By: Noha Gomaa, Schulich School of Medicine and Dentistry, Western University<\/p>\n
ngomaa@uwo.ca<\/a><\/p>\n @DrNGomaa<\/a><\/p>\n Le fran\u00e7ais suit \/ French follows<\/em><\/p>\n \u201cShow me your teeth, and I will tell you who you are.<\/em>\u201d This almost 300-year-old quote by the French naturalist and father of paleontology George Cuvier was initially intended to describe how the structure of teeth varied by the type of diet that was consumed by different populations. Cuvier\u2019s remark, although unintentionally, has proven to extend beyond its comparative anatomy connotation to portray the stark differences in oral health between socially advantaged and disadvantaged groups of the population. Oral health today continues to be determined by and reflect one\u2019s social and economic conditions.<\/p>\n <\/p>\n Observing such oral health inequalities gives rise to important questions around why social plight makes individuals more prone to oral diseases, and on the other hand, what makes fantastic teeth<\/em> a trait of social advantage. The answer is a multi-factorial one in which several forces are at play. Good oral health has occasionally been attributed to one\u2019s \u201cgood genes\u201d that can be protective against acquiring some of the most common yet preventable oral diseases, such as dental cavities\/caries and gum inflammation. However, genetic studies do not, on their own, fully justify the variation in oral disease risk, and are certainly unable to explain any oral (or non-oral) health inequalities. Along with the other determinants of health, an individual\u2019s social and economic conditions can impact their access to resources such as quality dental care, adequate nutrition, and fresh produce, while deterring their consumption of sticky and starchy foods that are known to cause oral diseases. Variations in health-compromising behaviours such as oral hygiene practices and smoking have also long been considered as some of the main drivers of oral disease risk that are largely determined by one\u2019s social stance. Earlier studies have however suggested that aiming to enhance oral health behaviours by educating patients about brushing and flossing, while definitely important, may arguably fail to yield the anticipated sustainable results\u2014at least not for those with less resources.<\/p>\n <\/p>\n Here, the role of psychosocial stress emerges. Chronic stress can result from the low-grade yet persistent exposures to adverse social and living conditions on a daily basis. Studies in psychoneuroimmunology have demonstrated the pivotal role of chronic stress in several health conditions. Stress acts on various biological responses, putting the hypothalamic-pituitary-adrenal axis in a constant activation mode. This in turn triggers a cascade of multi-system stress responses that contribute to the increased vulnerability to a multitude of diseases, including those of the mouth. Our team<\/a> at Western University has been diving deeper into how the psychosocial environment and related chronic stress can \u201cget under the skin and in between teeth\u201d<\/em> to become biologically embedded. In our previous clinical studies, we found that a higher accumulation of the stress biomarker cortisol in hair and saliva was linked to an increased risk of periodontal disease (inflammation of the tooth-supporting structures) in individuals of lower income. These patients also exhibited oral innate immune cells (neutrophils) that were primed to be more conducive of oral inflammation. In a large study of American children and adolescents, we found the risk of untreated dental cavities to increase with the multi-system cumulative biological toll of chronic stress, known as allostatic load. We noted this as being more evident in children from minority racial\/ethnic backgrounds. More recently, we started investigating how social disadvantage and related chronic stress may increase oral disease risk by getting down to the level of the genes involved in oral disease initiation and progression. We anticipate providing insight into how oral health inequalities occur over the life-course, and why socially disadvantaged individuals become more susceptible to oral diseases than their more advantaged counterparts.