Oral health-related behaviours do not mediate the effect of maternal education on adolescents’ gingival bleeding: A birth cohort study
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Related
- Self-medication among higher education students: prevalence, risk factors, and health information-seeking behaviours
- The need for pediatric sleep education to enhance healthcare for children and adolescents: A global perspective from a survey of members of the international pediatric sleep association
- Hypervitaminosis A and Oral Pathology: Genomic Disruption, Enamel Defects, and Gingival Hazards
- Reducing Occupational Exposure to Pesticides: Understanding the Preventive Behaviours of French Farmers
- Diurnal rhythmicity modulates self-blaming behaviours and neural processing of autobiographical guilt memories in the trait-like and state-like manner
BibTeX
@article{peres2026oral,
title = {{Oral health-related behaviours do not mediate the effect of maternal education on adolescents’ gingival bleeding: A birth cohort study}},
author = {Marco A. Peres and Gustavo G. Nascimento and Karen G. Peres and Flavio F. Demarco and Ana B. Menezes},
journal = {Community Dentistry and Oral Epidemiology},
year = {2026},
month = oct,
doi = {10.1111/cdoe.12350},
url = {https://hal.science/hal-05791984v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Oral health-related behaviours do not mediate the effect of maternal education on adolescents’ gingival bleeding: A birth cohort study
AU - Marco A. Peres
AU - Gustavo G. Nascimento
AU - Karen G. Peres
AU - Flavio F. Demarco
AU - Ana B. Menezes
PY - 2026
DA - 2026/10/11
JO - Community Dentistry and Oral Epidemiology
DO - 10.1111/cdoe.12350
UR - https://hal.science/hal-05791984v1
AB - OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
SN - 0301-5661
SN - 1600-0528
ER -