. African Americans (AA) have higher rates of poor oral health, including periodontal disease (gum disease) and edentulism (tooth loss) than whites, differences that are only partially explained by income, education, and insurance status. Psychosocial stress may contribute to poor oral health. Positive associations between psychosocial stressors (e.g., depression, occupational stress) and chronic inflammatory periodontal disease have been documented. In addition, evidence suggests that healthy coping mechanisms may ameliorate the adverse effect of stress on oral health. Stress may be particularly relevant to AAs, who are disproportionately exposed to racism, neighborhood deprivation, and violence (negative psychosocial factors), which may act as sources of chronic and acute stress. AAs are also significantly more likely than whites to indicate that religion and spirituality (positive psychosocial factors) are important in their daily lives. A possible mechanism to explain the stress-oral health association involves behavioral changes that may accompany psychosocial stressors, including smoking, oral hygiene, and dental visits (potential mediators), all factors that influence periodontal disease. Other mechanisms include effects of stressors on immune function and on the oral microbiome. The goal of the current proposal is to prospectively assess negative and positive psychosocial factors over the life course in relation to adult oral health (low self-rated oral health and higher levels of tooth loss and periodontal disease) among AA women within the Black Women's Health Study (BWHS), an ongoing longitudinal study of 59,000 U.S. Black women begun in 1995. We have extensive information on psychosocial factors, both negative and positive, that occurred during childhood and adolescence as well as during adulthood; we have data on potential mediating factors, and on important confounders (e.g., parity, individual socioeconomic status); and we have collected data on self-rated oral health, tooth loss, and dentist-diagnosed periodontal disease during the course of follow-up. Findings are intended to lay the groundwork for further mechanistic studies of how chronic stress leads to periodontal disease and tooth loss. Future studies could assess inflammatory and microbiome pathways, which in turn might inform the development of new therapeutic interventions.

Public Health Relevance

Our proposed study is highly innovative and will generate important information regarding the influence of psychosocial stressors on oral health in African-American women, a high risk population. It is also the first study to explicitly assess stressors experienced during childhood/adolescence and adult oral health and to apply longitudinal analyses of the hypotheses under study. Findings have the potential to direct interventions and to motivate further studies of how chronic stress leads to periodontal disease and tooth loss.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Small Research Grants (R03)
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Special Emphasis Panel (ZDE1)
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Riddle, Melissa
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Boston University
Public Health & Prev Medicine
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United States
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Cozier, Yvette C; Barbhaiya, Medha; Castro-Webb, Nelsy et al. (2018) A prospective study of obesity and risk of systemic lupus erythematosus (SLE) among Black women. Semin Arthritis Rheum :