**4. Social determinants of health and life-course related to oral health**

In the context of social determinants in health, as mentioned above, these have a significant influence on health inequalities. It will modulate people's health and disease during the life course. Returning to the concept of the WHO [41], which defines them as "the combination of the social conditions in which the individual is born, grows and the ages that affect his health". Cueto et al. [42] in a deeper analysis revealed two edges in this matter. In first place, older adults linked to work have less of time to go to a dentist appointment. They commonly attend when there is an emergency or pain that affects their job performance or social life. On the other hand, the older adults that are unemployed, or not perceive a pension are more likely to suffer damage to their health by the psychic instability that this condition entails, leading to a deterioration of their oral health.

An unhealthy lifestyle appears to be the most relevant SDH in older adults [43].

Kuh and Ben-Shlomo [44] defined life-course epidemiology as the "study of longterm effects on chronic disease risk of physical and social exposures during gestation, childhood, adolescence, young adulthood and later adult life". In other words, it links exposure to risk factors and consequences by considering the importance of the duration and timing of the development of the illness.

The sum in the biological systems could be influenced by independent and individual exhibitions. Specifically, the person is vulnerable to the risk factors, a series of separated situations at different phases of life and this combination increases the illness risk in later life. This is the "*accumulation risk model"*. From this model follows the framework of "*chain of risk"*, in which a negative or beneficial exposure guide to another negative or beneficial exposition. This version suggest a synergy between intrinsic factors (behavioral resources, self-esteem, conflict-solving abilities and coping methods) and extrinsic factors (family, sociocultural connections and material circumstances).

As stated by the WHO [45] clinically, oral diseases are caused by bad oral habits such as poor oral hygiene, high consumption of sugars, the use and abuse of alcohol and tobacco and a lack of fluoride. Moreover, it is well known that oral illnesses share behavioral risks with non-communicable diseases. For instance, a diet high in added sugars is the principal cause of dental decay and it is related to obesity and overweight.

Heilmann et al. [46] proposed a theoretical framework for oral health. In which they integrated a life course perspective, with the models of the social determinants of oral health illness and their effect on the usual risk factors that link general health and oral health. The model highlights the significance of socioeconomic factors in the

#### *Oral Health and Prevention in Older Adults DOI: http://dx.doi.org/10.5772/intechopen.101043*

infancy and adulthood, like as education and salary. These elements are affected by economic, political and social variables at the societal level. In this sense, the model shows the degree in which infancy socioeconomic status will influence adulthood socioeconomic status. For example, the advancement of dental decay over the course of life follows different patterns directions, to be specific caries levels calculated at one age predicts dental caries levels al later ages.

In 2010, Sheiham and Sabbah [47] reported in their study that the presence of caries in the infancy is a strongly precursor of caries in permanent dentition. Likewise, Hallet and O'Rourke [48] the incidence and severity of dental decay in the primary dentition is linked to the individual, together with socio-economic aspects just as income and maternal education.

However, this is not particularly surprising given the fact that the most significant outcome of enamel defects is a high susceptibility to dental decay. Seen from the *chain of risk* framework, smoking and low birth weight are an example that early stressors of life, lead to enamel defects, which are related to a higher risk to dental caries at later ages [49].
