Social Gradients in Dental Health among Low-Income Mothers

Background: Social gradients in oral health exist in the U.S. and other populations. However, very few studies have examined whether social gradients still exist within low-income populations.

Objectives: For low-income mothers of children aged 3-6, estimate whether a social gradient exists between mothers' socioeconomic status (income, education, and employment status) and perceived dental health, and whether these relationships differ by racial/ethnic group.

Methods: From a population of 108,151 Medicaid children aged 3-6 in Washington state (USA), disproportionate stratified sampling by racial/ethnic group selected 10,909 eligible children. Mothers (n=4,373) in four racial/ethnic groups (19% Black, 31% Hispanic, 33% White, and 17% other) completed a mixed-mode (web, mail, telephone) survey and reported their personal and family characteristics, socioeconomic status, self-rated dental health (excellent, very good, good, fair, poor), smoking status, oral health behaviors and beliefs, dental insurance and dental care frequency. Multivariable regression models estimated whether income, education and employment were associated with self-rated dental health, and whether the associations differed for Black, Hispanic and White mothers.

Results: Controlling for personal and family characteristics, each step up the income or education ladder was associated with better self-ratings of dental health; unemployment was associated with lower ratings (p<.03). Most associations were no longer significant (p>.05) only when dental insurance and dental care entered the model. Associations did not differ significantly by racial/ethnic group.

Conclusions: Social gradients in self-rated dental health exist in low-income mothers across racial/ethnic groups. Dental insurance and dental care may partly mediate these relationships. Supported by NIDCR DE17621.