The Association between Socioeconomic Status, Diet ... · The Association between Socioeconomic...

The Association between Socioeconomic Status, Diet, Psychological Status, and Oral Health

EC Dental Science Special Issue - 2017

Dr. Ahmed Tawfig1, Dr. Abdulrahman Al Saffan2*, Dr. Alya Al Fadhal3, Dr. Aseel Almadani3, Dr. Sabah Alanazi3 and Dr. Khloud Alajmi3

1Assistant Professor, Department of Preventive Dentistry, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia2Lecturer, Department of Preventive Dentistry, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia3Dental Interns at Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia

*Corresponding Author: Abdulrahman Al Saffan, Department of Preventive Dentistry, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia.

Received: November 08, 2017; Published: November 13, 2017

Citation: Dr. Abdulrahman Al Saffan., et al. “The Association between Socioeconomic Status, Diet, Psychological Status, and Oral

Health”. EC Dental Science SI.01 (2017): 06-20.

Abstract

Aim: To investigate the associations between socioeconomic status (SES), dietary habits, psychological status, and oral health outcomes.

Introduction

Methodology: This was a cross-sectional study conducted among 300 males and females population of Riyadh City, Saudi Arabia.

Socioeconomic status, dietary behavior, mental health status and oral health indices (Gingival, Plaque index and DMFT) were recorded and statistically analyzed by Chi square test and a regression analysis.

Conclusion: This study shows that there is significant impact of dietary habit, socioeconomic status, and psychological status on the oral health.

Keywords: Socioeconomic Status; Diet; Psychological Status; Oral Health

Oral health means more than good teeth; it is integral to general health and essential for wellbeing [1]. It implies being free of chronic oro-facial pain, oral and pharyngeal (throat) cancer, oral tissue lesions, birth defects such as cleft lip and palate, and other diseases and disorders that affect the oral, dental, and craniofacial tissues, collectively known as the craniofacial complex [1].

Diet and nutrition affect oral health in many ways. Nutrition, for example, influences craniofacial development, oral cancer, and oral infectious diseases [1]. Dental diseases related to diet include dental caries, developmental defects of enamel, dental erosion, and peri-odontal disease [1]. It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research [2]. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Sci-entific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship [2].

Socio-economic status (SES) and oral health factors related to tooth loss and chewing ability have been related to compliance with di-etary guidelines through food purchasing in older adults [3]. An inadequate dentition was associated with lower consumption of a range


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of fruits and vegetables indicating that dentition-related impairment of chewing ability could have adverse consequences on nutritional intake among Australian adults. Income also had independent associations with vegetable consumption, suggesting that both tooth loss and lower SES can have independent detrimental public health effects on dietary intake [3].

The link between general health and socio-economic status is well established [1,4]. There is also a body of evidence showing that poor oral health is associated with low socio-economic status or deprivation [4]. In both high and lower income countries around the world, low socio-economic status was significantly associated with increased oral diseases [5].

Limitation of the literature is lack of consensus on how to measure SES in a way that would provide a better understanding of how SES contributes to poor oral health [1]. In addition to accepted measures of SES, future studies should include variables that would provide opportunities for effective interventions to reduce risk. Relatively, few studies have examined the relationship between use of oral health services and mental health disorders [1]. The literature contains many studies exploring the unique and vague relationship between psychological profiles and satisfaction with the dental status in many fields of dentistry [1]. Particularly psychosocial stress, have been concerned as risk indicators for periodontal disease. Socioeconomic status, occupation, competitive work load, emotional disturbances, has led to increased stress levels in the modern lifestyle.

The impact of stress on periodontal health is not merely by its presence or absence but the type, duration and how an individual cope with it [6]. Individuals under stress tend to adopt behavioral changes like poor oral hygiene maintenance, smoking, clenching or grinding of teeth. It is, therefore, necessary, and worthwhile to understand these mechanisms in pursuit of analyzing the relationship between psychosocial stress and periodontal disease [6].

Dental caries is still a major health problem in most industrialized countries as it affects 60 - 90% of school-aged children and the clear majority of adults, in 2004, WHO updated the epidemiological information available in the databanks [7]. At present, the distribu-tion and severity of dental caries vary in different parts of the world and within the same region or country, illustrates the levels (sever-ity) of dental caries as measured in 12-year-olds by the Decayed, Missing and Filled Teeth index (DMFT) [7].

