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Sex differences in dental caries experience: clinical evidence, complex etiology

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Abstract

A sex difference in oral health has been widely documented through time and across cultures. Women's oral health declines more rapidly than men's with the onset of agriculture and the associated rise in fertility. The magnitude of this disparity in oral health by sex increases during ontogeny: from childhood, to adolescence, and through the reproductive years. Representative studies of sex differences in caries, tooth loss, and periodontal disease are critically reviewed. Surveys conducted in Hungary, India, and in an isolated traditional Brazilian sample provide additional support for a significant sex bias in dental caries, especially in mature adults. Compounding hormonal and reproductive factors, the sex difference in oral health in India appears to involve social and religious causes such as son preference, ritual fasting, and dietary restrictions during pregnancy. Like the sex difference in caries, tooth loss in women is greater than in men and has been linked to caries and parity. Results of genome wide association studies have found caries susceptible and caries protective loci that influence variation in taste, saliva, and enamel proteins, affecting the oral environment and the micro-structure of enamel. Genetic variation, some of which is X-linked, may partly explain how sex differences in oral health originate. A primary, but neglected, factor in explaining the sex differential in oral health is the complex and synergistic changes associated with female sex hormones, pregnancy, and women's reproductive life history. Caries etiology is complex and impacts understanding of the sex difference in oral health. Both biological (genetics, hormones, and reproductive history) and anthropological (behavioral) factors such culture-based division of labor and gender-based dietary preferences play a role.

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Notes

  1. The terms ‘sex’ and ‘gender’ connote biological and cultural distinctions between females and males, respectively [61, 62]. Because this contribution focuses on the influence of basic sex-related biological factors on differences in caries experience and associated oral health factors, I have opted to use the term sex rather than gender in this contribution. Exceptions occur when directly referring to a publication that uses the term gender, as in the title “Using the DMF gender difference to assess the...” or the phrase ‘...the gender gap in oral health...’ [1].

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Acknowledgments

Sections of this review were presented at professional meetings of the Australasian Society for Human Biology (Auckland, NZ; December 2003), the Canadian Association of Physical Anthropologists (Edmonton, Canada; October 2003), the 16th meeting of the European Paleopathology Association (Santorini, Greece; August 2006), the American Association of Physical Anthropologists (Philadelphia, PA; April 2007), and the 14th International Symposium on Dental Morphology (Griefswald, Germany; August 2008). Thanks to Prof. Dr. Kurt W. Alt for inviting me to contribute an article on sex differences in dental caries to this special issue of Clinical Oral Investigations.

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The author declares that he has no conflict of interest.

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  1. Department of Anthropology, University of Oregon, Eugene, 97403, OR, USA

    John R. Lukacs

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Lukacs, J.R. Sex differences in dental caries experience: clinical evidence, complex etiology. Clin Oral Invest 15, 649–656 (2011). https://doi.org/10.1007/s00784-010-0445-3

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