An exploration of the life course determinants of oral health in the United Kingdom

Abstract

Poor oral health has a substantial impact at both an individual and societal level and develops across the life course. This research explored the life course determinants of oral health in the UK, addressing an existing lack of research in this field. This mixed-methods research utilised an existing longitudinal prospective birth cohort study – the Newcastle Thousand Families Study – which recruited 1,142 babies born in Newcastle upon Tyne in 1947. Twenty in-depth interviews were conducted with participants at age 67, to explore what influenced how they looked after their oral health across the life course. The broader life course determinants of age 63 tooth retention in this cohort were subsequently modelled using path analysis techniques. The interviews revealed that a range of factors influenced oral health behaviours, centring around four sources: the dental profession, wider society (e.g. schools, peers, the media), family members and the individuals themselves. Determinants varied to some extent between different behaviours and also across the life course. Parents were reportedly the predominant influencers in childhood, whilst individual-level and peer influences played a major role during the transition to independent adulthood. Throughout independent adulthood, influences were diverse, although, notably, family influences transferred from parents to spouses and children, especially the former. The path analysis demonstrated that multiple factors across the life course influenced age 63 tooth retention, including smoking and dental attendance, socio-economic determinants, dental anxiety, sex and parental encouragement. However, the potential influence of unmeasured factors (specifically sugar consumption) could not be established due to data limitations. Subject to potential differences between this 1947 cohort and contemporary generations, this research suggests that oral health interventions should target an array of behavioural, social and psychological factors at the level of individuals, families, society and the dental profession, prioritising the most appropriate determinants at each life course stage.