Contextual socioeconomic determinants of tooth loss in adults and
               elderly: a systematic review

Barbato, Paulo Roberto; Peres, Karen Glazer

doi:10.1590/1980-5497201500020006

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Revista Brasileira de Epidemiologia

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Original Articles • Rev. bras. epidemiol. 18 (2) • Apr-Jun 2015 • https://doi.org/10.1590/1980-5497201500020006 copy

Contextual socioeconomic determinants of tooth loss in adults and elderly: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To perform a systematic review regarding studies that investigated the association between contextual socioeconomic factors and tooth loss.

METHODS:

MEDLINE, Embase, and LILACS databases were searched and no language or date restrictions were applied for this research. The search was also carried out at the Brazilian Library of Theses and Dissertations (BDTD), with the objective of seeking unpublished studies. We evaluated the bibliographical and methodological characteristics of the studies, as well as the findings.

RESULTS:

We found 348 articles, out of which only 6 were included in this study after revision by 2 independent researchers. We also identified an unpublished thesis. In general, these results show that the socioeconomic context interferes in tooth loss. We found an association between the highest number of missing teeth with less favorable contextual variables, despite the weak evidence, due to the fact that all selected studies had a cross-sectional design.

CONCLUSION:

We suggest the standardization of outcome formats and exposures in order to favor the comparison between studies and their quantitative analysis.

Tooth loss; Socioeconomic factors; Social conditions; Health inequalities; Oral health; Review

Criterion	% of adequacy
Description of the study
Is the hypothesis/objective described with clarity?	100.0
Are the main results to be measured described clearly in the Methods or Introduction section?	85.7
Well defined inclusion criteria?	71.4
Is the intervention of interest described clearly?	100.0
Are the confounding factors described clearly?	85.7
Are the main conclusions of the study described clearly?	85.7
Does the study provide estimates on the random variability of the data for the main results?	100.0
Is there description of loss?	71.4
Were the values of real probability reported for the main results?	100.0
External validity
Are the subjects selected for the study representative of the whole population from which they were selected?	71.4
Are the subjects selected for the study representative of the whole population from which they were selected?	71.4
Internal validity
Was there an attempt to blind the subjects of the study for the intervention they have undergone?	100.0
Was there an attempt to blind the evaluators?	100.0
If any of the results of the study was based in “data dredging “, was it clear?	100.0
Was there adjustment for the follow-up time?	100.0
The statistical tests used to evaluate the main results appropriate?
Was the fulfilling of the intervention reliable?	85.7
Were the measures used for the main outcomes accurate (valid and reliable)?	85.7
Selection bias
Were the patients from the different intervention groups (trials and cohort studies) or the case and control groups (case-control studies) selected in the same population?	100.0
Were the subjects from the different intervention groups (trials and cohort studies) or the case and control groups (case-control studies) selected in the same period of time?	100.0
Was there appropriate adjustment for the confounding factor in the analysis from which the main findings were taken?	85.7
Were the losses of patients in follow-up taken into account?	57.1
Power of the study
Was the power of the study presented?	–

Characteristic	n	%
Year of publication
2007 – 2008	2	28.6
2009	3	42.8
2010 – 2011	2	28.6
Institution of the first author
Instituto Aggeu Magalhães	1	14.2
Queensland University of Technology	1	14.3
Tohoku University	1	14.3
Universidade Estadual do Rio de Janeiro	1	14.3
Universidade de São Paulo	1	14.3
Universidade do Vale do Rio dos Sinos	1	14.3
University of Michigan	1	14.3
Journal
Acta Odontologica Scandinavica	1	14.3
Cadernos de Saúde Pública	1	14.3
Community Dentistry and Oral Epidemiology	1	14.3
Journal of Dental Research	1	14.3
Social Science & Medicine	2	28.5
Not published	1	14.3
Country of study
Australia	1	14.3
Brazil	4	57.1
United States of America	1	14.3
Japan	1	14.3
Sample size
Minimum – maximum	241 – 22,839
Mean (standard deviation)	9158.1 (8450.4)
Median	5560
Age of the participants
Minimum: mean (Standard deviation)	42.3 (10.6)
Minimum: median	40
Maximum: mean (stanrdar deviation)	53.3 (15.7)*
Maximum: median	44*

Lastname of the first author	Year of publication	Location of the study	Minimum age	Maximum age	Size of the sample	Design of the study	Outcome	Contextual variable(s)
Aida et al.³⁰	2009	Aichi	65	≥ 85	5,560	Cross-sectional	Number of self-referred teeth.	Vertical and horizontal social capital.
Celeste et al.³³	2009	Brazil	35	44	22,839	Cross-sectional	Edentulism	Gini índex and inequality coefficient of municipal income
Koltermann et al.³²	2011	Rio Grande do Sul	35	44	16,316	Cross-sectional	Presence of 20 or more teeth in the mouth.	Mean schooling of the municipality; fluoridated water availability time and location of the household.
Martins³⁵	2009	São Paulo	40	40	241	Cross-sectional	Presence of 20 or more teeth in the mouth.	23 variables*
Moreira et al.³¹	2010	Brazil	35	44	13,431	Cross-sectional	Number of teeth lost.	Number of dentists per thousand inhabitants; rate of extractions performed by the public service and population size of the municipality.
Sanders et al.²⁹	2008	Adelaide	43	58	2,860	Cross-sectional	Number of self-referred teeth.	IRSD (divided into 3 categories: wealthy, intermediate and poor neighborhoods).
Turrell et al.²⁸	2007	Adelaide	43	58	2,860	Cross-sectional	Number of self-referred teeth.	IRSD (divided into deciles).

Study	Contextual level	Contextual variable category	Direction of the association	Measure of association	Magnitude of the association	95%CI
Aida et al.³⁰	Kyuuson*	Low vertical social capital	Not associated	–	–	–
Aida et al.³⁰	Kyuuson*	Low horizontal social capital	Positive	OR	1.25	1.03 – 1.52
Celeste et al.³³	Municipality	Gini index	Not associated	–	–	–
Koltermann et al.³²	Municipality	Average schooling level ≥ 5.2 years of study	Positive	OR	1.72	1.17 – 2.53
		Fluoridated water availability time ≥ 10 years	Positive		1.78	1.32 – 2.40
		Living in urban area	Positive		1.23	1.09 – 1.39
Martins³⁵	Areas	≥ 4.5% illiterate with 15 or more years of age	Positive	OR	2.45	–
Martins³⁵	Micro-areas	Prevalence of ≥ 1.25% of alcoholism in people older than 14 years of age	Positive	OR	2.30	–
Moreira et al.³¹	Macro-region	Number of dentists per thousand inhabitants over the median (> 0.98)	Negative	Means ratio**	0.91	0.86 – 0.97
	State	3^rd tertile of extraction rates	Positive		1.13	1.05 – 1.22
	Municipality	Municipality with more than 100 thousand inhabitants	Negative		0.87	0.82 – 0.93
Sanders et al.²⁹	Postal Code ***	Poor neighborhood	Negative	Regression coefficient	-1.97	-2.75 – -1.18
Turrell et al. ²⁸	Postal Code ***	1^st decile of IRSD	Negative	Regression coeficient	3.56	1.27 – 4.85

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[1] Corresponding author: Karen Glazer Peres - Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, 122, Frome Street, Postal code 5000, Adelaide, Australia. E-mail: karen.peres@adelaide.edu.au