Title:

The Biology of Social Adversity in Oral Disease

Department: Dentistry
Issue Date: Nov-2018
Abstract (summary): Several pathways have been proposed to explain the relationship between adverse social and living conditions and oral health outcomes. However, little is known about the underlying biological mechanisms by which the social “gets under the skin” to bring about oral diseases. This work aims to investigate the pathobiological pathways by which adverse social exposures (focusing on socioeconomic position), become embodied in oral and systemic inflammation. The specific objectives are to: (1) evaluate the evidence on social-biological interactions in oral disease; (2) assess the contribution of socioeconomic factors to the association between periodontal and systemic inflammation; (3) assess socioeconomic differences in periodontal and oral immune parameters; and (4) examine the contribution of psychosocial stress factors and the activation of the stress pathway in these relationships. To do this, we first conducted a systematic review, based on which a conceptual model was plotted, followed by an analysis of secondary NHANES IV data where the contribution of socioeconomic position to the relationship between periodontal and systemic inflammation was assessed. Finally, an analysis of primary data was conducted to assess the socioeconomic differences in periodontal disease and oral immune outcomes and the contribution of financial stress, perceived stress and the stress hormone cortisol to these differences. Overall, the results showed that socioeconomic factors attenuate the relationship between periodontal disease and systemic inflammation, and that individuals on the lower rungs of the socioeconomic hierarchy are at a greater risk for a pro-inflammatory oral immune system that potentially increases their vulnerability to periodontal tissue damage. This relationship was significantly attenuated by the effect of financial and perceived stress and cortisol, indicating a biopsychosocial pathway between socioeconomic exposures and periodontal disease. Collectively, the results from this work show that the socioeconomic, psychosocial and biological factors have a convergent role in the oral disease process. Integrated policy solutions that target these underlying factors in oral disease and associated inequalities are required.
Content Type: Thesis

Permanent link

https://hdl.handle.net/1807/91830

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