Socioeconomic Inequality and Caries: A Systematic Review and Meta-Analysis
Abstract
Dental caries is the most prevalent disease worldwide, with the majority of caries lesions being concentrated in few, often disadvantaged social groups. We aimed to systematically assess current evidence for the association between socioeconomic position (SEP) and caries. We included studies investigating the association between social position (determined by own or parental educational or occupational background, or income) and caries prevalence, experience, or incidence. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies. Reported differences between the lowest and highest SEP were assessed and data not missing at random imputed. Random-effects inverse-generic meta-analyses were performed, and subgroup and meta-regression analyses were used to control for possible confounding. Publication bias was assessed via funnel plot analysis and the Egger test. From 5539 screened records, 155 studies with mostly low or moderate quality evaluating a total of 329,798 individuals were included. Studies used various designs, SEP measures, and outcome parameters. Eighty-three studies found at least one measure of caries to be significantly higher in low-SEP compared with high-SEP individuals, while only 3 studies found the opposite. The odds of having any caries lesions or caries experience (decayed missing filled teeth [DMFT]/dmft > 0) were significantly greater in those with low own or parental educational or occupational background or income (between odds ratio [95% confidence interval] = 1.21 [1.03–1.41] and 1.48 [1.34–1.63]. The association between low educational background and having DMFT/dmft > 0 was significantly increased in highly developed countries ( R 2 = 1.32 [0.53–2.13]. Publication bias was present but did not significantly affect our estimates. Due to risk of bias in included studies, the available evidence was graded as low or very low. Low SEP is associated with a higher risk of having caries lesions or experience. This association might be stronger in developed countries. Established diagnostic and treatment concepts might not account for the unequal distribution of caries (registered with PROSPERO [CRD42013005947]).
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Atraumatic restorative treatment-based programs significantly improved oral health outcomes in disadvantaged populations.
“A systematic review examining socioeconomic disparities and dental caries revealed that ART-based programs significantly improved oral health outcomes in disadvantaged populations.”
From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [45]
Atraumatic restorative treatment is cost-effective and easily integrated into public health initiatives.
“A significant advantage of ART is its cost-effectiveness and the ease of its integration into public health initiatives [45].”
From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [45]
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series
(2008) · doi:10.1002/9780470712184 · Cited by 25,048 · see citing works
Duval, S., & Tweedie, R. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00455.x · Cited by 14,099 · see citing works
Social determinants of health inequalities
Marmot, M. (2005) · The Lancet · doi:10.1016/s0140-6736(05)71146-6 · Cited by 5,086 · see citing works
Theories for social epidemiology in the 21st century: An ecosocial perspective
Krieger, N. (2001) · International Journal of Epidemiology · doi:10.1093/ije/30.4.668 · Cited by 2,155 · cited 2× · see citing works
“It should be highlighted that the evaluated socioeconomic parameters are not exhaustive but rather intertwined in a complex “eco-social” framework of macroenvironmental (political, economic, social), community-level, and individual-level factors (Krieger 2001; Sanders et al. 2006; Russell et al. 2010; Pitts et al. 201…”
BackgroundGlobal Burden of Oral Conditions in 1990-2010: A Systematic Analysis
Marcenes, W., Kassebaum, N. J., Bernabé, E., Flaxman, A., Naghavi, M., Lopez, A., & Murray, C. J. L. (2013) · Journal of Dental Research · doi:10.1177/0022034513490168 · Cited by 1,495 · see citing works
Changes in dental caries 1953–2003
Marthaler, T. M. (2004) · Caries Research · doi:10.1159/000077752 · Cited by 661 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Oral diseases: a global public health challenge
Peres, M. A., Macpherson, L. M. D., Weyant, R. J., Daly, B., Venturelli, R., Mathur, M. R., Listl, S., Celeste, R. K., Guarnizo-Herreño, C. C., Kearns, C., et al. (2019) · The Lancet · doi:10.1016/s0140-6736(19)31146-8 · Cited by 4,054 · see citing works
