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Social Relationships and Oral Health Among Adults Aged 60 Years or Older

Tsakos, Georgios PhD; Sabbah, Wael PhD; Chandola, Tarani PhD; Newton, Tim PhD; Kawachi, Ichiro PhD; Aida, Jun PhD; Sheiham, Aubrey PhD; Marmot, Michael G. PhD; Watt, Richard G. PhD

doi: 10.1097/PSY.0b013e31827d221b
Original Article

Objective This study assessed associations between social relationships and oral health outcomes and whether these associations were explained by demographic, socioeconomic, and behavioral factors, and physical health.

Methods We used the National Health and Nutrition Examination Survey (1999–2004) data on 4014 adults aged 60 years or older. Oral health outcomes were edentulism, number of decayed teeth, root decay, number of sound or filled teeth, and self-rated oral health. Social relationships referred to social networks (marital status, number of close friends) and social support (emotional support need, provision of financial support). Analyses consisted of regression models sequentially adjusting for demographic, socioeconomic, behavioral, and physical health confounders.

Results In fully adjusted models, widowed or divorced/separated individuals had fewer sound or filled teeth than those married or living with a partner: rate ratio (95% confidence interval) = 0.89 (0.82 to 0.97) and 0.90 (0.83 to 0.97), respectively. People with four to six close friends had fewer decayed teeth and lower probability for root decay than those with fewer friends. Emotional support need was associated with 1.41 (1.05 to 1.90) higher odds for root decay and 1.18 (1.04 to 1.35) higher odds for poorer self-rated oral health. Lack of financial support was associated with more decayed teeth. Edentulism was not related to any social network and social support markers.

Conclusions Social relationships are associated with clinical measures of current disease, markers of good oral function, and subjective oral health, but not with clinical measures of a lifetime history of oral disease among older Americans.

From the Department of Epidemiology and Public Health (G.T., W.S., J.A., A.S., M.G.M., R.G.W.), University College London, London; School of Social Sciences (T.C.), University of Manchester, Manchester; Dental Institute (T.N.), Kings College London, London, UK; School of Dentistry (W.S.), Oregon Health and Science University, Portland, Oregon; Department of Society, Human Development, and Health (I.K.), Harvard School of Public Health, Boston, Massachusetts; and Department of International and Community Oral Health (J.A.), Tohoku University Graduate School of Dentistry, Sendai, Japan.

Address correspondence and reprint requests to Georgios Tsakos, PhD, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. E-mail:

Received for publication November 22, 2011; revision received September 26, 2012.

Copyright © 2013 by American Psychosomatic Society
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