Canadian Journal of Public Health

, Volume 108, Issue 3, pp e224–e228 | Cite as

How does the social “get under the gums”? The role of socio-economic position in the oral-systemic health link

  • Noha GomaaEmail author
  • Belinda Nicolau
  • Arjumand Siddiqi
  • Howard Tenenbaum
  • Michael Glogauer
  • Carlos Quiñonez
Quantitative Research


OBJECTIVES: To evaluate the extent of association between systemic inflammation and periodontal disease in American adults, and to assess whether socio-economic position mediated this relationship.

METHODS: We used data from the National Health and Nutrition Examination Survey (NHANES IV) (2001–2010). Systemic inflammation was defined by individual and aggregate (cumulative inflammatory load) biomarkers (C-reactive protein, white blood cell counts, neutrophil counts, and neutrophil: lymphocyte ratio). Loss of attachment and bleeding on probing were used to define periodontal disease. Poverty:income ratio and education were indicators of socio-economic position. Covariates included age, sex, ethnicity, smoking, alcohol, and attendance for dental treatment. Univariate and multivariable logistic regressions were constructed to assess the relationships of interest.

RESULTS: In a total of 2296 respondents, biomarkers of systemic inflammation and cumulative inflammatory load were significantly associated with periodontal disease after adjusting for age, sex, and behavioural factors. Socio-economic position attenuated the association between markers of systemic inflammation and periodontal disease in the fully adjusted model.

CONCLUSION: Socio-economic position partly explains how systemic inflammation and periodontal disease are coupled, and may thus have a significant role in the mechanisms linking oral and non-oral health conditions. It is of critical importance that the social and living conditions are taken into account when considering prevention and treatment strategies for inflammatory diseases, given what appears to be their impactful effect on disease processes.

Key Words

Socio-economic position social determinants of oral health oral-systemic health systemic inflammation periodontal disease 


OBJECTIFS: Évaluer le degré d’association entre l’inflammation systémique et la maladie parodontale chez les Américains adultes et déterminer si le statut socioéconomique intervient dans une telle association.

MÉTHODE: Nous avons utilisé les données de la National Health and Nutrition Examination Survey (NHANES IV) (2001-2010). L’inflammation systémique a été définie par des biomarqueurs (protéine C-réactive, numération des leucocytes, numération des neutrophiles et ratio neutrophiles/lymphocytes) individuels et globaux (charge inflammatoire cumulative). Selon notre définition, la maladie parodontale était caractérisée par la perte d’attache et le saignement au sondage. Le ratio pauvreté/revenu et le niveau d’instruction ont été nos indicateurs du statut socioéconomique. Les covariables étaient l’âge, le sexe, l’ethnicité, le tabagisme, la consommation d’alcool et la réception de soins dentaires. Nous avons construit des modèles de régression logistique univariés et multivariés pour déterminer les relations d’intérêt.

RÉSULTATS: Sur notre échantillon de 2 296 répondants, les biomarqueurs d’inflammation systémique et la charge inflammatoire cumulative présentaient une corrélation significative avec la maladie parodontale après élimination des effets de l’âge, du sexe et des facteurs comportementaux. Le statut socioéconomique atténuait l’association entre les indicateurs d’inflammation systémique et la maladie parodontale dans le modèle entièrement rajusté.

CONCLUSION: Le statut socioéconomique explique en partie l’association entre l’inflammation systémique et la maladie parodontale; il pourrait donc jouer un rôle important dans le mécanisme qui associe les affections buccodentaires et non buccodentaires. Lorsqu’on envisage des stratégies de prévention et de traitement des maladies inflammatoires, il faut impérativement tenir compte des conditions sociales et des conditions de vie, car elles semblent avoir un impact sur les processus morbides.

Mots Clés

Statut socioéconomique déterminants sociaux de la santé buccodentaire santé buccodentaire-santé systémique inflammation systémique maladie parodontale 


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Copyright information

© The Canadian Public Health Association 2017

Authors and Affiliations

  • Noha Gomaa
    • 1
    Email author
  • Belinda Nicolau
    • 2
  • Arjumand Siddiqi
    • 3
  • Howard Tenenbaum
    • 4
  • Michael Glogauer
    • 4
  • Carlos Quiñonez
    • 1
  1. 1.Discipline of Dental Public Health, Faculty of DentistryUniversity of TorontoTorontoCanada
  2. 2.Oral Health and Society Research Unit, Faculty of DentistryMcGill UniversityMontrealCanada
  3. 3.Division of Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  4. 4.Discipline of Periodontics, Faculty of DentistryUniversity of TorontoTorontoCanada

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