Oral Health Inequalities: A Global Cross-Sectional Ecological Assessment in the Light of Economic Indicators

Gökçen Çeliker

doi:10.7126/cumudj.1653410

Research Article

AĞIZ VE DİŞ SAĞLIĞI EŞİTSİZLİKLERİ: EKONOMİK GÖSTERGELER IŞIĞINDA KÜRESEL BİR DEĞERLENDİRME

Year 2025, Volume: 28 Issue: 3, 349 - 360, 30.09.2025

Gökçen Çeliker

https://doi.org/10.7126/cumudj.1653410

Abstract

Amaç: Ağız sağlığında istenen düzeye ulaşmak için ekonomik faktörlerin belirlenmesi önemlidir. Bu araştırmanın amacı, ülkelerin ekonomik değişkenlerine göre ağız ve diş sağlığı problemlerinin ve hizmet düzeylerinin değerlendirilmesidir.
Gereç-Yöntem: Bu araştırma, 123 ülkenin ekonomik değişkenlerine göre ağız ve diş sağlığı problemlerini ve hizmet düzeylerini değerlendirmektedir. Kişi başına düşen GSYH, Gini katsayısı, işsizlik ve enflasyon oranları gibi ekonomik veriler Dünya Bankası’ndan; ağız sağlığına ilişkin veriler ise DSÖ’den elde edilmiştir. Verilerin analizinde Kolmogrov Smirnov, Skewness ve Kurtosis, Mann Whitney U, Spearman Korelasyon Analizi, Lojistik Regresyon Analizi ve Çoklu Regresyon Analizi kullanılmıştır.
Bulgular: Analizler, ağız sağlığı hizmetleri ile ekonomik değişkenler arasında anlamlı ilişkiler olduğunu göstermiştir.
Sonuç: GSYH düzeyi yüksek ülkelerde hizmet erişimi daha iyi olup, eşitlikçi politikaların gerekli olduğu vurgulanmaktadır.

Keywords

Diş Sağlığı Hizmetleri , Sağlıkta Eşitsizlikler , Sağlık Hizmetlerine Erişilebilirlik , Sağlık Politikası

