Stress, geographic and sociodemographic factors, and oral health outcomes in adolescents and young adults
Abstract
Oral health disparities are influenced by socioeconomic and demographic factors. Recent research suggests that stressors can contribute to these disparities. Adolescents and young adults are particularly vulnerable to these stressors, which can affect hypothalamic-pituitary-adrenal (HPA) axis reactivity. This thesis aimed to enhance understanding of the relationships among stress, geographic and sociodemographic factors, and oral health outcomes in adolescents and young adults. Additionally, salivary levels of mRNA encoding the glucocorticoid receptor (GR) were assessed and their relationship to stress and oral health outcomes investigated.
In the first study, the association between neighborhood-level socioeconomic status and dental care outcomes was explored in 2915 patients split into two groups: adolescents (15-17 years) and young adults (18-24 years). Young adults showed significantly worse preventive and treatment outcomes compared to adolescents. Individuals from neighborhoods with lower household income showed a significantly higher cost of dental care, yet worse treatment outcomes.
The second study assessed the association between perceived stress, cortisol levels (hair and saliva), and caries experience in 93 adolescents and young adults without periodontal disease. Results revealed a significant association of dental caries experience with hair cortisol level (a marker of chronic stress) and perceived stress scale score. These associations remained significant even after adjusting for sociodemographic variables.
The third study involved 78 individuals who had also participated in the second study. RNA was isolated from saliva, followed by quantitative real-time polymerase chain reaction to evaluate levels of GR mRNA. mRNA encoding GRα was identified in saliva. Its levels were inversely associated with hair cortisol levels, however there was no significant association with dental caries experience. Thus, additional factors likely contribute to the connection between stress and caries experience. Chronic stress has been associated with reduced expression of GRα and this association appears to hold for GRα mRNA in saliva.
Incorporating individual and community stressors into the analysis of oral health outcomes provides insights into the complex pathophysiological pathways underlying dental disorders. Establishing the association of biomarkers, such as hair cortisol and GRα mRNA levels, with oral disease may encourage further research and open new avenues for focused preventive strategies, diagnostics, and interventions.