Studies have postulated a role for cognitive ability in socio-economic inequalities in general health. This role has not been examined for oral health inequalities. We examined whether cognitive ability was associated with oral health, and whether it influenced the relationship between oral health and socio-economic position. Data were from the Third National Health and Nutrition Examination Survey (1988–1994), for participants aged 20–59 years. Oral health was indicated by extent of gingival bleeding, extent of loss of periodontal attachment, and tooth loss. Simple reaction time test, symbol digit substitution test, and serial digit learning test indicated cognitive ability. Education and poverty-income ratio were used as markers of socio-economic position. Participants with poorer cognitive ability had poorer oral health for all indicators. The association between oral health and socio-economic position attenuated after adjustment for cognitive ability. Cognitive ability explained part, but not all, of the socio-economic inequalities in oral health.
Get full access to this article
View all access options for this article.
References
1.
Avlund K, Holm-Pederson P, Morse, DE, Viitanen M, Winblad B -2004-. Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability. Gerodontology21:17–26.
2.
Berkman LF, Kawachi I -2000-. Social epidemiology. New York: Oxford University Press.
3.
Chalmers JM, Carter KD, Spencer AJ -2002- Caries incidence and increments in community-living older adults with and without dementia. Gerodontology19:80–94.
4.
Deary IJ -2005-. Intelligence, health and death: the new field of cognitive epidemiology. Psychologist18:610–613.
5.
Gilbert GH, Duncan RP, Shelton BJ -2003-. Social determinants of tooth loss. Health Serv Res38:1843–1862.
6.
Gottfredson LS, Deary IJ -2004-. Intelligence predicts health and longevity, but why? Curr Direct Psychol Sci13:1–4.
7.
Gregg EW, Yaffe K, Cauley JA, Rolka DB, Blackwell TL, Narayan KM, et al. -2000-. Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group. Arch Intern Med160:174–180.
8.
Kim JM, Stewart R, Prince M, Kim SW, Yang, SJ, Shin IS, et al. -2007- Dental health, nutritional status and recent-onset dementia in a Korean community population. Int J Geriatr Psychiatry22:850–855.
9.
Kivimaki M, Lawlor DA, Davey Smith G, Kouvonen A, Virtanen M, Elovainio M, et al. -2007-. Socioeconomic position, co-occurrence of behavior risk factors, and coronary heart disease: the Finnish Public Sector Study. Am J Public Health97:874–879.
10.
Knopman D, Boland LL, Mosley T, Howard G, Liao D, Szklo M, et al. -2001-. Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology56:42–48.
11.
Krieg EF Jr, Chrislip DW, Letz RE, Otto DA, Crespo CJ, Brightwell WS, et al. -2001-. Neurobehavioral test performance in the third National Health and Nutrition Examination Survey. Neurotoxicol Teratol23:569–589.
12.
Locker D -2000-. Deprivation and oral health: a review. Community Dent Oral Epidemiol28:161–169.
13.
Lopez R, Fernandez O, Baelum V -2006-. Social gradients in periodontal diseases among adolescents. Community Dent Oral Epidemiol34:184–196.
14.
Marmot M, Wilkinson R -2006-. Social determinants of health. Oxford: Oxford University Press.
15.
Miller AJ, Brunelle JA, Carlos JP, Brown LJ, Löe H -1987-. Oral health of the United States adults. The national survey of oral health in US employed adults and seniors, 1985–86. Bethesda, MD: National Institute of Dental Research. NIH pub no 87–2868.
Newton JT, Bower EJ -2005-. The social determinants of oral health: new approaches to conceptualizing and researching complex causal networks. Community Dent Oral Epidemiol33:25–34.
18.
Sabbah W, Tsakos G, Chandola T, Sheiham A, Watt RG -2007-. Social gradients in oral and general health. J Dent Res86:992–996.
19.
Sanders AE, Slade GD, Turrell G, Spencer AJ, Marcenes W -2006-. The shape of the socioeconomic-oral health gradients: implications for theoretical explanations. Community Dent Oral Epidemiol34:310–319.
20.
Shimazaki Y, Soh I, Saito T, Yamashita Y, Koga T, Miyazaki H, et al. -2001-. Influence of dentition status on physical disability, mental impairment, and mortality in institutionalized elderly people. J Dent Res80:340–345.
21.
Ship JA, Puckett SA -1994-. Longitudinal study on oral health in subjects with Alzheimer’s disease. J Am Geriatr Soc42:57–63.
22.
Singh-Manoux A, Ferrie JE. Lynch JW, Marmot M -2005-. The role of cognitive ability -intelligence- in explaining the association between socioeconomic position and health: evidence from the Whitehall II Prospective Cohort Study. Am J Epidemiol161:831–839.
23.
Slade GD, Beck JD -1999-. Plausibility of periodontal disease estimates from NHANES III. J Public Health Dent59:67–72.
24.
Stewart R, Hirani V -2007-. Dental health and cognitive impairment in an English national survey population. J Am Geriatr Soc55:1410–1414.
25.
Suhr JA, Stewart JC, France CR -2004-. The relationship between blood pressure and cognitive performance in the Third National Health and Nutrition Examination Survey -NHANES III-. Psychosom Med66:291–297.
26.
U.S. Department of Health and Human Services -DHHS- -1997-. National Center for Health Statistics. Third National Health and Nutrition Examination Survey, 1988–1994, NCHS CD-ROM Series 11, No 1 Version 1.22a. Public Use Data File Documentation Number 76200. Hyattsville, MD: Centers for Disease Control and Prevention.
27.
van Oort FVA, van Lenthe FJ, Mackenbach JP -2005-. Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in the Netherlands. J Epidemiol Community Health59:214–220.