Pitts, N. B., Zero, D. T., Marsh, P. D., Ekstrand, K., Weintraub, J. A., Ramos-Gomez, F., Tagami, J., Twetman, S., Tsakos, G., & Ismail, A. (2017) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2017.30 · Cited by 1,823 · see citing works
Fluoride toothpastes of different concentrations for preventing dental caries
Walsh, T., Worthington, H. V., Glenny, A.-M., Marinho, V. C., & Jeroncic, A. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007868.pub3 · Cited by 620 · see citing works
Understanding dental caries as a non-communicable disease
Pitts, N. B., Twetman, S., Fisher, J., & Marsh, P. D. (2021) · British Dental Journal · doi:10.1038/s41415-021-3775-4 · Cited by 346 · see citing works
Oral health-related quality-of-life scores differ by socioeconomic status and caries experience
Chaffee, B. W., Rodrigues, P. H., Kramer, P. F., Vítolo, M. R., & Feldens, C. A. (2017) · Community Dentistry and Oral Epidemiology · doi:10.1111/cdoe.12279 · Cited by 281 · see citing works
The relationship between income and oral health: a critical review
Singh, A., Peres, M. A., & Watt, R. G. (2019) · Journal of Dental Research · doi:10.1177/0022034519849557 · Cited by 243 · see citing works
Dorri, M., Martinez-Zapata, M. J., Walsh, T., Marinho, V. C., Sheiham deceased, A., & Zaror, C. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008072.pub2 · Cited by 135 · see citing works
Costa, S. M., Martins, C. C., Pinto, M. Q. C., Vasconcelos, M., & Abreu, M. H. N. G. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15081775 · Cited by 86 · see citing works
Social determinants of pediatric oral health
da Fonseca, M. A., & Avenetti, D. (2017) · Dental Clinics of North America · doi:10.1016/j.cden.2017.02.002 · Cited by 69 · see citing works
Impact of dental visiting patterns on oral health: A systematic review of longitudinal studies
Mohd Khairuddin, A. N., Bogale, B., Kang, J., & Gallagher, J. E. (2024) · BDJ Open · doi:10.1038/s41405-024-00195-7 · Cited by 67 · see citing works
Oral health disparities in children
Watt, R. G., Mathur, M. R., Aida, J., Bönecker, M., Venturelli, R., & Gansky, S. A. (2018) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2018.05.006 · Cited by 58 · see citing works
Tickle, M., O’Neill, C., Donaldson, M., Birch, S., Noble, S., Killough, S., Murphy, L., Greer, M., Brodison, J., Verghis, R., et al. (2016) · Health Technology Assessment · doi:10.3310/hta20710 · Cited by 48 · see citing works
Liu, M., Song, Q., Xu, X., & Lai, G. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.959125 · Cited by 31 · see citing works
Is dietary pattern a mediator of the relationship between socioeconomic status and dental caries?
Stein, C., Cunha-Cruz, J., & Hugo, F. N. (2021) · Clinical Oral Investigations · doi:10.1007/s00784-021-03852-5 · Cited by 23 · see citing works
Cost-effectiveness of caries preventive interventions – a systematic review
Davidson, T., Blomma, C., Bågesund, M., Krevers, B., Vall, M., Wärnberg Gerdin, E., & Tranæus, S. (2021) · Acta Odontologica Scandinavica · doi:10.1080/00016357.2020.1862293 · Cited by 23 · see citing works
Randall, C. L. (2023) · Community Dentistry and Oral Epidemiology · doi:10.1111/cdoe.12841 · Cited by 17 · see citing works
AL-Kaff, A. A., Alshehri, A. Z., Alasmari, R. A., Alsubaie, N., Aldaws, A., Althaqeel, A., Alshehri, R. S., & Alawaji, Y. M. (2025) · Cureus · doi:10.7759/cureus.87450 · Cited by 5 · see citing works
“A significant advantage of ART is its cost-effectiveness and the ease of its integration into public health initiatives [45].”
- Authors
- Schwendicke, F., Dörfer, C. E., Schlattmann, P., Page, L. F., Thomson, W. M., & Paris, S.
- Affiliations
- Charité – Universitätsmedizin Berlin (DE)
- Christian-Albrechts-Universität zu Kiel (DE)
- Jena University Hospital (DE)
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
- University of Otago (NZ)
- Venue
- Journal of Dental Research
- Publisher
- SAGE Publications
- Published
- 2014-11-13
- Volume
- 94
- Issue
- 1
- Pages
- 10-18
- ISSN
- 0022-0345 (ISSN-L)
- 1544-0591
- OpenAlex
- W2014460531
- Cited by
- 786
- References
- 8
- Citations by year
- 2026: 81 · 2025: 88 · 2024: 77 · 2023: 82 · 2022: 91 · 2021: 71 · 2020: 77 · 2019: 54 · 2018: 52 · 2017: 47 · 2016: 36 · 2015: 27 · 2014: 1
- FWCI
- 6.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Dental Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- dental caries, socioeconomic disparities, socioeconomic position, educational background, parental education, occupational status, income, DMFT index, caries prevalence, health disparities, developed countries
- MeSH terms
- Dental Caries, DMF Index, Educational Status, Humans, Income, Occupations, Social Class, Incidence, Prevalence, Vulnerable Populations, Health Status Disparities
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
