Socioeconomic differences in caries persist among U.S. adults, with higher rates consistently seen in disadvantaged populations between 2011 and 2020, according to a large study recently published in the American Journal of Preventive Medicine.
The study is believed to be among the first to use recent, nationally representative data to analyze the link between socioeconomic status (SES) and caries trends, the authors wrote.
“The findings underscore the significance of socioeconomic factors in potentially shaping inequalities in caries, with important implications for oral health and public policy,” wrote the authors, led by Dr. Vahan Boyajyan, MPH, of Drexel University in Philadelphia (Am J Prev Med, December 23, 2025).
The study used 2011-2020 data from the U.S. National Health and Nutrition Examination Survey to examine changes in caries by SES among 22,855 adults age 25 years and older. SES was measured using the income-to-poverty ratio, education, health insurance, employment, and food security, they wrote.
Education was grouped into high school or less, some college or associate degree, and college graduate or higher, while health insurance was categorized as uninsured, privately insured, or publicly insured. Employment status was based on work type and hours worked in the previous week, and food security was assessed using the U.S. Food Security Survey Module. Lastly, caries experience was measured using the decayed, missing, and filled teeth (DMFT) index.
After adjusting for age, sex, and race/ethnicity, adults in lower socioeconomic groups had higher caries than those with full-time employment, higher income, full food security, private insurance, and a college degree. Unemployed participants had DMFT scores that were 17% higher (95% confidence interval [CI]: 14% to 19%) than full-time workers, while part-time workers had only a small increase of 3% (95% CI: 0% to 5%), they wrote.
Compared with high-income adults, the DMFT was 27% higher (95% CI: 24% to 30%) among low-income individuals and 16% higher (95% CI: 14% to 18%) among middle-income individuals. Food-insecure adults had 13% higher DMFT (95% CI: 6% to 11%) than those with full food security. Adults without insurance and those with public insurance had 9% (95% CI: 6% to 11%) and 15% (95% CI: 13% to 17%) higher DMFT, respectively, compared with privately insured adults.
Educational disparities were the largest, with DMFT 31% higher (95% CI: 28% to 33%) among those with a high school education or less and 19% higher (95% CI: 17% to 22%) among those with some college or an associate degree compared with college graduates.
Nevertheless, this study had limitations. Its cross-sectional design prevented the researchers from determining causal relationships, the authors added.
“These findings highlight the need for targeted policies to reduce financial and structural barriers to dental care and address broader socioeconomic determinants of oral health,” Boyajyan and colleagues concluded.