What illustrates the time trends in dental caries experience of 12-year-old children in developing and developed countries. In most developing countries, the levels of dental caries were low until recent years but prevalence rates of dental caries and dental caries expe-rience are now inclined to increase. This is largely due to the increasing consumption of sugars and inadequate exposure to fluorides [7].

AimTo investigate the associations between socioeconomic status (SES), dietary habits, psychological status, and oral health outcomes.

ObjectivesTo study the associations between dietary habits (such as intake of fruits, fruit juices and vegetables), SES (including income, em-

ployment status and educational achievement and area-based indicators of SES), psychological status and markers of poor oral health outcomes, as measured by the self-reported number of missing teeth and perceived oral health and clinical examination in Riyadh City.

Material and Methods

Study Design: A cross-sectional study will be performed using a questionnaire and clinical oral examination.

Study Population: Population of Riyadh City on middle and elderly aged.

Sample Size: 300 males and females.

Sample Selection: Simple Random Sampling.


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Duration of Study: 4 months.

Informed Consent: Will be obtained from the participants before they answer the survey.

The DMFT (Decayed, Missing and Filled Teeth) and periodontal examination (Plaque index, gingival index and periodontal screening and recording (PSR) indexes will be used for oral examination in accordance with the standards recommended by the World Health Organization.

SES measures surveys and income level (measured as annual household income), employment status (measured by current work and retirement status), educational achievement (measured by the highest qualification), and area-based indicators of SES (e.g. SEIFA score).

Dietary Behavior (as measured by the amount of fruit and vegetable intake per day, amount of breakfast cereal intake per week, and consumption of dairy products).

Mental health status will be defined based on self-report from surveys (using the Kessler 10-item scale for psychological distress-a questionnaire with a score ranging from 10 to 50 to measure psychological stress in the past 4 weeks). We will consider K-10 scores of 25 and more as an indicator of mental disorders (Andrews and Slade, 2001).

Data analysis and result

Statistical analysis was done using SPSS version 20. Aim of this analysis to:

1) Test the associations between dietary habits (such vegetables, Dairy Products, Meat, bean, water, sugars, and soft drinks) and Oral health measures by Plaque Index, Gingival Index and DMFT (Ordinal variables).

2) Test the associations between SES (including income, employment status and educational achievement and area-based indica-tors of SES) and Oral health measures by Plaque Index, Gingival Index and DMFT (Ordinal Variables).

3) Test the association between psychological health status (as measured by self-report K-10) and Oral health measures by Plaque Index, Gingival Index and DMFT (Ordinal Variables).

ResultsLinear Regression was conduct to test the association between dietary habits and Oral Health Dietary Habits and Plaque Index

The Results shows that vegetables and soft drink has statistically significant effect on Plaque Index (F-test = 11.65, P-value = 0.000, R2 = 0.104).

Regression Model Summary

Model R2 F-test P-ValueVegetables, Soft drink -Independent Factor

Plaque Index-Outcome Factor10.4% 11.65 0.000 HS*

*P-value High significant.

Interpretation of R2 that 10.4% of variability of Plaque index levels of patients is explained by (needs a noun/adjective) vegetables and soft drinks.


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Regression Model Coefficients

Independent factors Regression Coefficients (β) t-test P-value 95% Confidence Interval for βVegetables -0.148 -3.18 0.002 (-0.239, -0.056)Soft drinks 0.135 2.96 0.003 (0.045,0.224)Constant 1.67 12.74 0.000 (1.41,1.92)

Above table shows that vegetables have significant negative influence on plaque index (β = -0.148, p-value = 0.002) as vegetable in-take increase/decrease the plaque index level decrease/increase by value 0.148. Soft drinks have significant positive influence on plaque index as soft drinks intake increase/decrease by one time the plaque index increase/decrease by 0.135 (β = 0.135, p-value = 0.003).

The Model

Plaque Index = 1.67 - 0.148 (vegetables) + 0.135 (soft drink) + ee: represents other factors not included in study. Unexplained variability of plaque Index.

Dietary Habits and Gingival Index

The Results show that vegetables and soft drinks have statistically significant effect on Gingival Index, the regression model is signif-icant (F-test = 11.7, P-value = 0.000, R2 = 0.1).


