Increases in exposure to gun violence may be associated with going to the dentist less frequently and tooth loss, according to a large U.S. study published on April 4 in the American Journal of Preventive Medicine.
This study highlights gun violence as a social determinant of oral health and dental care access, the authors wrote.
"This study pioneers a new direction in dental public health research by demonstrating a connection between community exposure to firearm violence and lower levels of dental care utilization, as well as poorer oral health," wrote the authors, led by Daniel Semenza, PhD, of Rutgers University in Camden, NJ.
In the U.S. in 2022, approximately 20,000 individuals were victims of firearm homicides. Additionally, tens of thousands more experience nonfatal gun injuries annually, often leading to long-lasting physical and psychological trauma. Despite research revealing the consequences of violence on individuals' health, there is little evidence exploring the relationship between community firearm violence and patterns of community dental care use and oral health, according to the study.
To investigate the correlation between community-level firearm violence and dental health, 20,332 census tracts within the 100 largest U.S. cities from 2014 to 2022 were analyzed. Dental care use and tooth loss rates were sourced from the U.S. Centers for Disease Control and Prevention PLACES project, which provides health and related data using small-area estimation for counties, incorporated and census-designated places, census tracts, and other areas within the nation. The American Violence Project was used to gather firearm violence data. Lagged random intercept mixed-effects models were used to estimate associations.
A rise in shootings the prior year resulted in a drop in dental care use the following year. Specifically, a one-shooting increase resulted in a 0.01% decrease in dental care use (p = 0.003). It's suggested that the cumulative effects would be that 10 shootings the prior year would result in a 0.1% decrease in dental care use, while 50 shootings the prior year would result in a 0.5% decrease, the authors wrote.
Furthermore, shootings that occurred the prior year were linked to a 0.06% increase in tooth loss the subsequent year (p < 0.001). Therefore, this suggests that 10 shootings the prior year would lead to a 0.6% increase in tooth loss, while 50 shootings the prior year would result in a 3% increase in edentulism, they wrote.
Moreover, the study had shortcomings, including the findings in this study should not be interpreted as a causal effect between firearm violence and oral health. In the future, studies should be done that attempt to link gun violence data with longitudinal individual-level survey that captures dental care use and oral health metrics, the authors wrote.
"Neighborhoods experiencing higher levels of firearm violence face disparities in dental care and oral health, highlighting firearm violence as a social determinant of oral health," Semenza and colleagues wrote.
