Summary
This cross-sectional study of 2,812 Dutch adults examined the mechanisms through which socioeconomic inequalities in oral health operate. Mediation analysis revealed that behavioural factors—particularly smoking—contributed most substantially to explaining the education and income gradients in tooth retention and self-rated oral health, followed by material factors, while cultural and psychosocial factors played more modest roles. The inclusion of all four factor categories substantially attenuated the socioeconomic disparities in both oral health outcomes, suggesting that interventions addressing modifiable behaviours and material constraints may reduce health inequalities.
UK applicability
The findings are likely applicable to the United Kingdom, which shares similar socioeconomic structures and oral health patterns to the Netherlands. However, differences in NHS provision, fluoridation policy, and cultural attitudes to dental care may affect the magnitude of associations observed.
Key measures
Rate ratios for number of teeth; odds ratios for poor self-rated oral health; mediation analysis of material factors (financial difficulties), behavioural factors (smoking), cultural factors (cultural activities) and psychosocial factors (psychological distress)
Outcomes reported
The study measured self-reported number of teeth and self-rated oral health (SROH) as indicators of oral health status. It quantified how material, behavioural, cultural and psychosocial factors mediate the relationship between socioeconomic position (education and income) and these oral health outcomes.
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