<\/p>\n <\/p>\n To this end, we can conclude that fantastic teeth<\/em> may not just be found<\/em> with good genes or oral hygiene. For many, they are a prerogative of affluence and access to enabling resources that can determine whether one becomes susceptible or resilient to oral diseases. Consequently, concerted multi-level solutions that target social and living conditions, curb psychosocial stressors (and their biological toll), and enable equitable access to quality oral health care, will continue to be key.<\/p>\n Il y a pr\u00e8s de trois si\u00e8cles, George Cuvier disait\u00a0: \u00ab\u00a0Montre-moi tes dents, je te dirai qui tu es.\u00a0\u00bb \u00c0 l\u2019\u00e9poque, le naturaliste fran\u00e7ais et p\u00e8re de la pal\u00e9ontologie faisait r\u00e9f\u00e9rence aux diff\u00e9rences qu\u2019il avait observ\u00e9es dans la structure dentaire de diverses populations selon le r\u00e9gime alimentaire. Il ne se doutait pas que ses mots seraient un jour repris dans un autre contexte que celui de l\u2019anatomie, cette fois pour illustrer les in\u00e9galit\u00e9s en mati\u00e8re de sant\u00e9 buccodentaire entre les groupes socialement favoris\u00e9s et les groupes socialement d\u00e9favoris\u00e9s. La sant\u00e9 buccodentaire demeure aujourd\u2019hui un enjeu socio\u00e9conomique.<\/p>\n De telles in\u00e9galit\u00e9s en mati\u00e8re de sant\u00e9 buccodentaire soul\u00e8vent d\u2019importantes questions\u00a0: pourquoi les personnes socialement d\u00e9favoris\u00e9es sont-elles plus sujettes aux maladies buccodentaires? Pourquoi les dents \u00e9tincelantes<\/em> sont-elles un signe de statut privil\u00e9gi\u00e9? La r\u00e9ponse comporte plusieurs couches et implique diff\u00e9rents facteurs. On a d\u00e9j\u00e0 dit qu\u2019une bonne sant\u00e9 buccodentaire \u00e9tait due \u00e0 une \u00ab\u00a0bonne g\u00e9n\u00e9tique\u00a0\u00bb qui prot\u00e9geait des maladies \u00e9vitables les plus fr\u00e9quentes telles que les caries et la gingivite. Or, la science g\u00e9n\u00e9tique ne peut elle-m\u00eame r\u00e9pondre enti\u00e8rement de la variation du risque de maladies buccodentaires, et ne peut encore moins expliquer les in\u00e9galit\u00e9s en sant\u00e9 buccodentaire (ou m\u00eame en sant\u00e9 de mani\u00e8re g\u00e9n\u00e9rale). La situation socio\u00e9conomique, au m\u00eame titre que les autres d\u00e9terminants de la sant\u00e9, a une incidence non seulement sur l\u2019acc\u00e8s \u00e0 des ressources telles que les soins dentaires de qualit\u00e9, l\u2019alimentation saine et les fruits et l\u00e9gumes frais, mais aussi sur la propension \u00e0 consommer des aliments qui compromettent la sant\u00e9 buccodentaire, comme les sucreries et les f\u00e9culents. D\u2019autres comportements nuisibles \u00e0 la sant\u00e9, par exemple la mauvaise hygi\u00e8ne dentaire et le tabagisme, ont aussi longtemps \u00e9t\u00e9 vus comme d\u2019importants vecteurs de maladies buccodentaires qui sont intrins\u00e8quement li\u00e9s au statut social. Des \u00e9tudes ont aussi conclu que bien qu\u2019il soit important d\u2019enseigner l\u2019hygi\u00e8ne dentaire \u2013\u00a0brossage, utilisation du fil dentaire\u00a0\u2013, cette pratique ne donne pas forc\u00e9ment les r\u00e9sultats escompt\u00e9s, surtout chez les populations d\u00e9favoris\u00e9es.