The Salutogenic Theory and Oral Health: A Meta-Analysis

Objective:  To systematically review the literature relating to the Salutogenic theory (Sense of coherence - SoC) and oral health. Method: Six electronic databases (Pubmed, PsycINFO, CINAHL, Web of Knowledge, EMBASE, Cochrane Library) were searched for publications up to February 2014. Different and multiple oral health (OH) parameters were considered, including oral health behaviours; and all measurements of SoC were included. Result: An initial search identified 4297 papers; 37 were identified as ‘potentially effective papers’ (Kappa 0.91, SE 0.04) and ultimately 30 ‘effective papers’ (Kappa0.80, SE 0.14) informed this review. This review included two randomized controlled trials, four longitudinal observational studies and 24 cross-sectional studies relating to: oral health behaviours (13) dental caries (6); periodontal diseases (4); perceived oral health (6) and others. Among the observational studies (STROBE ‘quality of reporting’ scores ranged from 14.5 to 25.0), all 24 cross-sectional studies identified significant associations between SoC and OH parameters. Likewise, all 4 longitudinal studies identified a significant positive association between OH parameter changes and SoC. Three separate meta-analyses were conducted among 7 studies. Individuals with higher SoC were more likely to visit the dentist for check-ups (pooled OR=1.34, 95%CI=1.23-1.46, p<0.05) and brushed their teeth more frequently than those with lower SoC (pooled OR=1.82, 95%CI=1.50-2.21, p<0.05). Mothers’ SoC was not associated with their children’s dental attendance pattern (p>0.05). The two clinical trials produced conflicting evidence. Conclusion: There is a growing interest in the Salutogenic theory (SoC) and Oral Health. SoC is associated with several OH behaviours including dental attendance and tooth brushing. SoC may explain ‘how and why’ oral health promotion is effective; and this is likely to have implications for future oral health promotion strategies and practices.