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.