Pathways of Socioeconomic Position in Oral Health Self-Perception in Brazil

This study aims to explore the pathways through which socioeconomic position (SEP) at birth influences oral health self-perception in adolescence. A representative sample (N = 1,120) of all births from the 2004 Pelotas cohort was prospectively investigated. Interviews and clinical examinations were performed at 5 and 12 y. Gingivitis was assessed at 12 y. Dental caries (dmf-t/DMF-T), malocclusion, and the use of dental services were assessed at 5 and 12 y. SEP at birth (latent variable) was the main exposure. The outcome was a negative oral health self-perception at 18 y. Missing data were imputed using multivariate imputation. Structural equation modeling (SEM) was used to estimate the direct, indirect, and total effects from SEP to outcome. A negative perception of oral health self-perception was reported by 21.5% of the adolescents. SEP at birth influences, directly and indirectly, oral health self-perception at 18 y old. A direct effect (standard coefficient [SC] = -0.28, P < 0.001) and an indirect effect (SC = -0.04, P < 0.001) of SEP were observed on oral health self-perception. Dental caries at 12 y was the main mediator pathway between SEP and oral health self-perception with significant results (SC = -0.03, P < 0.001). The pathways through occlusal status at 12 y (P = 0.989) and gingivitis (P = 0.238) were not statistically significant. The total effect of SEP on negative self-perception of oral health was SC = -0.32 (P < 0.001). Thus, SEP at birth directly and indirectly influenced oral health self-perception at the age 18 y. SEM shows that the main pathway was direct. The main indirect effect was thought to be dental caries at 12 y.