Peres Marco A, Nascimento Gustavo G, Peres Karen G, Demarco Flavio F, Menezes Ana B
Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.
Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.
Community Dent Oral Epidemiol. 2018 Apr;46(2):169-177. doi: 10.1111/cdoe.12350. Epub 2017 Nov 27.
To test whether maternal education has a direct effect on gingival bleeding in adolescents aged 12 and to assess whether oral health behaviours over time mediate that association.
Two oral health studies nested in the 1993 Pelotas (Brazil) birth cohort study were carried out in participants aged 6 (n = 359) and 12 years (n = 339). The proportion of teeth with bleeding on probing (BOP) and the median number of teeth with gingivitis at age 12 were recorded. Maternal education at birth was the exposure. Toothbrushing frequency and dental visit at ages 6 and 12 years were investigated as mediators of the association between maternal education at birth and gingival bleeding. Time-varying family income through childhood and adolescence was included as later confounder. Paternal education was taken as baseline confounder. The controlled direct effect (CDE) of maternal education at child's birth on gingival bleeding at age 12 was estimated using marginal structural models (MSM). Additionally, path analysis was employed to estimate standardized direct, indirect and total effects of maternal education at birth on gingival bleeding.
Adjusted analyses using MSM showed that adolescents whose mothers had <8 years of education had 3.82 higher risk of having teeth with gingival bleeding above the median (rate ratio RR 3.82; 95% CI: 1.68-8.19). Low maternal education doubled the proportion of gingival bleeding at age 12 not mediated by dental visit and toothbrushing frequency (RR 1.99; 95% CI: 1.52-2.60). Path analysis revealed that maternal education had a direct effect on gingival bleeding independently of the mediators.
The pattern of oral health behaviours does not explain the association between mother's education and adolescent's gingival bleeding. Individual-based approaches focused on oral health-related behaviours tend to fail to prevent gingival bleeding.
检验母亲的教育程度是否对12岁青少年的牙龈出血有直接影响，并评估随着时间推移的口腔健康行为是否介导了这种关联。
在1993年佩洛塔斯（巴西）出生队列研究中嵌套了两项口腔健康研究，对6岁（n = 359）和12岁（n = 339）的参与者进行。记录12岁时探诊出血（BOP）的牙齿比例和患牙龈炎的牙齿中位数。出生时母亲的教育程度为暴露因素。将6岁和12岁时的刷牙频率和看牙医情况作为出生时母亲教育程度与牙龈出血之间关联的中介因素进行调查。纳入童年和青少年时期随时间变化的家庭收入作为后期混杂因素。父亲的教育程度作为基线混杂因素。使用边际结构模型（MSM）估计孩子出生时母亲的教育程度对12岁时牙龈出血的受控直接效应（CDE）。此外，采用路径分析估计出生时母亲的教育程度对牙龈出血的标准化直接、间接和总效应。
使用MSM进行的校正分析表明，母亲教育年限<8年的青少年牙龈出血牙齿数高于中位数的风险高3.82倍（率比RR 3.82；95%CI：1.68 - 8.19）。母亲教育程度低使12岁时未由看牙医和刷牙频率介导的牙龈出血比例增加一倍（RR 1.99；95%CI：1.52 - 2.60）。路径分析显示，母亲的教育程度对牙龈出血有独立于中介因素的直接影响。
口腔健康行为模式并不能解释母亲教育程度与青少年牙龈出血之间的关联。侧重于口腔健康相关行为的基于个体的方法往往无法预防牙龈出血。