<\/p>\n C\u2019est ici qu\u2019entre en jeu le stress psychosocial. L\u2019exposition continue \u00e0 des conditions de vie difficiles et \u00e0 un environnement social hostile, peu importe le degr\u00e9, peut entra\u00eener du stress chronique. Les \u00e9tudes en psychoneuroimmunologie ont fait \u00e9tat du r\u00f4le central que joue le stress chronique dans l\u2019apparition de plusieurs probl\u00e8mes de sant\u00e9. L\u2019action du stress sur diverses r\u00e9ponses biologiques active de fa\u00e7on ininterrompue l\u2019axe hypothalamo-hypophyso-surr\u00e9nalien, ce qui provoque une succession de r\u00e9ponses multisyst\u00e9miques au stress. Cet \u00e9tat accentue la vuln\u00e9rabilit\u00e9 \u00e0 une multitude de maladies, notamment les maladies buccodentaires. Notre \u00e9quipe (en anglais seulement)<\/a> \u00e0 l\u2019Universit\u00e9 Western a cherch\u00e9 \u00e0 mieux comprendre comment l\u2019environnement psychosocial et le stress chronique qui en r\u00e9sulte arrivent \u00e0 \u00ab\u00a0entrer dans la peau et dans les dents<\/em>\u00a0\u00bb pour s\u2019int\u00e9grer \u00e0 la biologie. Dans le cadre d\u2019\u00e9tudes cliniques ant\u00e9rieures, nous avions constat\u00e9 que l\u2019augmentation de cortisol, un biomarqueur de stress, dans les cheveux et la salive co\u00efncide avec une hausse du risque de maladies parodontales (inflammation des structures de soutien des dents) chez les personnes \u00e0 faible revenu. Nous avions \u00e9galement trouv\u00e9 chez ces personnes des cellules immunitaires inn\u00e9es (neutrophiles) qui favorisaient les inflammations buccales. Il est ressorti d\u2019une autre \u00e9tude de grande envergure, qui portait sur des enfants et des adolescents am\u00e9ricains, que le risque de caries dentaires non soign\u00e9es augmentait de pair avec l\u2019accumulation multisyst\u00e9mique du fardeau biologique occasionn\u00e9 par le stress chronique, aussi appel\u00e9e charge allostatique. Cette caract\u00e9ristique semblait encore plus \u00e9vidente chez les enfants issus de minorit\u00e9s raciales ou ethniques. Nous avons donc cherch\u00e9 \u00e0 savoir si les in\u00e9galit\u00e9s sociales et le stress chronique qui en d\u00e9coule augmentaient le risque de maladies buccodentaires en regardant de plus pr\u00e8s les g\u00e8nes qui d\u00e9clenchent et font progresser ces maladies. Nous esp\u00e9rons jeter une lumi\u00e8re sur les causes des in\u00e9galit\u00e9s en mati\u00e8re de sant\u00e9 buccodentaire et sur les fa\u00e7ons dont elles se manifestent tout au long d\u2019une vie, ainsi que sur les facteurs qui pr\u00e9disposent davantage les personnes socialement d\u00e9favoris\u00e9es aux maladies buccodentaires que les personnes privil\u00e9gi\u00e9es.<\/p>\n En conclusion, nous pouvons dire que les dents \u00e9tincelantes<\/em> ne se cachent<\/em> peut-\u00eatre pas derri\u00e8re la bonne g\u00e9n\u00e9tique ou la bonne hygi\u00e8ne dentaire. Pour certains, elles sont simplement le reflet d\u2019une bonne situation et d\u2019un acc\u00e8s aux ressources qui sont essentielles \u00e0 la sant\u00e9 buccodentaire. Il semble donc qu\u2019il faille des solutions concert\u00e9es et pluridimensionnelles qui am\u00e9lioreront les conditions de vie et l\u2019environnement social, qui apaiseront les stresseurs psychosociaux (et leur fardeau biologique) et qui assureront un acc\u00e8s \u00e9quitable aux soins buccodentaires de qualit\u00e9.<\/p>\n","protected":false},"excerpt":{"rendered":" By: Noha Gomaa, Schulich School of Medicine and Dentistry, Western University ngomaa@uwo.ca @DrNGomaa Le fran\u00e7ais suit \/ French follows \u201cShow me your teeth, and I will tell you who you are.\u201d This almost 300-year-old quote by the French naturalist and … Continue reading
\nMais o\u00f9 se cachent les dents \u00e9tincelantes?<\/strong><\/h1>\n