Social position, social ties and adult’s oral health: 13 year cohort study

Objectives This study explored different pathways by which social position and social ties influence adult’s oral health over a 13-year period. Methods A cohort investigation (Pro-Saúde Study) was conducted of non-faculty civil servants at a university in Rio de Janeiro, Brazil (N = 1613). Baseline data collected in 1999 included age, social position, social ties, and access to dental care. Psychological factors and smoking were assessed in 2001, whereas tooth loss and self-rated oral health (SROH) were collected in 2012. A hypothesised model exploring different direct and indirect pathways was developed and tested using structural equation modelling. Results The model was a good fit to the data and accounted for 40% and 27% of the variance in tooth loss and SROH, respectively. A greater social position was linked to more social ties (β = 0.31), health insurance (β = 0.48), low psychological distress (β = 0.07), less smoking (β = −0.21), more regular dental visiting (β = 0.30), less tooth loss (β = −0.44) and better SROH (β = −0.25) over time. Social position (β = 0.0005) and social ties (β = −0.0015) were linked indirectly with psychological distress, smoking and tooth loss. Social position was linked indirectly with social ties, psychological distress and SROH (β = −0.0071). Conclusions Poor social position and weak social ties were important predictors for tooth loss and poor SROH in adults over the 13-year period. Direct and indirect pathways via psychological factors and smoking on the aforementioned relationships were identified, suggesting different areas of intervention to promote adults’ oral health. Clinical significance Adult’s oral health is influenced by social conditions through direct and indirect pathways, including via psychological factors and smoking