diseases constitute a major worldwide public health problem, with their burden concentrating in socially disadvantaged and less affluent groups of the population, resulting in significant oral health inequalities. Biomedical and behavioural approaches have proven relatively ineffective in reducing these inequalities, and have potentially increased the health gap between social groups. Some suggest this stems from a lack of understanding of how the social and psychosocial contexts in which behavioural and biological changes occur influence oral disease. To unravel the pathways through which social factors affect oral health outcomes, a better understanding is thus needed of how the social ‘gets under the skin,’ or becomes embodied, to alter the biological. In this paper, we present the current knowledge on the interplay between social and biological factors in oral disease. We first provide an overview of the process of embodiment in chronic disease and then evaluate the evidence on embodiment in oral disease by reviewing published studies in this area. Results show that, in periodontal disease, income, education and perceived stress are correlated with elevated levels of stress hormones, disrupted immune biomarkers and increased allostatic load. Similarly, socioeconomic position and increased financial stress are related to increased stress hormones and cariogenic bacterial counts in dental caries. Based on these results, we propose a dynamic model depicting social-biological interactions that illustrates potential interdependencies between social and biological factors that lead to poor oral health. This work and the proposed model may aid in developing a better understanding of the causes of oral health inequalities and implicate the importance of addressing the social determinants of oral health in innovating public health interventions.
Highlights
Oral diseases are some of the most common chronic conditions around the world [1]
Social-Biological Interactions for example, over 95 percent of adults are affected by untreated coronal decay and/or periodontitis, with the burden of disease concentrating in individuals of lower income and education, those who lack dental insurance, and those who decline recommended dental care because of costs [3]
Extensive research has shown that while periodontal conditions are initiated by dental plaque, perpetuation of inflammation and the severity and progression of the disease depends upon the effectiveness of the innate immune response to the bacterial biofilm [5,6,7]
Summary
Oral diseases are some of the most common chronic conditions around the world [1]. Despite the advent of preventive and therapeutic dentistry, oral diseases continue to place a heavy toll on socially disadvantaged groups, creating persistent social gaps in oral health [2]. Social-Biological Interactions for example, over 95 percent of adults are affected by untreated coronal decay and/or periodontitis, with the burden of disease concentrating in individuals of lower income and education, those who lack dental insurance, and those who decline recommended dental care because of costs [3] Such inequalities have led several national and international institutions, such as the Public Health Agency of Canada (PHAC), World Health Organization (WHO) and International Association for Dental Research (IADR), to call for a better understanding of the causal pathways in oral disease to inform public health policy and to guide new and innovative public health interventions [4]. Addressing these factors alone as the causes of oral disease has resulted in reductionist approaches to prevention and treatment that often lack a sound theoretical basis, and that have generally been unsuccessful in reducing the burden of oral disease and oral health inequalities [11]
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