Oral pain disparities extend beyond known factors

Dental Tribune International

Tue. 29 September 2026

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SICHUAN, China: Social disadvantage has long been associated with oral disease and pain, but most research has examined individual socio-economic factors rather than the cumulative burden of disadvantage. Researchers in China therefore analysed nationally representative US data to investigate the relationship between cumulative social disadvantage and oral pain and whether cost-related barriers to dental care might help explain it. The findings highlight dental affordability alongside the behavioural, physiological and psychosocial factors already proposed to contribute to this association.

The cross-sectional study analysed National Health and Nutrition Examination Survey data covering adults aged 30 and over. To capture cumulative social disadvantage, the researchers created a composite measure based on employment status, income, food security, education, healthcare access, insurance, home ownership and relationship status and examined its link with self-reported oral pain.

They found that people with oral pain had a higher average social disadvantage score than those without pain. Even after accounting for demographic, behavioural and health factors, the researchers found that higher social disadvantage scores were associated with oral pain. The association became stronger as the burden of disadvantage increased. Each of the eight social factors was also independently associated with oral pain.

The researchers then examined whether dental attendance or financial barriers to dental care might help explain the association. Not having attended a dentist within the previous year was not independently associated with oral pain, but being unable to obtain necessary dental care because of cost was strongly associated with oral pain. Further analysis found that cost-related barriers accounted for about a third of the association between cumulative social disadvantage and oral pain, suggesting that affordability is one important factor among the range of behavioural, physiological and psychosocial pathways noted in previous research.

Other US research has similarly indicated that social disadvantages associated with lower use of dental services tend to occur together rather than in isolation. A recent study using data from the All of Us research programme found that related social factors, such as lower income, lack of insurance and housing instability, were associated with reduced dental care utilisation, and it identified clusters of disadvantages among participants who had not received dental care in the previous year. The findings highlight the multidimensional nature of social disadvantage in relation to oral healthcare.

Overall, the research supports considering the cumulative burden of social disadvantage, rather than individual socio-economic factors in isolation, when examining disparities in oral pain. The authors suggested that this approach could help inform population-level efforts to address oral health inequalities.

The study, titled “Associations of social determinants of health with oral pain in U.S. adults: A cross-sectional study on the mediating role of cost-related barriers to dental care”, was published online in the July–September 2026 issue of Science Progress.