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Cited by 243Dental Health and Care UtilizationHealth disparities and outcomesOral microbiology and periodontitis research

The relationship between income and oral health: a critical review

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Singh, A., Peres, M.A., Watt, R.G.·2019·Journal of Dental Research
DOI 10.1177/0022034519849557
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Abstract

In this critical review, we summarized the evidence on associations between individual/household income and oral health, between income inequality and oral health, and income-related inequalities in oral health. Meta-analyses of mainly cross-sectional studies confirm that low individual/household income is associated with oral cancer (odds ratio, 2.41; 95% confidence interval [CI], 1.59–3.65), dental caries prevalence (prevalence ratio, 1.29; 95% CI, 1.18–1.41), any caries experience (odds ratio, 1.40; 95% CI, 1.19–1.65), tooth loss (odds ratio, 1.66; 95% CI, 1.48–1.86), and traumatic dental injuries (odds ratio, 0.76; 95% CI, 0.65–0.89). Reviews also confirm qualitatively that low income is associated with periodontal disease and poor oral health–related quality of life. Limited evidence from the United States shows that psychosocial and behavioral explanations only partially explain associations between low individual/household income and oral health. Few country-level studies and a handful of subnational studies from the United States, Japan, and Brazil show associations between area-level income inequality and poor oral health. However, this evidence is conflicting given that the association between area-level income inequality and oral health outcomes varies considerably by contexts and by oral health outcomes. Evidence also shows cross-national variations in income-related inequalities in oral health outcomes of self-rated oral health, dental care, oral health–related quality of life, outcomes of dental caries, and outcomes of tooth loss. There is a lack of discussion in oral health literature about limitations of using income as a measure of social position. Future studies on the relationship between income and oral health can benefit substantially from recent theoretical and methodological advancements in social epidemiology that include application of an intersectionality framework, improvements in reporting of inequality, and causal modeling approaches. Theoretically well-informed studies that apply robust epidemiological methods are required to address knowledge gaps for designing relevant policy interventions to reduce income-related inequalities in oral health.

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  • Large segments of the U.S. population-particularly those from lower-income backgrounds, racially marginalized communities, and individuals with disabilities-continue to face persistent barriers to accessing routine dental care.

    “large segments of the U.S. population—particularly those from lower-income backgrounds, racially marginalized communities (5), and individuals with disabilities—continue to face persistent barriers to accessing routine dental care (6, 7).”

    From Access to oral health care and its social determinants across the lifespan in the United States (2025) · cites this paper as [6]

    The Theoretical pathways and explanations section (page unavailable) describes how low income can make preventive and regular dental care unaffordable; Dental care utilization (page unavailable) reports an inverse association between income inequality and dental care use. The source does not establish that large segments of the U.S. population face persistent access barriers, or specifically document such barriers for people with disabilities. The racial-disparities phrase has a separate citation (5). (LLM, conf=0.84)

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  • Individuals in the highest income group (annual household income 150,000 or more) were nearly twice as likely to have had a dental visit in the past 12 months compared to those in the lowest (less than 35,000), with this gradient persisting across all age groups.

    “Individuals in the highest income group (annual household income 150,000 or more) were nearly twice as likely to have had a dental visit in the past 12 months compared to those in the lowest (less than 35,000), with this gradient persisting across all age groups (6, 20).”

    From Access to oral health care and its social determinants across the lifespan in the United States (2025) · cites this paper as [6]

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  • Income emerged as a foundational determinant of dental care utilization.

    “Consistent with previous research, income emerged as a foundational determinant of dental care utilization.”

    From Access to oral health care and its social determinants across the lifespan in the United States (2025) · cites this paper as [6]

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Authors
Singh, A., Peres, M. A., & Watt, R. G.
Affiliations
  • The University of Melbourne (AU)
  • Griffith University (AU)
  • University College London (GB)
Corresponding author
Singh, A.
ORCID
Venue
Journal of Dental Research
Publisher
SAGE Publications
Published
2019-05-15
Volume
98
Issue
8
Pages
853-860
ISSN
  • 0022-0345 (ISSN-L)
  • 1544-0591
DOI
10.1177/0022034519849557
OpenAlex
W2945622476
Cited by
243
References
83
Citations by year
2026: 33 · 2025: 34 · 2024: 55 · 2023: 44 · 2022: 42 · 2021: 16 · 2020: 14 · 2019: 3 · 2012: 1
FWCI
2.65
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Dental Research (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Griffith Research Online (submittedVersion)
Funders
National Institute for Health and Care Research (NF-SI-0515-10032)
Topics
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
Keywords
household income, income inequality, oral cancer, dental caries, tooth loss, dental trauma, periodontal disease, oral health-related quality of life, social determinants of oral health, intersectionality, access to dental care
MeSH terms
Brazil, Cross-Sectional Studies, Dental Caries, Humans, Income, Japan, Oral Health, Periodontal Diseases, Quality of Life, Socioeconomic Factors, United States, Tooth Loss, Health Status Disparities

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