Oral Health and Food Insecurity among Working Poor Canadians

Objectives: This study explored oral health disparities associated with food insecurity among working poor Canadians and assessed whether access to dental care would eliminate disparities between food insecure and food secure working poor persons.

Method: A cross-sectional stratified sampling approach and telephone interviews collected data from a nationally representative sample of 1049 working poor persons aged between 18 and 64 years. Working poor persons worked for pay for at least 20 hours a week, were not full-time students and had annual family incomes below $34,300. Trained interviewers used a pre-tested questionnaire including sociodemographic items, self-reported oral health indicators and access to care items (dental visiting patterns and insurance coverage). Food insecure persons gave “often” or “sometimes” responses to any of the three food insecurity questions assessing “worry” about not having enough food, not eating enough food and not having the desired quality of food because of insufficient finances in the previous 12-months.

Results: Food insecure persons reported poor oral health compared to food secure persons indicated by a higher percentage of denture wearers (p=0.01), fewer food insecure persons rating their oral health as very good/excellent (p<0.001), and an almost twofold increase in the percentage of food insecure persons reporting a toothache in the past month (p<0.001). Food insecure persons were also significantly more likely to report an oral health impact; experiencing pain, chewing, speech or work difficulties because of their oral health condition (p<0.001). Multivariate logistic regression analyses showed that oral health disparities between food insecure and food secure persons associated with having a toothache, reporting poor/very poor self-rated oral health or experiencing an oral health impact remained after adjusting for demographic and access to care factors (p<0.001).

Conclusions: This study identified oral health disparities within an already marginalized group which were not alleviated by access to dental care.