Is there socioeconomic inequality in periodontal disease among adults with optimal behaviors

Objective: To examine if socioeconomic inequalities exist in periodontal disease among adult with optimal oral health behaviors. Material and Methods: Data were from the Adult Dental Health Survey 2009, a national survey of England, Wales and Northern Ireland. Overall, 4738 participants aged 35 years and older were included in the analysis. Periodontal disease indicated by pocket depth or loss of attachment >4 mm, and gingival bleeding were used as periodontal outcomes. Education and deprivation indicated socioeconomic position. Behavioral factors were dental visits, toothbrushing and smoking. The subset of adults with and without optimal health related behaviors included 2916 and 1822 participants, respectively. The associations between periodontal disease and socioeconomic position were tested adjusting for demographic and behavioral factors. Additional models stratifying the sample to those with and without optimal behavior subgroup were constructed. Results: Education and deprivation were significantly associated with periodontal disease in the partially adjusted models. In the analysis of those with optimal behaviors, only deprivation and highest level of education showed significant association with periodontitis, but not with gingival bleeding. Among those without optimal behaviors, all socioeconomic factors were associated with all outcomes except deprivation and periodontitis. Conclusions: Oral health behaviors marginally contributed to inequalities in gingival bleeding and periodontal disease. Socioeconomic inequalities were attenuated among those with optimal behaviors and persisted among those without optimal behaviors. Behaviors appeared to be an effect modifier for the relationship between periodontal outcomes and socioeconomic factors.