| Despite major advances in prevention and treatment of periodontal disease and dental caries over past decades, documented differences in the prevalence of dental disease by social class remain in the US remain substantial (Borrell 2002a and 2002b, DHHS 2000, Drury 1999 Brown 1996, Albandar 1999a). This dissertation describes three analyses using a large population-based US database (NHANES III) which investigate and define the pathways by which social class influences dental health. Specifically, these analyses explore (1) whether racial differences in tooth loss can be accounted for by differences in social class; (2) whether parity (number of children) influences the degree of a woman's tooth loss, and whether this relationship varies by social class, and (3) whether the majority of tooth loss in US adults is due to caries or to periodontal disease and how social class influences this relationship across the adult years. A theoretical model containing mediators of the social class-oral health relationship was created based on Adler's (Adler 1993) model for general health, and tested via robust regression path analysis. In addition, negative binomial regression analysis was used to evaluate the relationship of social class to dental disease and of the two major dental diseases, coronal dental caries and periodontal disease over the adult years. The major findings of these analyses are: (1) both social class and racial differences in dental health in the United States are profound; (2) social class differences do not account for racial disparities seen in dental disease, and mechanisms by which social class affects dental health vary by race; (3) parity is strongly related to dental disease in adult US women and the effect of parity does not vary by social class; (4) both caries and periodontal disease are related to tooth loss throughout adulthood; and (5) social class is complex and various measures should be evaluated when exploring dental health. Factors important in indicating social class are likely to vary by race and by age. |