References

1. World Health Organization. Global strategy and action plan on oral health 2023–2030. World Health Organization, 2024.
2. Zucoloto ML, Maroco J, Campos JADB. Impact of oral health on health-related quality of life: a cross-sectional study. BMC Oral Health, 2016;16(1):55.
3. Rawal I, Ghosh S, Hameed SS, Shivashankar R, Ajay VS, Patel SA, Goodman M, Ali MK, Venkat Narayan KM, Tandon N, Prabhakaran D. Association between poor oral health and diabetes among Indian adult population: potential for integration with NCDs. BMC Oral Health 2019;19(1):191.
4. Listl S, Galloway J, Mossey PA, Marcenes W. Global economic impact of dental diseases. J Dent Res 2015;94(10):1355-1361.
5. Solar O, Irwin A. A conceptual framework for action on the social determinants of health. World Health Organization 2010.
6. Marmot M, Wilkinson RG, eds. Social determinants of health. 2nd ed. Oxford University Press, 2005.
7. World Health Organization. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: World Health Organization, 2008.
8. Lee JY, Divaris K. The ethical imperative of addressing oral health disparities: a unifying framework. J Dent Res 2014;93(3):224-230.
9. Timiş T, Dănilă I. Socioeconomic status and oral health policy, J Prev Med 2005;7(8).
10. Nicolau B, Marcenes W, Bartley M, Sheiham A. Associations between socio‐economic circumstances at two stages of life and adolescents' oral health status. J Public Health Dent 2005;65(1):14-20.
11. Verlinden DA, Reijneveld SA, Lanting CI, van Wouwe JP, Schuller AA. Socio‐economic inequality in oral health in childhood to young adulthood, despite full dental coverage. Eur J Oral Sci 2019;127(3):248-253.
12. Lalloo R, Myburgh NG, Hobdell MH. Dental caries, socio‐economic development and national oral health policies. Int Dent J 1999;49(4):196-202.
13. Yfantopoulos J, Oulis CJ, Yfantopoulos P, Papaioannou W. Socio-economic inequalities in oral health: the case of Greece. Health 2014;6(16):2227.
14. Elani HW, Harper S, Allison PJ, Bedos C, Kaufman JS. Socio-economic inequalities and oral health in Canada and the United States. J Dent Res 2012;91(9):865-870.
15. Corbet EF. An international comparison of socio-economic status and oral health. Br Dent J 2003;194(2):88-88.
16. Dugmore CR, Rock WP. The effect of socio-economic status and ethnicity on the comparative oral health of Asian and White Caucasian 12-year-old children. Community Dent Health 2005;22(3):162.
17. Hosseinpoor AR, Itani L, Petersen PE. Socio-economic inequality in oral healthcare coverage: results from the World Health Survey. J Dent Res, 2012;91(3):275-281.
18. Tickle M, Milsom K, Blinkhorn A. Inequalities in the dental treatment provided to children: an example from the UK. Community Dent Oral Epidemiol 2002; 30(5): 335-341.
19. Yousaf M, Aslam T, Saeed S, Sarfraz A, Sarfraz Z, Cherrez-Ojeda I. Individual, family, and socioeconomic contributors to dental caries in children from low-and middle-income countries. Int J Environ Res Public Health 2022;19(12):7114.
20. Bencze Z, Mahrouseh N, Andrade CAS, Kovács N, Varga O. The burden of early childhood caries in children under 5 years old in the European Union and associated risk factors: An ecological study. Nutrients 2021;13(2):455.
21. Palència L, Espelt A, Cornejo‐Ovalle M, Borrell C. Socioeconomic inequalities in the use of dental care services in Europe: what is the role of public coverage?. Community Dent Oral Epidemiol 2014;42(2):97-105.
22. Keller Celeste R, Guarnizo-Herreño C, Costa F, Ayo-Yusuf O, Barros AJ, Fritzell J, Peres MA, Watt RG. Welfare regimes and socioeconomic inequalities in edentulism: A multilevel analysis of 40 countries. Eur J Public Health 2024;34(Supplement_3):144-1254.
23. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet 2007;370(9596):1453-1457.
24. Aguiar VR, Pattussi MP, Celeste RK. The role of municipal public policies in oral health socioeconomic inequalities in Brazil: a multilevel study. Community Dent Oral Epidemiol 2018;46(3):245-250.
25. Watt R. Sheiham A. Inequalities in oral health: a review of the evidence and recommendations for action. Br Dent J, 1999;187(1):6-12.
26. Çolakoğlu N, Has L. A Research for People to Determine the Relationship between Oral Hygiene and Socio-Economic Status. Procedia Soc Behav Sci 2015;195:1268-1277.
27. Feizi A, Hafezi B, Bagheri Faradonbeh S, Tofighi S. Decomposition Analysis of Socioeconomic Inequalities in Utilization of Oral Health Services: A Population-Based Study in Urban and Rural Households of Ahvaz. Med J Islam Repub Iran 2024;38:8.
28. Ghanbarzadegan A, Bastani P, Luzzi L, Brennan D. Inequalities in utilization and provision of dental services: a scoping review. Syst Rev 2021;10(1):222.
29. Schwendicke F, Dörfer CE, Schlattmann P, Page LF, Thomson WM, Paris S. Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res 2015;94(1):10-18.
30. Peres MA, Peres KG, Frias AC, Antunes JLF. Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach. BMC Oral Health 2010;10:1-9.
31. Fidan S, Fidan M. Relevance of Internet Data on Dentistry in Global Countries using the Google Trends Approach. NEU Dent J 2024;6(3):259-268.
32. Gaygisiz E. Economic and cultural correlates of subjective well-being in countries using data from the Organisation for Economic Co-operation and Development (OECD). Psychol Rep 2010;106(3):949-963.
33. Ardila CM, Agudelo‐Suárez AA. Association between dental pain and caries: a multilevel analysis to evaluate the influence of contextual and individual factors in 34 843 adults. J Investig Clin Dent 2016;7(4):410-416.
34. King NB, Harper S, Young ME. Who cares about health inequalities? Cross-country evidence from the World Health Survey. Health Policy Plan 2013;28(5):558-571.
35. Bhandari B, Newton JT, Bernabé E. Income inequality and use of dental services in 66 countries. J Dent Res 2015;94(8):1048-1054.
36. O'Brien KJ, Forde VM, Mulrooney MA, Purcell EC, Flaherty GT. Global status of oral health provision: identifying the root of the problem. Public Health Chall 2022;1(1):e6.
37. Bilgin M, Erdem A, Dilber E, Ağlarcı O, Baytaroğlu E. The economic impact of early tooth loss in turkish children and adolescents. Cumhuriyet Dent J 2015;18(3) :249
38. Kronström M, Palmqvist S, Söderfeldt B, Vigild M. Utilization of dental health services among middle-aged people in Sweden and Denmark. Acta Odontol Scand 2002;60(5):276-280.
39. Palmqvist S. Utilization of dental services in an elderly population. Swed Dent J, 1989;13(1-2):61-68.
40. Bagewitz IC, Söderfeldt B, Palmqvist S, Nilner K. Dental care utilization: a study of 50-to 75-year-olds in southern Sweden. Acta Odontol Scand 2002;60(1):20
41. Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31:3-24.
42. Sabbah W, Sheiham A, Bernabé E. Income inequality and periodontal diseases in rich countries: an ecological cross-sectional study. Int Dent J 2010;60(5):370-374.
43. Andersen RM. National health surveys and the behavioral model of health services use. Med Care 2008;46(7):647.