Above table shows that vegetables has significant negative influence on gingival index (β = -0.157, p-value = 0.001) as vegetable in-take increase/decrease one time the gingival index level decrease/increase by value 0.157. Soft drinks have significant positive influence on gingival index (β = 0.130, p-value = 0.005); as their intake increases/decreases by one time the gingival index increases/decreases by 0.130.

The Model

Gingival Index = 1.68 - 0.157 (vegetables) + 0.130 (soft drink) + ee: represents other factors not included in study. Unexplained variability of gingival Index.

Dietary Habits and DMFT

The Results show that vegetables, beans and Dairy products have statistically significant effect on DMFT, the regression model was significant (F-test = 4.36, P-value = 0.037, R2 = 0.067).


Model R2 F-test P-ValueVegetables, beans and Dairy products -Independent Factor

DMFT- Outcome Factor7% 4.36 0.037 *

*P-value is significant

Interpretation of R2 that 7% of variability of DMFT of patients explained by vegetables, bean, and Dairy products.

Model R2 F-test P-ValueVegetables, Soft drink -Independent Factor Gingival

Index- Outcome Factor10% 11.7 0.000 HS*

*P-value High significant


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Independent factors Regression Coefficients (β) t-test P-value 95% Confidence Interval for βVegetables -0.854 -2.27 0.024 (-1.59, -0.114)

Bean 1.254 3.44 0.001 (0.536,1.971)Dairy Products -0.819 -2.09 0.037 (-1.59, -0.048)

Constant 12.08 11.89 0.000 (10.08,14.07)

Above table shows that vegetables have significant negative influence on DMFT (β = -0.854, p-value = 0.024) as vegetable intake increase/decrease one time the DMFT decrease/increase by value 0.854. Bean has significant positive influence on DMFT (β = 1.254, p-value = 0.001) as Bean intake increase/decrease by one time the DMFT increase/decrease by 1.254 times. Dairy Products has signifi-cant negative influence on DMFT (β = -0.819, p-value = 0.037) as Dairy Products intake increase/decrease one time the DMFT decrease/Increase by 0.819.

The Model

DMFT = 12.8 - 0.854 (vegetables) + 1.254 (Bean) - 0.819 (Dairy products) + ee: represents other factors not included in study. Unexplained variability of gingival Index.

Chi-square test (Association of Dairy Products with Plaque Index/Gingival Index)

Dairy Products is important factor on Oral Health but not entered in the regression model as main factor because it has high correla-tion with vegetables factor(r = 0.7, P-value = 0.000). Chi square test used to test the association between Dairy Products and Plaque In-dex, the Results showed Dairy Products and Plaque Index have significant association (χ2 = 23.9, P-value = 0.001) and significant negative correlation (r = -0.113, P-value = 0.000) (Using Chi -Square test).

There was a significant association between Dairy Products and Gingival Index (χ2 = 22.9, P-value = 0.003) and significant negative correlation (r = -0.113, P-value = 0.035).

Linear Regression was conduct to test the associations between SES and Oral HealthSES and Plaque Index

The result shows that age, educational achievement and area have statistically Significant effect on Plaque Index, Regression Model is significant with (F-test = 7.25, P-value = 0.007, R2 = 0.107).


Independent factors R2 F-test P-ValueAge, educational achievements, and area North (Riyadh) and area East

(Riyadh) - Independent factors. Plaque Index -Outcome factor10.7% 7.25 0.007 *

Interpretation of R2 that 10.7% of variability in Plaque index (mild, moderate and severe) among patients are explained by age, area (North and East Riyadh) and educational achievement (Factors of Linear Regression Model).


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Independent factors Regression Coefficients (β) t-test P-value 95% Confidence Interval for βEducational achievements -0.161 -4.09 0.000 (-0.237, -0.083)

Age 0.012 3.07 0.002 (0.004,0.020)Area North -0.265 -3.49 0.002 (-.430, -0.099)Area East -0.293 -2.69 0.007 (-0.508, -0.079)Constant 2.06 8.9 0.000 (1.61,2.53)

Above table shows that educational achievements has significant negative influence on plaque index (β = -0.161, p-value = 0.000) as educational level increase/decrease the plaque index level decrease/increase by value approximately 0.2. Age has significant positive influence on plaque index as age increase/decrease the plaque index increase/decrease by 0.012 (β = 0.012, p-value = 0.002).

