Socioeconomic position during life and periodontitis in adulthood: a systematic review

Socioeconomic position (SEP) is a well-known risk indicator for chronic periodontitis. However, it is still unclear how SEP during the life course influences periodontal outcomes in adulthood. This study aimed to systematically review longitudinal studies investigating the influence of individual-level SEP during the life course on subsequent periodontitis in adulthood. Inclusion criteria were epidemiological longitudinal observational studies, in which indicators of relative SEP were assessed prior to clinical assessment of periodontitis. Six electronic databases (PubMed, EMBASE, Web of Science, Scopus, Latin American and Caribbean Health Sciences Literature (LILACS) and ScieLO) were searched. The methodological quality of the studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). The search identified 1720 papers. After removal of duplicates (n=697), title and abstract screening (n=996), and full-text review (n=19), eight original manuscripts from seven studies were finally included. Sample sizes ranged from 167 to 2806, and the follow-up time from exposure to outcome ranged from 2 to 28 years. Studies evaluated education, occupation or income as SEP indicators. Prevalence, extent and severity of periodontal attachment loss, probing pocket depth and alveolar bone loss were the studied outcomes. Based on NOS, studies presented low risk of bias. Six of eight papers reported that relatively low SEP earlier in life was associated with poorer periodontal health in adulthood. The available scientific evidence demonstrates potential longitudinal impact of earlier lower SEP on later periodontal health. The findings were consistent despite differences in study methods.