**3. The social gradient and biological factors as causes of oral diseases**

Considering only biological factors as the cause of oral diseases is not enough to explain the social differences in oral health. Consequently, addressing these factors alone, has led to reductionist approaches to prevention and treatment. Unfortunately there is a lack a sound theoretical basis and which, in general, have also failed to reduce the burden of oral diseases, and oral health inequalities [22].

In this regard, as reported by Link & Phelan, 1995, it is necessary to "contextualize risk factors" and understand the "fundamental social causes" of the disease. "Contextualize" risk factors based on the individual means that it is required (1) use an interpretive framework to understand why people become exposed to risk or protective factors and (2) determine the social conditions under which individual risk factors are related to disease [23].

#### **3.1 Social determinants of oral diseases**

In the case of oral health, there is considerable evidence of the influence of the social gradient on the oral health status of individuals. We know that many oral diseases are associated with socioeconomic status, which is linked to family income, educational level, employment status, housing, physical health, and mental health [23].

The fundamental social causes of disease essentially involve the resources that determine the degree to which people can avoid the risks of morbidity and mortality. Resources broadly can include money, knowledge, power, prestige, and the types of interpersonal resources incorporated into the concepts of social support and social

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

network. Variables examined by medical sociologists and social epidemiologists, such as race/ethnicity and gender, are linked to resources such as money, power, prestige and/or social connection that should be considered as possible root causes of the disease [24].

### **3.2 Biological risk factors and the social gradient of oral disease in old age**

Oral diseases share the same determinants and risk factors as the major Noncommunicable Diseases (NCDs), which include heart disease, cancer, chronic obstructive pulmonary disease, diabetes, dementia, and stroke [23]. For NCDs, risk factors have been identified and many are related to lifestyle. Risk reduction is associated with smoking cessation, diet control (including reducing excessive consumption of calories, saturated fat and salt), moderate alcohol consumption, and exercise. Furthermore, many of these risk factors are important for the development of oral diseases. **Table 1**, resumes both biological and social risk factors [25].