Oral Health Inequalities: A Global Cross-Sectional Ecological Assessment in the Light of Economic Indicators

Year 2025, Volume: 28 Issue: 3, 349 - 360, 30.09.2025

Gökçen Çeliker

https://doi.org/10.7126/cumudj.1653410

Abstract

Aim: Achieving the desired level of oral health requires identifying economic factors. The purpose of this research is to evaluate oral and dental health problems and service levels according to the economic variables of the countries.
Material-Method: This study evaluates oral health problems and service levels in 123 countries based on economic variables. Data on GDP per capita, Gini coefficient, unemployment, and inflation rates were obtained from the World Bank, while oral health data were sourced from the WHO. Kolmogrov Smirnov, Skewness and Kurtosis, Mann Whitney U, Spearman Correlation Analysis, Logistic Regression Analysis and Multiple Regression Analysis were used in the analysis of the data.
Results: Analyses revealed significant relationships between oral health services and economic variables.
Conclusion: Countries with higher GDP levels have better ccess to services, highlighting the need for equitable policies to ensure universal oral health coverage.

Keywords

Dental Health Services , Health Inequities , Health Services Accessibility , Health Policy

References

1. World Health Organization. Global strategy and action plan on oral health 2023–2030. World Health Organization, 2024.
2. Zucoloto ML, Maroco J, Campos JADB. Impact of oral health on health-related quality of life: a cross-sectional study. BMC Oral Health, 2016;16(1):55.
3. Rawal I, Ghosh S, Hameed SS, Shivashankar R, Ajay VS, Patel SA, Goodman M, Ali MK, Venkat Narayan KM, Tandon N, Prabhakaran D. Association between poor oral health and diabetes among Indian adult population: potential for integration with NCDs. BMC Oral Health 2019;19(1):191.
4. Listl S, Galloway J, Mossey PA, Marcenes W. Global economic impact of dental diseases. J Dent Res 2015;94(10):1355-1361.
5. Solar O, Irwin A. A conceptual framework for action on the social determinants of health. World Health Organization 2010.
6. Marmot M, Wilkinson RG, eds. Social determinants of health. 2nd ed. Oxford University Press, 2005.
7. World Health Organization. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: World Health Organization, 2008.
8. Lee JY, Divaris K. The ethical imperative of addressing oral health disparities: a unifying framework. J Dent Res 2014;93(3):224-230.
9. Timiş T, Dănilă I. Socioeconomic status and oral health policy, J Prev Med 2005;7(8).
10. Nicolau B, Marcenes W, Bartley M, Sheiham A. Associations between socio‐economic circumstances at two stages of life and adolescents' oral health status. J Public Health Dent 2005;65(1):14-20.
11. Verlinden DA, Reijneveld SA, Lanting CI, van Wouwe JP, Schuller AA. Socio‐economic inequality in oral health in childhood to young adulthood, despite full dental coverage. Eur J Oral Sci 2019;127(3):248-253.
12. Lalloo R, Myburgh NG, Hobdell MH. Dental caries, socio‐economic development and national oral health policies. Int Dent J 1999;49(4):196-202.
13. Yfantopoulos J, Oulis CJ, Yfantopoulos P, Papaioannou W. Socio-economic inequalities in oral health: the case of Greece. Health 2014;6(16):2227.
14. Elani HW, Harper S, Allison PJ, Bedos C, Kaufman JS. Socio-economic inequalities and oral health in Canada and the United States. J Dent Res 2012;91(9):865-870.
15. Corbet EF. An international comparison of socio-economic status and oral health. Br Dent J 2003;194(2):88-88.
16. Dugmore CR, Rock WP. The effect of socio-economic status and ethnicity on the comparative oral health of Asian and White Caucasian 12-year-old children. Community Dent Health 2005;22(3):162.
17. Hosseinpoor AR, Itani L, Petersen PE. Socio-economic inequality in oral healthcare coverage: results from the World Health Survey. J Dent Res, 2012;91(3):275-281.
18. Tickle M, Milsom K, Blinkhorn A. Inequalities in the dental treatment provided to children: an example from the UK. Community Dent Oral Epidemiol 2002; 30(5): 335-341.