Negative coefficient of area North (Riyadh) (β = -0.265, p-value = 0.002) indicates that patients live in this area have low level of plaque index (by 0.265) in comparison with south and west area. Negative coefficient of Area East (Riyadh) (β = -0.293, p-value = 0.007) indicates that patients living in this area have low level of plaque index by approximately 0.3 in comparison with other areas.

The Model

Plaque Index = 2.07 - 0.161 (educational achievements) + 0.012 (Age) - 0.265 (area North) - 0.293 (area East) + eE (error): Represents other factors of SES not included in the study (unexplained variability error).

SES and Gingival Index

The results show that age and education achievement have statistically significant effect on Gingival index, Regression Model is sig-nificant with (F-test = 11, P-value = 0.000, R2 = 0.065).


Model R2 F-test P-ValueAge, educational achievements Independent factors Gingival

Index-Outcome factor7% 13 0.000 *

Interpretation of R2 that 7% of variability in Gingival index levels among patients explained by age and educational achievements.


Independent factors Regression Coefficients (β) t-test P-value 95%Confidence Interval for βEducational achievements -0.132 -3.32 0.001 (-0.211, -0.054)

Age 0.014 3.59 0.000 (0.007,0.02)Constant 1.73 7.2 0.000

Above table shows that educational achievements has significant negative influence on Gingival index (β = -0.132, p-value = 0.001) as educational level increase/decrease the gingival index level decrease/increased by value 0.132. Age has significant positive influence on Gingival index as age increase/decrease the Gingival index increase/decrease by 0.014 (β = 0.014, p-value = 0.000).


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The ModelGingival Index = 1.73 + 0.014 (Age) - 0.132 (educational achievements) + ee: e (error): Represents other factors of SES not included in the study (Unexplained variability error).

SES and DMFTThe results show that age and area have Statistical significant effect on DMFT, the regression model is significant with (F-test = 9.97,

P-value = 0.002, R2 = 0.07).


Model R2 F-test P-ValueAge, Area West -Independent Factor DMFT- Outcome Factor 7% 9.97 0.002 HS

Interpretation of R2 that 7% of variability in DMFT values explained by age and area, West Riyadh.


Independent factors Regression Coefficients (β) t-test P-value 95% Confidence Interval for β

Age 0.124 4.18 0.000 (0.065,0.182)Area West 1.78 3.16 0.002 (0.679,2.918)Constant 6.37 6.2 0.000 (4.34,8.38)

The table above shows that age has significant positive influence on DMFT (β = 0.124, p-value = 0.001) as age increase/decrease by one unit the DMFT increase/decrease by value 0.124. Area West has significant positive influence on DMFT as positive co effect of Area West (β = 1.78, p-value = 0.002) indicates that people live in the West of Riyadh have high level of DMFT in comparison with others areas.

Oral Health and Psychological StatusTest the association between psychological health status (as measured by self-report K-10) and Oral health measures by Plaque In-

dex, Gingival Index and DMFT (Ordinal Variables).

Statistical MethodsReliability test was performed to test the reliability of questionnaire of psychological status measured by self -report K-10 distributed

to 350 random individuals in Riyadh city. The Questionnaire was reliable with Cranach’s Alpha 0.869.

Chi-square test is used to test the association between psychological health status and Oral healthPsychological health status and Gingival Index

Chi square test used to test the association between Psychological health status measured by K-10 levels (Well, Mild, Moderate and severe disorder) and Gingival Index (Normal, Mild, Moderate and severe).

The result shows that there is high association between Gingival Index and Psychological health status (χ2 = 23.03, P-value = 0.006) (See table 13).


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Likely to be well

Mild mental disorder

Moderate mental disorder

Severe mental disorder

Total Test Statistic

P-value

Gingival Index

Normal 0 (0.0%) 2 (28.6%) 0 (0.0%) 12 (3.8%) 14 (4%) 23.03 0.006*Mild 4 (50%) 2 (28.6) 8 (40%) 146 (46.8%) 160 (46.1%)

Moderate 4 (50%) 3 (42.9%) 6 (30%) 126 (40.4%) 139 (40.1%)Severe 0 (0%) 0 (0%) 6 (30%) 28 (9%) 34 (9.8%)Total 8 (100%) 7 (100%) 20 (100%) 312 (100%) 347

Table 13: Gingival index * K10LEVELS Cross tabulation.*Significant P value < 0.05

Figure 1: Psychological status and Gingival Index.

