1. Oral health-related quality of life Oral health-related quality of life (OHRQoL); one indicator of oral health. OHRQoL was assessed with the 14-item Oral Health Impact Profile.
2. 1. Socioeconomic positionAnnual household income was used as the indicator of socioeconomic position.
3. 2. Dental behaviour and OHRQoL Results supported the assumption of apositive relationship between dentalbehaviour and OHRQoL. As scores for dental visiting and self-care increased from Low to High levels,a corresponding decrease in thenegative impact of dental problems onOHRQoL was observed.
4. 3. Socioeconomic position and behaviour• Table 3 presents mean impactscores for Visiting and Self-carebehaviours by income categories.• As expected, adults with the highesthousehold income were most likelyto make dental visits, as indicated bythe highest mean score for Visiting.• However, visiting behaviour did notfollow a socioeconomic gradient.
5. 4. Social determinants• A number of conceptual models for explaining socioeconomic inequality in healthhas emphasised the role of social and psychosocial factors.• Three scales were used to measure personal control, stress, and social support.Each was scored on a five-point Likert-style scale of agreement. Higher meanscores indicated a higher level of the measured factor.
6. 5. Social determinants and socioeconomic position
7. • Thus, the more individualsperceived outcomes in life tobe beyond their control, theless likely they were to act inways associated withfavourable OHRQoL
8. • Figure 3 depicts the reverserelationship for Masanddental behaviour. Greatermastery was associ withbetter utilisation and betterdental self-care.
9. Figures 4 and 5 address the relationship between stress and dental behaviours. As levels ofDistress increased, the likelihood of practicing dental self-care decreased incrementally.
10. • As the availability of Social supportincreased from Low to High levels, dentalvisiting and dental self-care increasedsignificantly (Figure 6).• Findings indicated that dental behavioursdo not occur independently, but rathertend to cluster together. The performanceof dental visiting and dental self-care wasmore closely associated with personalcontrol, stress, and social support, than itwas with income.• The final section examined whetherOHRQoL was socially distributedaccording to levels of these socialdeterminants.
11. Social determinants and OHRQoLFigures 7 to 11 present results graphically using the negative impact of dental problems as the measureof OHRQoL.
12. • Overall, greatest variation inimpact was apparent on theDistress subscale.• An almost 3-fold difference inmagnitude was observed, withimpact increasing incrementallywith increasing Distress (Figure 9).
13. Conclusions• The distribution of population OHRQoL follows a socioeconomic gradient. It is not coincidental thathealth inequalities mirror social inequalities. However, although correlated with oral healthoutcomes, income per se does not produce social inequality in subjective oral health. To advancethe understanding of the social determinants of OHRQoL, this study examined a series of socialdeterminants found in general health research to be strongly related to health outcomes.• Results showed that personal control, stress, and social support were linked to income, dentallyrelevant behaviours and OHRQoL.• Findings have implications for oral health promotion at both individual and societal levels.Understanding the factors that influence self-care and the use of dental services can informbehavioural interventions. In addition, the finding that social determinants of general health are alsoassociated with oral health has implications for a common risk factor approach that takes a broadersocioenvironmental view of the factors influencing health.