19. Yousaf M, Aslam T, Saeed S, Sarfraz A, Sarfraz Z, Cherrez-Ojeda I. Individual, family, and socioeconomic contributors to dental caries in children from low-and middle-income countries. Int J Environ Res Public Health 2022;19(12):7114.
20. Bencze Z, Mahrouseh N, Andrade CAS, Kovács N, Varga O. The burden of early childhood caries in children under 5 years old in the European Union and associated risk factors: An ecological study. Nutrients 2021;13(2):455.
21. Palència L, Espelt A, Cornejo‐Ovalle M, Borrell C. Socioeconomic inequalities in the use of dental care services in Europe: what is the role of public coverage?. Community Dent Oral Epidemiol 2014;42(2):97-105.
22. Keller Celeste R, Guarnizo-Herreño C, Costa F, Ayo-Yusuf O, Barros AJ, Fritzell J, Peres MA, Watt RG. Welfare regimes and socioeconomic inequalities in edentulism: A multilevel analysis of 40 countries. Eur J Public Health 2024;34(Supplement_3):144-1254.
23. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet 2007;370(9596):1453-1457.
24. Aguiar VR, Pattussi MP, Celeste RK. The role of municipal public policies in oral health socioeconomic inequalities in Brazil: a multilevel study. Community Dent Oral Epidemiol 2018;46(3):245-250.
25. Watt R. Sheiham A. Inequalities in oral health: a review of the evidence and recommendations for action. Br Dent J, 1999;187(1):6-12.
26. Çolakoğlu N, Has L. A Research for People to Determine the Relationship between Oral Hygiene and Socio-Economic Status. Procedia Soc Behav Sci 2015;195:1268-1277.
27. Feizi A, Hafezi B, Bagheri Faradonbeh S, Tofighi S. Decomposition Analysis of Socioeconomic Inequalities in Utilization of Oral Health Services: A Population-Based Study in Urban and Rural Households of Ahvaz. Med J Islam Repub Iran 2024;38:8.
28. Ghanbarzadegan A, Bastani P, Luzzi L, Brennan D. Inequalities in utilization and provision of dental services: a scoping review. Syst Rev 2021;10(1):222.
29. Schwendicke F, Dörfer CE, Schlattmann P, Page LF, Thomson WM, Paris S. Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res 2015;94(1):10-18.
30. Peres MA, Peres KG, Frias AC, Antunes JLF. Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach. BMC Oral Health 2010;10:1-9.
31. Fidan S, Fidan M. Relevance of Internet Data on Dentistry in Global Countries using the Google Trends Approach. NEU Dent J 2024;6(3):259-268.
32. Gaygisiz E. Economic and cultural correlates of subjective well-being in countries using data from the Organisation for Economic Co-operation and Development (OECD). Psychol Rep 2010;106(3):949-963.
33. Ardila CM, Agudelo‐Suárez AA. Association between dental pain and caries: a multilevel analysis to evaluate the influence of contextual and individual factors in 34 843 adults. J Investig Clin Dent 2016;7(4):410-416.
34. King NB, Harper S, Young ME. Who cares about health inequalities? Cross-country evidence from the World Health Survey. Health Policy Plan 2013;28(5):558-571.
35. Bhandari B, Newton JT, Bernabé E. Income inequality and use of dental services in 66 countries. J Dent Res 2015;94(8):1048-1054.
36. O'Brien KJ, Forde VM, Mulrooney MA, Purcell EC, Flaherty GT. Global status of oral health provision: identifying the root of the problem. Public Health Chall 2022;1(1):e6.
37. Bilgin M, Erdem A, Dilber E, Ağlarcı O, Baytaroğlu E. The economic impact of early tooth loss in turkish children and adolescents. Cumhuriyet Dent J 2015;18(3) :249
38. Kronström M, Palmqvist S, Söderfeldt B, Vigild M. Utilization of dental health services among middle-aged people in Sweden and Denmark. Acta Odontol Scand 2002;60(5):276-280.
39. Palmqvist S. Utilization of dental services in an elderly population. Swed Dent J, 1989;13(1-2):61-68.
40. Bagewitz IC, Söderfeldt B, Palmqvist S, Nilner K. Dental care utilization: a study of 50-to 75-year-olds in southern Sweden. Acta Odontol Scand 2002;60(1):20
41. Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31:3-24.
42. Sabbah W, Sheiham A, Bernabé E. Income inequality and periodontal diseases in rich countries: an ecological cross-sectional study. Int Dent J 2010;60(5):370-374.
43. Andersen RM. National health surveys and the behavioral model of health services use. Med Care 2008;46(7):647.

