GOLD COAST, Australia: High socioeconomic status has often been associated with better health outcomes. However, according to a global study of 30 countries, affluence may also predispose people to oral conditions such as cavities and tooth wear, since children with high household incomes enjoy increased access sugary or acidic drinks such as soft drinks, energy drinks and packaged juices.
Dr Khaled Ahmed, Head of Internationalization and Senior Lecturer in Prosthodontics at Griffith University Gold Coast School of Medicine and Dentistry, is the study’s principal investigator. He has had a long-standing interest in tooth wear since 2007 when he completed postgraduate training at the School of Dental Sciences at Newcastle University in the UK. “This was my first attempt at a full mouth rehabilitation of a case of severe tooth wear. It took over 16 months to complete, but the pronounced transformation dentally and in patient confidence and satisfaction towards her appearance was both overwhelming and heartwarming,” he told Dental Tribune International.
He then chose tooth wear as a research topic for his PhD while teaching at Glasgow University Dental School and was a member of one of the first research groups to use digital dentistry to monitor clinically the progression of tooth wear in patients. Nowadays, he remains curious about the subject and continues to research it. He explained, “My interest in tooth wear has not waned over the years, and as a dental condition, it continues to intrigue me. It demonstrates how the impact of lifestyle factors such as diet, wealth, underlying medical and mental health issues, oral hygiene practices, habits, hobbies and occupations can manifest dentally for many years.
Socio-economic status and dental wear: is there a correlation?
In the study, Dr. Ahmed and fellow researchers from Griffith University and the National Institute of Dental Research in Singapore sought to examine the link between socioeconomic status and tooth wear in children and the adults. In total, they analyzed 65 studies involving 64,000 participants and found that children who attend private schools or who have a high family income are more susceptible to tooth wear than those from lower socioeconomic backgrounds. Additionally, they reported that increased access to soft drinkenergy drinks and packaged juices increased the risk of cavities in rich countries, predisposing their populations to a higher risk of erosion.
The study also found that teenagers whose parents had higher levels of education and wealth and who attended private schools had a greater prevalence of tooth wear, while adults who had a college education had reduced risk of developing tooth wear.
Discussing the findings, Dr. Ahmed noted that he found it fascinating to see how socioeconomic status and wealth on a global scale can determine the risk of tooth wear as a function of age, whether it be l childhood or adulthood. He explained that several studies had previously sought to investigate the link, but had come up with conflicting results.
Speaking of the research, he commented: “Identifying these studies, synthesizing and analyzing them, and then merging the results to discern a global link was a daunting task.” However, he noted that it was worth it, as the study is the first definitive assertion of wealth as a risk factor in children from families with high socioeconomic status, with the reverse being true for adults. “When we embarked on this research project, we had an open approach. Nevertheless, I had an idea that this might be the result,” Dr Ahmed said.
The impact of diet on children’s teeth
According to the researchers, the study has three main recommendations. First, regarding public policy initiatives, Dr. Ahmed believes that the confirmed link between tooth wear and wealth supports a mandate to review access to acidic foods such as soft drinks and packaged fruit juices. While some of them contain little or no sugar, they are still harmful to oral health due to their acidity.
“Wealth does not translate into better oral health without awareness and consistent access to dental care”
Secondly, from a pedagogical point of view, the study shows a strong need to sensitize the public to the impact of diet on children’s teeth. This does not only include sweet foods, but acidic foods as well. “Wealth does not translate into better oral health without awareness and consistent access to dental care,” Dr. Ahmed noted.
Finally, from a professional point of view, dental professionals should perform oral health screenings for tooth wear in patients and include socioeconomic status as a risk factor. As Dr. Ahmed said, “Early diagnosis and management can prevent long-term and irreversible damage to the dentition that will be difficult to treat later due to its biological and financial cost.
A journey to healthy teeth
In addition to socioeconomic status, other major factors including caries experience, fluoridation, access to dental care, education, oral hygiene practices, and obesity have previously been associated with tooth wear. Although some countries are becoming more aware of the harmful effects of sugar on oral health and offer dietary, low-sugar or sugar-free alternatives to sugary drinks, which remain acidic. However, Dr Ahmed believes that the introduction of a sugar tax, which has been imposed in countries such as South Africa, Australia, UK and Singapore, is a step in the right direction, especially when combined with awareness campaigns and advertising regulation. However, the extent of its effect remains to be seen.
The study, titled “Tooth wear and socioeconomic status in childhood and adulthood: results of a systematic review and meta-analysis of observational studies”, was posted on September 30, 2021 in the journal of dentistrybefore inclusion in an issue.