Tooth decay (dental caries) remains one of the most common non-communicable diseases, being the 10th most prevalent condition in deciduous (milk) teeth, affecting 9% of the world's population, while also affecting 35% of adults with permanent teeth, making it the most prevalent disease worldwide for that group. Despite overall reductions in tooth decay, inequalities in the disease persist, particularly in the most deprived areas of England. Despite this, there has been a lack of geographical studies analysing pathways that lead to these inequalities. Many geographical studies within dental public health have used aggregate statistics or single deprivation indicators, limiting their ability to study patterns within smaller geographical areas. More advanced simulation modelling, such as agent-based models (ABMs), offer advantages over traditional statistics methods, through inclusion of dynamic interactions and independent feedback mechanisms occurring between individuals, groups and their environments over time. ABMs have been becoming increasingly powerful with the inclusion of geocomputational capabilities, and have previously been used to investigate numerous health related themes, including mortality, healthy eating and walking patterns. The use of ABMs in dental public health remains rare however, and while several studies have used this method in combination with GIS and other systems science methods, this research has focused more on social networks than the effects of neighbourhood environments. The research presented in this paper builds on this work and presents proof of concept ABMs for the socio-spatial analysis of oral health. The key objective was to test a series of hypothesised theoretical pathways by which neighbourhoods may influence adult tooth decay, to examine which had the greatest influence on tooth decay scores, and whether this differed between areas of higher and lower socio-economic status within the city of Sheffield, UK. Numerous social determinants of health have been linked to inequalities in tooth decay. Income has shown strong associations with tooth decay through both area based  and average income measures, with higher decay scores being found in lower income brackets. Income can also influence access to amenities such as dental services, fluoridated water, and dental information and can influence decay in early life through material circumstances. Education has also been shown to be important for decay in childhood  as well as adulthood  and can act as a mediating pathway between socio-economic position and decay. Negative associations between employment standing and decay have also been found with parental occupation being linked to levels of decay in children. Associations between unemployment and increased decay have also been found, while unemployment is also associated with less favourable oral health related behaviours. Related concepts including socio-economic position have also shown social gradients in decay in children and adults. Psychological stress has shown links to detrimental oral health, including self-reported oral health and periodontal disease. Stress has been associated with increased decay through biological factors such as cortisol secretion, although not all studies have found such associations. Coping mechanisms for stress, specifically smoking, can have detrimental effects on decay although this literature is inconsistent. Diet is vitally important to oral health, with undernourishment leading to decay. Increased sugar consumption has been conclusively linked to increasing numbers of decayed teeth, particularly through soft drink consumption. Oral health-related behaviours such as the use of fluoridated oral dentifrice have also been shown to be important for decay. Attitudes towards oral health and brushing frequency are also associated with levels of decay, with socio-economic and educational gradients  in oral health behaviours also being demonstrated, as well as in dental education and knowledge. However, while there is evidence that attendance follows a social gradient, dental self-care does not always. Despite evidence to the contrary, the majority of the literature demonstrates the importance of social gradients in influencing disease and oral health behaviours.

Journal Homepage: https://orthodontics-endodontics.imedpub.com/
Regards,
Catherine
Journal Co-Ordinator
Journal of Orthodontics and Endodontics