Adolescents' sense of coherence and smoking predicts self-reported gingivitis

Abstract

CONTEXT: Smoking, which may be initiated as a response to stress during adolescence, is a risk for periodontal disease among adults. Only limited information is available on the effect of smoking on South African adolescents’ oral health. Given that the sense of coherence (SOC) construct seeks to explain the relationship between coping with life stresses and maintaining health, this study sought to examine the independent influence of smoking and SOC on the gingival health of a cohort of rural black South African adolescents. METHODS: This 18-month longitudinal study involved a three-wave questionnaire survey and clinical oral examination of a representative sample of 8th-graders from 11 randomly selected high schools in Limpopo province, South Africa (n=970). Using a generalized estimating equation (GEE) model, we prospectively examined the correlates of experiencing recent or persistent gingivitis, defined as self-reporting recent or persistent frequent bleeding gums. Explanatory variables included baseline socio-economic status, age, gender, plaque levels, tooth-brushing frequency, smoking and snuff use status and SOC levels (measured on a six-item scale with cronbach alpha=0.63). Results: Among our sample, 74.6% self-reported experiencing gingivitis at some point during follow-up, while 41.9% self-reported gingivitis at the last survey. Factors that were positively associated with recent or persistent gingivitis include living in poor households (odds ratio [OR] = 1.49; p<0.01), having higher plaque levels (OR = 1.18; p=0.04) and smoking regularly (OR = 1.57; p=0.04). Recent or persistent gingivitis was negatively associated with being female (OR = 0.76; p=0.02) and having higher SOC (OR = 0.96; p<0.001). CONCLUSIONS: Our findings support the integration of smoking prevention with oral health promotion programmes. In addition, poverty alleviation and teaching of stress-coping skills may be important interventions for promoting adolescents’ gingival health.