Contact: Noha Gomaa, PhD
For Release: Immediately
Poorer people are more likely than the better off to have periodontal disease—inflamed and bleeding gums, cavities and teeth that are so infected they must be pulled. And this is not only about mouth pain. Such poor oral health is linked to people having a higher risk for several serious illnesses: heart disease, diabetes, kidney disease, Alzheimer’s disease and asthma. Of course, the cost of preventive dental care and poor oral hygiene are believed to be the key reasons that the most needy tend to have the least healthy teeth and gums.
But now a groundbreaking new study finds that inadequate oral hygiene may not tell the full back story: Independent of how much they cleaned their teeth, poor adults who feel financially stressed have significantly more immune cells in their mouth that can trigger inflammation, promoting periodontal disease. The study is the first to show how social and economic factors can “get under the skin” through the immune system, contributing to dental disease. It’s published in the February-March issue of Psychosomatic Medicine, journal of the American Psychosomatic Society.
“What we found suggests that these social factors contribute to oral health as much as biological factors because they can leave a destructive imprint on the immune system. Oral health and diseases are as much a social problem as they are a biological one,” says study leader Noha Gomaa, BDS, MDS, PhD, Research Fellow at the Hospital for Sick Children in Toronto. She conducted this study at the Faculty of Dentistry, University of Toronto, with Professors Carlos Quinonez, Michael Glogauer and Howard Tenenbaum.
There were 102 study participants, 20 to 59 years old, who filled out questionnaires about their education, financial status and how much stress they felt around money. They also were asked about dental care and some lifestyle habits. Hair samples were used to measure levels of the stress hormone cortisol. And everyone also received a full-mouth exam. Researchers evaluated exactly how much periodontal disease each study participant had, as well as measuring important immune cell and inflammation levels.
One key sign of dental disease is so-called “pockets” around the teeth, formed when supporting tissue and bones that hold the teeth in place are destroyed. The gums pull away from the teeth, creating these pockets that gradually deepen, providing a space for bacteria to thrive. Compared to those in the lowest economic class, adults in the middle and upper bracket were significantly less likely to show this pocketing around their teeth. The more affluent also had less immune cell activity reflecting inflammation. Participants who reported high stress about money were twice as likely to show pocketing and to have immune cells that made them more prone to inflammation in their mouths. Higher cortisol stress levels also were linked to being twice as likely to have destructive immune cell activity.
After taking into account how often people brushed their teeth and visited the dentist, along with smoking and alcohol consumption, the results remained significant. High financial stress and cortisol levels alone could account for pockets that showed dental disease in an additional five to six teeth, says Gomaa. That may lead to a considerable amount of inflammation, bleeding gums and pain. The research suggests periodontal disease may be prevented “not only at the chair-side in the dentist’s office,” she says. This has been the traditional view. “We need to be proactive about poverty and poor education as well.” Since this is the first study of its kind, more research with more people in varying age groups could shed additional light on how this health problem develops and can be prevented, says Gomaa.
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The American Psychosomatic Society (APS) (http://www.psychosomatic.org),
founded in 1942, is an international multidisciplinary academic society that conducts an annual scientific meeting and educational programs. Psychosomatic Medicine is its scientific journal. The membership of over 700 is composed of academic scientists and clinicians in medicine, psychiatry, epidemiology, health psychology and allied health services. The mission of the APS is “to advance and integrate the scientific study of biological, psychological, behavioral and social factors in health and disease.”