Sense of Coherence and oral health behaviours


The relationships between health and stress have been explained by the ‘Salutogenic’ theory that emphasises the role of psycho-social determinants in maintaining human well being rather than causing the diseases. A key element of this theory is a sense of coherence (SOC), which evaluates an individual’s ability to use existing resources in order to overcome difficulties and cope with life stressors to perform healthy behaviour and stay well, with those with a stronger SOC having a better ability to cope. The aim of this review was to analyse the association between SOC and oral health behaviors.


The Medline/PubMed, ISI Web of Science and PsychInfo databases were searched without restriction. A partial gray literature search was performed by using Google Scholar. Three reviewers independently assessed studies for inclusion. Oral health studies that evaluated the relationship between SOC and oral health behaviors were considered. Studies that assessed the relationship between SOC and oral health status without evaluating the impact of SOC on oral health behaviors were excluded.

Three reviewers independently extracted data and assessed study quality using the Newcastle-Ottawa Scale (NOS) for cohort studies and modified NOS for cross-sectional studies. A narrative summary was presented.


  • 9 studies (8 cross-sectional, 1 cohort ) were included.
  • The cohort study and 7 of the cross-sectional studies were considered to be high quality.
  • Studies were conducted in Brazil, China, Iran, Sweden, South Africa, Finland, and Turkey with sample sizes from 190 – 5,399.
  • 6 studies assessed the association between SOC and different oral health behaviors in individuals aged 17 and older.
  • 3 studies examined this association in adolescents, between 11 and 16 years.
  • 2 studies evaluated the relationship between mothers’ SOC and their adolescent children’s oral health behaviors.
  • 1 study investigated the correlation between caregivers’ SOC and their preschoolers’ oral health behaviors.
Health behaviour No. of studies Findings
Tooth cleaning.


5 reported a significant association meaning that individuals with a strong SOC were more likely to brush their teeth twice or more per day compared with those who had lower levels of SOC. In 1 study this association was significant for only one subcomponent of SOC, meaningfulness. T2 studies assessed the correlation between SOC and tooth flossing behavior reporting no significant association.
Fluoride usage. 3 No significant association was reported.
Dietary habits. 6 3 studies reported that individuals with a strong SOC were less likely to consume sugar between meals than those with a poor SOC. One of these studies found that among different oral health behaviors, low frequency of between-meal sugar intake was the most important indicator of strong SOC.Another study found no correlation between children’s sugar snaking and their parents’ SOC; However, where grandparents were caregivers (8.9%) lower sugar intake observed in those with a stronger SOC.
Dental attendance. 7 4 studies reported that individuals with a strong SOC were more likely to visit dentists regularly for check-ups. 2 studies reported positive significant association between mothers’ SOC and their children’s regular dental visits.
Smoking habits. 3 2 studies found a significant correlation indicating that SOC has a positive association with less frequent smoking. 1 study reported a significant association for only one sub-component of SOC, meaningfulness.


The authors concluded:

A cross-sectional association was found between SOC and oral health-related behaviors. A stronger SOC was associated with more favorable behaviors of tooth brushing frequency, daily smoking, and dental attendance.

Mothers’ SOC can influence children’s oral health practices in particular their pattern of preventive dental attendance.


There is now a greater recognition of the impact of psychosocial factors on positive health behaviours with SOC being a strong determinant of individuals’ health behaviour. This well conducted review brings together the available evidence on oral health behaviours and SOC. As the authors acknowledge in their discussion there are limitations because almost all of the studies are cross-sectional, and therefore cannot provide information on cause or changes with time.


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 Aug 14;10(8):e0133918. doi: 10.1371/journal.pone.0133918. eCollection 2015. PubMed PMID: 26275064; PubMed Central PMCID: PMC4537196.

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