Socioeconomic status and tooth wear

Abstract

OBJECTIVE: To systematically review the literature investigating the socioeconomic status (SES) as a potential risk factor of tooth wear in children, adolescents, and adults. METHODS AND MATERIALS: PubMed, MEDLINE (Ovid), and Web of Science databases were screened for studies from 1990 to 2015. Cross-referencing was used to further identify articles. Language was restricted to English. A quality appraisal of included studies was carried out using the Newcastle-Ottawa scale. RESULTS: One thousand-one hundred and thirteen articles were initially identified from which 56 articles were full-text reviewed. Twenty-three cross-sectional multiple random clusters and prospective longitudinal studies were selected for inclusion. Included studies investigated tooth wear in 29326 individuals between the ages of 2 to ≥65. The majority of studies investigated erosion in children and adolescents, with only 2 studies examining adults. Included studies employed 5 different indices, and their modifications, in evaluating tooth wear and varying indicators to assess SES. Ten studies found no association between tooth wear and SES (n= 13911 participants). Thirteen studies found a positive association with SES, with 7 studies (n= 9559) demonstrating an association with high SES, and 6 studies (n= 5856) an association with low SES. On a country basis, Brazil (5 studies, n= 4835), USA (2 studies, n= 5735), and Saudi Arabia (2 studies, n= 2303) demonstrated no association between tooth wear and SES. Conversely, findings of different studies within the UK (4 studies, n= 6110) and China (4 studies, n= 4168) demonstrated conflicting positive associations with SES. CONCLUSION: Evidence supporting SES as an independent global risk factor of tooth wear in children and adolescents remains lacking, tending to be regionally-dependent. Other cofounding risk factors might explain the conflicting results, such as diet, caries, fluoridation or acid reflux. Further investigation is required to identify any potential association between SES and tooth wear in adults.