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Is dietary pattern a mediator of the relationship between socioeconomic status and dental caries?

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Abstract

Objective

To investigate whether a healthy diet and added sugar mediate the relationship between socioeconomic status and oral health status in adults.

Methods

This is a secondary cross-sectional analysis of adult participants from the 2015–2016 National Health and Nutrition Examination Survey from the United States (n=3367). Structural equation modeling tested direct and indirect pathways from a latent variable for socioeconomic status to oral health via healthy eating (Health Eating Index) and added sugar in a multiple-mediator multiple-outcome model.

Results

Added sugar was directly associated with untreated dental caries [Standardized coefficient (SC)=0.10], and healthy eating was directly associated with both untreated dental caries (SC=–0.11) and tooth loss (SC=–0.05). Higher socioeconomic status was associated with lower untreated dental caries through direct (SC =–0.246) and small indirect paths via healthy diet (SC= –0.026), lower consumption of added sugar (SC=–0.007), and dental visits (SC=–0.162). Higher socioeconomic status was associated with fewer teeth lost through direct (SC =–0.306) and very small indirect paths via healthy diet (SC=–0.016), added sugar consumption (SC=–0.001), and untreated dental caries (SC=–0.094).

Conclusions

Both socioeconomic status and dietary pattern independently contributed to tooth loss and dental caries. The contribution of dietary factors as a mediator to socioeconomic inequities in oral health was small, and statistically significant.

Clinical Relevance

A systems approach to socioeconomic inequities in oral health takes into account the complex relationships between socioeconomics, dietary patterns, oral health and health. Socioeconomic conditions and nutrition, as common risk factors to noncommunicable disorders, should be tackled in programs to improve oral health.

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Funding

National Health and Nutrition Examination Survey is funded by the National Center for Health Statistics (NCHS) which is part of the Centers for Disease Control and Prevention (CDC).

CS holds a fellowship from the Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES); FNH holds a PQ-2 fellowship from the Brazilian National Council for Scientific and Technological Development (CNPq).

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Authors and Affiliations

  1. Postgraduate Program in Dentistry, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2492, Santa Cecília, Porto Alegre, RS, Brazil

    Caroline Stein & Fernando Neves Hugo

  2. Department of Oral Health Sciences, School of Dentistry and Department of Health Services, School of Public Health University of Washington, Seattle, WA, USA

    Joana Cunha-Cruz

  3. Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Fernando Neves Hugo

Authors
  1. Caroline Stein
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  2. Joana Cunha-Cruz
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  3. Fernando Neves Hugo
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Correspondence to Caroline Stein.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the primary study.

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Stein, C., Cunha-Cruz, J. & Hugo, F.N. Is dietary pattern a mediator of the relationship between socioeconomic status and dental caries?. Clin Oral Invest 25, 5441–5447 (2021). https://doi.org/10.1007/s00784-021-03852-5

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