Association Between Childhood Dental Attendance and Adult Oral Health: A Path Analysis of the British Cohort Study

OBJECTIVES: Oral health outcomes reflect cumulative life-course exposures, with early-life experiences, particularly patterns of dental attendance, playing a key role in shaping oral health trajectories and inequalities in adulthood. This study aimed to assess socio-demographic differences in adult perceived oral health status and to examine the pathways linking childhood dental attendance to adult oral health. METHODS: Data from the 1970 British Cohort Study involving over 17 000 participants born in England, Scotland, and Wales were drawn for this study. Oral health outcomes were assessed through self-reported dental problems at age 26 and self-rated oral health status at age 46. Childhood dental attendance patterns were derived from follow-up data collected at ages 5, 10, and 16. Guided by a directed acyclic graph, path analysis was conducted to examine the hypothesised pathways between childhood dental attendance and adult oral health, incorporating socioeconomic status, oral health behaviours, and general health conditions across the life course. RESULTS: This study analysed data from 4 699 participants, of whom 23% reported poor oral health. Poor oral health was more prevalent among participants who brushed their teeth less than twice daily, had comorbidities in childhood or adulthood, had a history of dental problems, and were smokers. Childhood dental attendance pattern had a very weak, yet positive direct effect on adult oral health at age 46 (OR = 1.03, 95% CI = 1.00-1.06). Higher parental social class was associated with regular childhood dental attendance (OR = 1.17, 95% CI = 1.14-1.21) and with higher social class in adulthood (ages 26 and 46), which in turn indirectly influenced adult oral health. Regular dental visits in childhood were linked to improved oral hygiene practice (OR = 1.05, 95% CI = 1.02-1.08), and in turn, marginally associated with better oral health in adulthood (OR = 1.04, 95% CI = 1.01-1.07). While dental problems in early adulthood did not mediate the effect of childhood dental attendance, they were associated with poorer oral health in middle adulthood (OR = 1.15, 95% CI = 1.11-1.19). CONCLUSION: This study suggests that childhood dental attendance has a modest but positive effect on adult oral health. Socio-demographic factors, particularly parental social class, influence both childhood dental attendance and adult social class, indirectly affecting oral health outcomes. Oral hygiene practices partially mediated the effects, highlighting the importance of early prevention and sustained self-care. Interventions promoting regular dental visits in childhood, alongside addressing social inequalities, may help improve oral health trajectories across the life course.