Psychological health status and Plaque IndexChi square test used to test the association between Psychological health status measured by K-10 levels (Well, Mild, Moderate and

severe disorder) and Plaque Index (Normal, Mild, Moderate and severe).

The result shows that there is high association between Plaque Index and Psychological health status (χ2 = 24.575, P-value = 0.003) (See table 14).


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Plaque Index *K10LEVELS Cross

tabulation Likely to be well

K10LEVELS Total Statistic test χ2

P-valueMild

mental disorder

Moderate mental disorder

Severe mental disorder

Plaque index

Normal 0 (0%) 1 (14.3%) 0 (0%) 5 (1.6%) 6 (1.7%) 24.575 0.003Mild 5 (62.5%) 4 (57.1%) 10 (50%) 157 (50.3%) 176 (50.7%)

Moderate 2 (25%) 2 (28.6%) 2 (10%) 115 (36.9%) 121 (34.9%)Severe 1 (12.5%) 0 (0%) 8 (40%) 35 (11.2%) 44 (12.7%)

Total 8 (100%) 7 (100%) 20 (100%) 312 (100%) 347

Table 14: Plaque Index *K10LEVELS Cross tabulation.

Figure 2: Psychological Status and Plaque Index.

Descriptive Statistics of Demographics variables

Variables Frequency PercentagesDemographics Variables

GenderMale 160 46.1%

Female 187 53.9%Working

Not Working 10 2.9%Retire 12 3.5%

Working 325 93.7%Salary≤ 3000 91 26.2%

[4000,9000] 142 40.9%More than 10000 114 32.9%Education LevelNone educated 5 1.4%

Primary 10 2.9%Intermediate 23 6.6%High School 70 20.2%Graduated 201 57.9%

Post graduate 38 11%Area

West Riyadh 145 41.8%East 53 15.3%

South 40 11.5%North 109 31.4%Age Mean ± SD

31.84 ± 9.5


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Figure 3: Demographics variables.

Descriptive statistics of Dietary Habits

Dietary Habits Variables Frequency PercentagesVegetablesOnce/Twice 126 36.3%

Three/four times 110 31.7%Five/Six times 111 32%

Dairy ProductsOnce/Twice 103 29.7%

Three/four times 115 33.1%Five/Six times 129 37.2%

MeatOnce/Twice 96 27.7%


BeanOnce/Twice 132 38%

Three/four times 124 35.7%Five/Six times 91 26.2

WaterOnce/Twice 15 4.3%


SugarOnce/Twice 113 32.6%


Soft DrinkOnce/Twice 206 59.5%



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Figure 4: Dietary habits variables.

Descriptive Statistics of Oral Health

Variables Frequency PercentagesPlaque Index

Normal 6 1.7%Mild 176 50.7%

Moderate 121 34.9%Severe 44 12.7%

Gingival IndexNormal 12 3.5%

Mild 160 46.1%Moderate 139 40.1%

Severe 34 9.8%Mean ± SD

DMFT 11.05 + 5.388


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Figure 5: Plaque index and gingival index.

Descriptive of K-10 levels of Psychological Status

K-10 levels is a categorical ordinal variable represents the ordered categories of psychological status.

K-10 Levels Frequency PercentLikely to be well 8 2.3%

Mild mental disorder 7 2.%Moderate mental disorder 20 5.8%

Severe mental disorder 312 89.9%Total 347 100.0%

Figure 6: Psychological Status.

K-10 is as continuous variables represent the scores of Psychological Status with (Mean ± SD) = (40 ± 7.65).

Discussion

Our study show that there is significant association between dietary intake and oral health as vegetable, diary product and bean intake increase the gingival, plaque index and DMFT decrease.


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Every kind of study, from experimental studies in vitro to human intervention studies, has confirmed the important role of both the amount and frequency of sugars consumption in the development of dental caries [7,8]. The recently-published World Health Organiza-tion/Food and Agriculture Organization (2003) report on diet, nutrition and the prevention of chronic diseases has concluded that there is convincing evidence that both the amount and frequency of free sugars consumption are associated with an increased risk of dental caries [8].

