Abstract
The present study aimed at understanding the relationship between periodontitis and socio-contextual and individual determinants of health. Data from "The First Uruguayan Oral Health Survey, 2011", which included 223 and 455 individuals with 35-44 and 65-74 years old respectively, were used. A stratified, multistage cluster sampling design was adopted (cities with ≥ 20.000 residents). Periodontitis was assessed using the modified Community Periodontal Index (CPI) and clinical attachment loss (CAL) (periodontal pocket and CAL ≥ 4 mm). Independent variables included contextual socioeconomic status (SES) measured by proportion of houses with Unsatisfied Basic Needs (UBN) and individual demographic and behavioral factors. Logistic regression multilevel models were generated. Living in contexts with a higher UBN was associated with higher odds for periodontitis in both age groups, even when adjusting for individual level variables (odds ratio [OR] = 1.51, 95%CI = 1.42-1.60 and 1.31, 95%CI = 1.21-1.42, respectively). Being male or heavy smoker increased the odds of periodontitis in this population for both age groups. Social structure impacts periodontal disease by modifying individual socioeconomic situations: in better socioeconomic context, UBN acts increasing the protector role of socioeconomic situation but in a poverty context the role is attenuated. Conclusions for this study are that periodontitis varies across contextual socio-demographic groups being higher in the population with a lower SES, challenging health authorities to integrate oral health into national non-communicable diseases programs.
Highlights
Periodontitis is a chronic inflammatory disease caused by bacterial infection of the supporting tissues around teeth.[1]
The characteristics of the sample compared to the Uruguayan population data that was available is shown in Table 3; the sample was in concordance with data from the 2011 Uruguayan census
Our results have contributed to improving the understanding of periodontitis as a socially related condition, providing useful information for planning health interventions within the national health system recently developed in Uruguay.[23]
Summary
Periodontitis is a chronic inflammatory disease caused by bacterial infection of the supporting tissues around teeth.[1]. Chronic diseases, such as periodontitis, explains the pathways through which social structure, behavioral, and genetic factors may influence periodontitis and how these factors may interrelate. This model postulates that social structure impacts periodontitis through material and contextual factors and that health behaviors influence pathophysiological changes.[4] the individual micro-level and group-level characteristics are accounted for at the same time;[5] as a consequence, methodological aspects become relevant when considering individual and contextual variables in order to deal with multi-level data[5]. It has been observed that periodontitis is more common in relatively socially deprived population groups.[6,7]
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