Objective:
To examine whether oral health behaviours completely eliminate inequality in increments of dental caries in a sample of the Finnish population
Method:
Baseline data is from the Health 2000 Survey, a nationally representative survey of 8028 subjects, aged 30 years or older living in mainland Finland. Approximately four years later, 1248 subjects were invited to a clinical oral re-examination and 1049 agreed to participate (84% response rate). At baseline, participants provided information pertaining to demographic characteristics (sex and age), education level and dental behaviours (dental attendance pattern, toothbrushing frequency, use of fluoride toothpaste, frequency of sugar consumption and daily smoking). Clinical oral examinations were conducted identically at baseline and follow-up. The 4-year net DMFT increment was calculated by subtracting the number of reversals from the caries increment for each participant. Negative binomial regression models were fitted and rate ratios (RR) reported.
Result:
The mean four-year increment of DMFT was 0.75 (SD: 1.22), with 57% having zero increments. Finnish adults who had only basic education had a greater increment of DMFT than those who had high education at baseline (RR 1.41, 95%CI 1.07,1.85). Adjusting for single behaviours attenuated but did not eliminate education inequality in DMFT increment, with toothbrushing showing the greatest impact on inequality (13% reduction in DMFT increment). Adjusting for all four health-related behaviours completely eliminated inequality in DMFT increment in this sample of the Finnish population.
Conclusion:
Accounting for a number of important oral health-related behaviours appears to explain all education inequality in oral health in the Finnish population. The results however should be interpreted with caution when applied to less egalitarian populations.