There are 43 citations in total.

Details

Primary Language	English
Subjects	Dental Public Health
Journal Section	RA
Authors	Gökçen Çeliker 0000-0003-3099-5654
Publication Date	September 30, 2025
Submission Date	March 7, 2025
Acceptance Date	August 6, 2025
Published in Issue	Year 2025 Volume: 28 Issue: 3

Cite

EndNote	Çeliker G (September 1, 2025) Oral Health Inequalities: A Global Cross-Sectional Ecological Assessment in the Light of Economic Indicators. Cumhuriyet Dental Journal 28 3 349–360.

Download Cover Image

Article Files

Full Text

Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.

CDJ accepts articles in English. Submitting a paper to CDJ is free of charges. In addition, CDJ has not have article processing charges.

Frequency: Four times a year (March, June, September, and December)

IMPORTANT NOTICE

All users of Cumhuriyet Dental Journal should visit to their user's home page through the "https://dergipark.org.tr/tr/user" " or "https://dergipark.org.tr/en/user" links to update their incomplete information shown in blue or yellow warnings and update their e-mail addresses and information to the DergiPark system. Otherwise, the e-mails from the journal will not be seen or fall into the SPAM folder. Please fill in all missing part in the relevant field.

Please visit journal's AUTHOR GUIDELINE to see revised policy and submission rules to be held since 2020.