The present research describes the association between psychosocial features and tooth loss in a teenage and young adult population in Mexico. Using culturally relevant and age appropriate psychosocial measures researchers were able to corroborate reports46-48 relevant to other populations that report446-48 there is an association between unfavorable lifestyle, increased stress, and tooth loss. Results from the present study are one of the first explorations into the role of social features effecting tooth loss and oral health in the Mexican environment. While suggestive of well-defined trends within this specified study population, the present results should be interpreted cautiously due to methodological limitations. Among these, the study framework resorted to secondary analysis of an existing database.27 This resource did not attempt to provide population-level data within a probabilistic assessment of the health status of the Campeche population. Because the data collection was cross-sectional and, thus, may be effected by temporary ambiguity, the researchers could not discern whether tooth loss preceded increased stress or unfavorable lifestyle or vice versa.
No reliable tooth loss incidence studies are available for the Mexican setting, but longitudinal studies in other countries indicated a substantial proportion of people lose at least one tooth within a three-year interval.32-34 Periodontal problems were often associated with tooth loss, and the proportion of people at risk of losing teeth due to periodontal breakdown increases with age35 and is associated with lower SES.36 The role of caries4,37,38 in tooth loss is unclear when contrasted with the role of periodontal diseases,10 particularly in adults.3,7,8 Most teeth, however, are lost due to caries (crown and root lesions), periodontal diseases, or a combination of pathosis and judgments that culminate in a decision made by clients and clinicians.39
While it is believed, among older persons, poor oral health is a concomitant of aging and nothing can be done to improve this situation40,41, tooth loss will likely diminish the quality of life when all functional, psychosocial, and economic implications are considered. It has been postulated, however, depending on specific circumstances and outcomes, losing a tooth can be either an improvement or a worsening of health status.42 For younger persons with reasonable access to dental health care, it is speculated tooth loss would generally be a negative outcome. The proportion of our study population who had lost at least one tooth was somewhat low (21.4%, with an average tooth loss of 0.42) compared to other studies on Latino adults, which found a prevalence of 59% and a mean of 2.64 teeth lost.43 When contrasts are limited to comparable age groups, however, findings from other studies and the present study are similar.44,45
This is not surprising; tooth loss is the result of complex interactions between clinical, patho-physiological, and socio-behavioral factors.11,36 The strength of the association between psychosocial factors and tooth loss has not been as thoroughly evaluated. Lifestyle is dependent on specific circumstances and social milieu. The findings of the present study suggest an unfavorable lifestyle is associated with increased tooth loss – just as Sakki et al.46, Schou et al.47, and Yoshida et al.48 have found. It is not known, however, whether people with negative lifestyles lose more teeth due to direct patho-physiologic causes or if they have behavior patterns that are less efficacious to maintain good oral health by themselves or through the timely use of dental care services.49,50 It is likely various combinations of contributing factors are at play in different social settings and at different stages in a lifetime. The present study found stress was associated with tooth loss. Interactions between stress levels and immune responses that have been characterized with, e.g., periodontal diseases51,52 open the possibility the contribution of stress to tooth loss was mediated by periodontal breakdown. However, it is not known whether such a pathway is the only explanation linking the two phenomena or merely a contributing factor. Unrelated studies have found depressed cellular immunity under conditions of severe stress, especially when coupled with poor social support53 or signs of worse gingival status under psychosocial duress.54 Such changes may allow increased vulnerability to infectious agents such as periodontopathogenic bacteria.55
As in many studies, age was an associated factor for tooth loss in our (adolescents and youth adults) population10,45,26,14; more teeth are lost in older age groups. This can be explained by teeth being in contact with acidic environments for longer periods of time, being subject to repetitive cycles of dental treatment that may have added a measure of iatrogenic weakening, and/or having a longer history of periodontal undermining. The increased likelihood of women losing teeth in the present study population at the bivariate analysis level was not consistent with the importance ascribed in the final model. It is difficult to place these findings in the context of reports on tooth loss because some studies have found women lose more teeth then men10,11, some studies have found women lose fewer teeth44,46 than men, and some studies had ambiguous results.56
The present research describes the association between psychosocial features and tooth loss in a teenage and young adult population in Mexico. Using culturally relevant and age appropriate psychosocial measures researchers were able to corroborate reports46-48 relevant to other populations that report446-48 there is an association between unfavorable lifestyle, increased stress, and tooth loss. Results from the present study are one of the first explorations into the role of social features effecting tooth loss and oral health in the Mexican environment. While suggestive of well-defined trends within this specified study population, the present results should be interpreted cautiously due to methodological limitations. Among these, the study framework resorted to secondary analysis of an existing database.27 This resource did not attempt to provide population-level data within a probabilistic assessment of the health status of the Campeche population. Because the data collection was cross-sectional and, thus, may be effected by temporary ambiguity, the researchers could not discern whether tooth loss preceded increased stress or unfavorable lifestyle or vice versa.
