The empirical evidence
Over the past decades a large number of research
reports have shown that dental caries is linked to
social and behavioural factors (3–5). Figure 3
applies the general conceptual framework as outlined
in Fig. 2 to the analysis of risk factors in dental
caries. The model is based on the evidence available
on potential sociobehavioural risks of dental caries
and some widely used outcome measures are listed.
Most studies on sociobehavioural risk factors in
dental caries have been carried out in industrialized
countries. Such reports from low- and middleincome
countries have been published in recent
years, probably in response to the growing prevalence
rates and severity of dental caries experience
in these countries. In 1997, the WHO published a
comprehensive document which described and
analysed the oral health status of children and
adults in selected countries (6). The primary objective
of the so-called WHO International Collaborative
Studies (ICS-I or -II) was to compare oral
health care systems and their impacts on oral
health status. Secondly, the data provide a unique
opportunity to analyse important sociobehavioural
determinants of oral disease, as information on
living conditions, oral health-related behaviour and
quality of life was also collected. The study was
truly international in scope and sought to analyse
the oral health situation in countries with different
oral health systems ranging from demand-based
private oral health care delivery systems (e.g.
Japan, USA) to public oral health care systems
(e.g. Poland, at the time of study).
Across countries and oral health systems, the
existence of a social gradient in dental caries
prevalence was found as measured by the association
in dental caries indicators and socioeconomic
status (Figs 4–6). The effect of educational background
on measures of dental caries was observed
for all countries but was found to be particularly
strong when the disease prevalence was high.
Additional analyses focussed on the effects of
occupational and behavioural factors on clinical
outcome measures. Multivariate regression analyses
were performed in order to control for effects of
socioeconomic status; low scores of DT and MT
were found in adults when respondents had
preventive dental care habits and when they had