Osborn., et al. (1977) performed a cross-sectional study of dietary intake among patients with periodontal disease. The authors found no difference in nutrient intake compared with that of the general population [9].

In cross-sectional study, was attempted by D. BEIGHTON to investigate the inter-relations between dental caries experience, amount, and frequency of consumption of carbohydrates (sugars and starches) in the diet, salivary levels of caries-associated micro-organisms and GI. GI was taken as the best clinical indicator of the usual accumulation of plaque and tooth brushing performance, as there is a strong correlation between the quantity of plaque and the severity of gingivitis (L6e, Thailander and Jensen, 1965). These four different types of variables (caries, diet, micro-organisms, and plaque levels) have been studied previously as interactive pairs. Thus, in population studies, in which sucrose is introduced, excluded due to war, or replaced in controlled dietary experiments, there is a clear association between the availability of sucrose and caries [10].

The results of study done on 2008 by Zühre Zafersoy Akarslan showed that approximately one third of the young adult patients did not have regular main meal patterns and snacking was common. In addition, oral hygiene related behaviors were not properly performed by approximately half of the patients and a majority had visible dental plaque. Patients having snacking habits did not put much pres-sure on the oral health related behaviors. Plaque amount, improper main meal patterns, snacking, plaque accumulation and oral health related behaviors were found to be in relation with the DMFT index [11].

The interaction between snacking and removal of the plaque with oral health related behaviors in respect to caries should be ex-plained to these patients and they should be encouraged to decrease snacking frequency and enhance their oral health related behav-iors. Some previous studies reported that DMFT scores did not differ significantly, despite a higher intake of sugar and a greater snack frequency as oral hygiene was found to be the dominant variable related with the index [12].

Our study show that there is statistically significant association between the oral health and socioeconomic status (SES), as educa-tional achievement and age increase the gingival index and the plaque index decrease, also the result show there is association between area and oral health, people living in North (Riyadh) show low level of plaque and gingival index in comparison to other areas.

And the people live in the West (Riyadh) have high level of DMFT in comparison with others areas.

In study done by MH Hobdell, ER Oliveira, R Bautista, on 2003 there is a discernable association between the three oral diseases and the SES variables selected. The strength of the association varies. It is strongest for chronic destructive periodontitis and weakest for oral cancer. Dental caries lies in between these two. Second, the degree to which SES variables individually account for differences in the three oral diseases between the countries studied is striking. It is insignificant for the incidence of oral cancer, modest regarding oral cancer mortality but stronger for dental caries and strongest of all for destructive periodontal disease (CPITN 4) [13].


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Destructive periodontitis is well known to be strongly associated with the presence of dental plaque, smoking and alcohol consump-tion. It is likely that in populations with poor access to water, toothbrushes, and toothpastes there is likely to be a greater accumulation of dental plaque, which would result in the strong correlation observed in this study [14]. it is interesting to note that since Goldhaber and Giddon reported their findings in the 1960s concerning acute necrotizing ulcerative gingivitis (ANUG), the role of psychosocial stress has also been a recurring theme in the search for the etiological factors of destructive periodontitis [14,15].

Our result in present study shows that there is high association between plaque and gingival index (periodontal status) and psycho-logical status, but no significant association between DMFT and psychological status. This result agrees with (Breivik) who concluded that stress maybe contributing factor in periodontal disease; Emotional stress effects on immunity, gingivitis, and periodontitis [16].

On the other hand, our present study disagrees with (Mengel) who didn’t find association between psychological stress and peri-odontal status stress in periodontally diseased patients [17].

Conclusion

Diet and nutrition affects oral health in many ways. Nutrition, for example, influences craniofacial development, oral cancer, and oral infectious diseases.

To implement nutritional counselling, covering not only the general health aspects of good nutritional behavior but also emphasizing the aspects directly linked to oral health. The post-eruptive effect of sugar consumption is one of the etiologic factors for dental caries.

Our data in the present study show that there is significant impact of dietary habit, socioeconomic status, and psychological status on the oral health. WHO/FAO recently published a Global Strategy on Diet, Physical Activity and Health, based on analysis of the best available evidence on the relationship between diet and physical activity patterns and the major nutrition-related chronic diseases [1].

Competing Interests

The authors declare that there is no conflict of interest regarding the publication of this paper.

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