Document Type : Original Article

Authors

1 Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Oral Public Health, Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

The sense of coherence (SOC) is defined as a personal orientation to life. People with higher SOC
are better at dealing with stressful situations, psychological stress, and problems and are more able
to manage them, leading to better general health. The purpose of this study was to evaluate the effect
of SOC on the oral health status of people in different age groups. A systematic search up to May
2019 was carried out in PubMed,Scopus, Psycho info, and Persian sources. Studies were included
if they evaluated the relationship between SOC and oral health behaviors (OHBs) or oral health
status including dental caries. The Newcastle‑Ottawa checklist was used to appraise the selected
articles and meta‑analysis of included studies were performed using Comprehensive Meta‑Analysis
software. Value of P < 0.05 was considered to be statistically significant. Odds ratio (OR) was used
to measure effect size with 95% confidence interval (CI). The random‑effects model was chosen
in the presence of heterogenicity. I2 index and Q index were used to measure the heterogeneity
present between the studies. Fifteen articles received the minimum score of criticism. In general,
SOC could significantly affect the oral health and OHBs of adults independently of the underlying
factors. There was a significant relationship between SOC and tooth decay in adolescents, but this
association was poor after adjusting for the underlying factors. In children, only one article revealed
an association with OHBs. Meta‑analysis revealed that SOC was significantly associated with the
caries rate (OR = 0.78, CI 95% = 0.9–0.67, P = 0.001) and tooth brushing frequency (OR = 1.22,
CI 95% = 1.1–1.31 and P < 0.001). Sense of coherence appears to be one of the effective factors
in predicting oral health behaviors and ultimately oral health, especially in adults. The number of
articles available for children and adolescents was not sufficient in this regard.

Keywords

1. Chu JJ, Khan MH, Jahn HJ, Kraemer A. Sense of coherence and
associated factors among university students in China: Crosssectional evidence. BMC Public Health 2016;16:336.
2. Eriksson M, Lindström B. Antonovsky’s sense of coherence scale
and the relation with health: A systematic review. J Epidemiol
Community Health 2006;60:376-81.
3. Savolainen JJ, Suominen-Taipale AL, Uutela AK, Martelin TP,
Niskanen MC, Knuuttila ML. Sense of coherence as a determinant
of toothbrushing frequency and level of oral hygiene. J Periodont
2005;76:1006-12.
4. Mohamamdirizi S, Mohamadirizi M, Mohamadirizi S. The
comparison of fear of childbirth and sense of coherence among
low-risk and high-risk pregnancy women. J Educ Health Promot
2018;7:143.
5. Wiseman J, McLeod J, Zubrick SR. Promoting mental health and
well-being: Integrating individual, organisational and communitylevel indicators. Health Promot J Austr 2007;18:198-207.
6. Patrick DL, Lee RS, Nucci M, Grembowski D, Jolles CZ,
Milgrom P. Reducing oral health disparities: A focus on social
and cultural determinants. BMC Oral Health 2006;6 Suppl 1:S4.
7. Lundman B, Norberg A. The significance of a sense of coherence
for subjective health in persons with insulin dependent diabetes.
J Adv Nurs 1993;18:381-6.
8. Wainwright NW, Surtees PG, Welch AA, Luben RN, Khaw KT,
Bingham SA. Healthy lifestyle choices: Could sense of coherence
aid health promotion? J Epidemiol Community Health
2007;61:871-6.
9. Freire M, Sheiham A, Hardy R. Adolescents’ sense of coherence,
oral health status, and oral health-related behaviours. Community
Dent Oral Epidemiol 2001;29:204-12.
10. Hall-Scullin E, Goldthorpe J, Milsom K, Tickle M. A qualitative
study of the views of adolescents on their caries risk and
prevention behaviors. BMC Oral Health 2015;15:141.
11. Nammontri O, Robinson P, Baker S. Enhancing oral health
via sense of coherence: A cluster-randomized trial. J Dent Res
2013;92:26-31.
12. Lindmark U, Hakeberg M, Hugoson A. Sense of coherence and
oral health status in an adult Swedish population. Acta Odontol
Scand 2011;69:12-20.
13. Lindmark U, Stegmayr B, Nilsson B, Lindahl B, Johansson I. Food
selection associated with sense of coherence in adults. Nutr J
2005;4:9.
14. Elyasi M, Abreu LG, Badri P, Saltaji H, Flores-Mir C, Amin M.
Impact of sense of coherence on oral health behaviors:
A systematic review. PLoS One 2015;10: e0133918. doi: 10.1371/
journal.pone. 0133918.
15. Savolainen J, Suominen-Taipale A, Uutela A, Aromaa A,
Härkänen T, Knuuttila M. Sense of coherence associates with
oral and general health behaviours. Community Dent Health
2009;26:197-203.
16. Antonovsky A. The structure and properties of the sense of
coherence scale. Soc Sci Med 1993;36:725-33.
17. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M,
et al. The Newcastle-Ottawa Score for Non-Randomized Studies;
2013. Available at: http://www.ohri.ca. Accessed June 2019.
18. Viswanathan M, Ansari MT, Berkman ND, Chang S, Hartling L,
McPheeters LM, et al. Assessing the Risk of Bias of Individual
Studies in Systematic Reviews of Health Care Interventions.
Agency for Healthcare Research and Quality Methods Guide
for Comparative Effectiveness Reviews. AHRQ Publication
No. 12-EHC047-EF; 2012. Available from: http//www.
effectivehealthcare.ahrq.gov/. [Last accessed on 2019 Jun].
19. Zhang J, Yu KF. What’s the relative risk? A method of correcting
the odds ratio in cohort studies of common outcomes. JAMA
1998;280:1690-91.
20. DersimonianR, Laird N. Meta-analysis in clinical trailas. Contemp
Clin Trials 2015;45:139-45.
21. Bernabé E, Newton JT, Uutela A, Aromaa A, Suominen AL. Sense
of coherence and four-year caries incidence in Finnish adults.
Caries Res 2012;46:523-9.
22. Bernabé E, Watt RG, Sheiham A, Suominen-Taipale AL, Uutela A,
Vehkalahti MM, et al. Sense of coherence and oral health in
dentate adults: Findings from the Finnish health 2000 survey.
J Clin Periodontol 2010;37:981-7.
23. Cyrino RM, Costa FO, Cortelli JR, Cortelli SC, Cota LO. Sense of
coherence and periodontal health outcomes. Acta Odontol Scand
2016;74:368-73.
24. Lindmark U, Hakeberg M, Hugoson A. Sense of coherence and its
relationship with oral health-related behaviour and knowledge
of and attitudes towards oral health. Community Dent Oral
Epidemiol 2011;39:542-53.
25. Bernabé E, Kivimäki M, Tsakos G, Suominen-Taipale AL,
Nordblad A, Savolainen J, et al. The relationship among sense of coherence, socio-economic status, and oral health-related
behaviours among Finnish dentate adults. Eur J Oral Sci
2009;117:413-8.
26. Wennström A, Wide Boman U, Stenman U, Ahlqwist M,
Hakeberg M. Oral health, sense of coherence and dental anxiety
among middle-aged women. Acta Odontol Scand 2013;71:256-62.
27. Lage CF, Fulgencio LB, Corrêa-Faria P, Serra-Negra JM, Paiva SM,
Pordeus IA. Association between dental caries experience and
sense of coherence among adolescents and mothers. Int J Paediatr
Dent 2017;27:412-9.
28. Ayo-Yusuf OA, Reddy PS, Van Den Borne BW. Longitudinal
association of adolescents’ sense of coherence with tooth-brushing
using an integrated behaviour change model. Community. Dent
Oral Epidemiol 2009;37:68-77.
29. Dorri M, Sheiham A, Hardy R, Watt R. The relationship between
sense of coherence and tooth brushing behaviours in Iranian
adolescents in Mashhad. J Clin Periodontol 2010;37:46-52.
30. Bernabé E, Watt RG, Sheiham A, Suominen AL, Vehkalahti MM,
Nordblad A, et al. Childhood socioeconomic position, adult
sense of coherence and tooth retention. Community Dent Oral
Epidemiol 2012;40:46-52.
31. Vettore MV. Sense of coherence modifies the association between
untreated dental caries and dental pain in low-social status
women. Community Dent Health 2016;33:54-9. 29
32. Dorri M, Sheiham A, Watt RG. Modelling the factors influencing
general and oral hygiene behaviours in adolescents. Int J Paediatr
Dent 2010;20:261-9.
33. Antonovsky A. Unraveling the Mystery of Health: How People
Manage Stress and Stay Well New Jersey: Jossey-Bass; 1987.
34. Volanen SM, Lahelma E, Silventoinen K, Suominen S. Factors
contributing to sense of coherence among men and women. Eur
J Public Health 2004;14:322-30.
35. Lalani A, Dasar PL, Sandesh N, Mishra P, Kumar S, Balsaraf S.
Assessment of relationship between oral health behavior, oral
hygiene and gingival status of dental students. Indian J Dent Res
2015;26:592.
36. Rad AB, Joulaei H, Vossoughi M, Golkari A. Assessing oral
health status and behaviors in 6-year-old school children in rural
and urban areas of Shiraz, Southern Iran. Int J School Health
2016;3 (1): e33036.
37. Peltzer K, Pengpid S. Dental health status and oral health behavior
among university students from five ASEAN countries. Nagoya
J Med Sci 2017;79:123.
38. Schützhold S, Holtfreter B, Schiffner U, Hoffmann T, Kocher T,
Micheelis W. Clinical factors and self-perceived oral health. Eur
J Oral Sci 2014;122:134-41.
39. Locker D, Wexler EW, Jokovic A. What do older adults’ global
self-ratings of oral health measure? J Public Health Dent
2005;65:146-52.
40. Goodarzi A, Heidarnia A, Tavafian SS, Eslami M. Predicting oral
health behaviors among Iranian students by using health belief
model. J Educ Health Promot 2019;8:10.
41. Tahani B, Yadegarfar G, Ahmadi A. Knowledge, attitude, and
practice of parents of 7-12-year-old children regarding fissure
sealant therapy and professional fluoride therapy. J Educ Health
Promot 2017;6:106.
42. Van Woerkum C, Bouwman L. Getting things done: An everydaylife perspective towards bridging the gap between intentions
and practices in health-related behavior. Health Promot Int
2014;29:278-86.
43. Lindström B, Eriksson M. Contextualizing salutogenesis and
antonovsky in public health development. Health Promot Int
2006;21:238-44.
44. Silva AN, Mendonça MH, Vettore MV. A salutogenic
approach to oral health promotion. Cad Saude Publica
2008;24 Suppl 4:s521-30.
45. Super S, Wagemakers MA, Picavet HS, Verkooijen KT,
Koelen MA. Strengthening sense of coherence: Opportunities
for theory building in health promotion. Health Promot Int
2016;31:869‑78.