Association between socioeconomic status and dental caries in adolescents – a systematic review of cohort studies
DOI:
https://doi.org/10.2340/aos.v85.46953Keywords:
Adolescent, socioeconomic factors, dental caries, epidemiologyAbstract
Introduction: Early adolescence is a critical period for caries initiation, underlining the need for updated knowledge on effective caries indicators. This systematic review of cohort studies aimed to assess the association between socioeconomic status (SES), involving a wide range of indicators, and dental caries in adolescents aged 12–19.
Materials and methods: Four databases (MEDLINE, Embase, Cochrane Library, and Web of Science) were systematically searched for relevant publications from January 1, 2000, through December 5, 2025. SES and SES proxy indicators were parental education, income, and occupation, and adolescents’ school type, their social capital, and immigrant background. Composite SES indicators combined the aforementioned variables. The risk of bias was evaluated using a modified Newcastle-Ottawa Scale.
Results: Studies (n = 21) from 11 countries across five continents were included, covering approximately 66,000 adolescents. An inverse relationship was documented between caries and mothers’ education (six of seven studies), fathers’ education (three of four studies), and parental income (three of six studies). School type (three studies), social capital (two studies), immigrant background (four studies), and composite SES indicators (five of six studies) were also linked to caries. However, the effect measures and definitions of exposures and outcomes were not consistent.
Conclusions: An inverse association was observed between maternal education and caries, while corresponding associations with fathers’ education and parental income were weaker and less consistent. This type of association was also observed for adolescents’ school types, their social capital, and composite SES indicators. Immigrant background served as a caries predictor. However, the substantial heterogeneity in the included studies did not allow for meta-analyses and limited definite conclusions. The findings underscore the need to develop and validate robust composite SES measures applicable across diverse global contexts.
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References
Engels F. The condition of the working class in England. Leipzig: Wigland O; 1845.
Poulain T, Vogel M, Kiess W. Review on the role of socioeconomic status in child health and development. Curr Opin Pediatr. 2020;32(2):308–14. DOI: https://doi.org/10.1097/MOP.0000000000000876
Jung SH, Kim MH, Ryu JI. Inequalities in oral health among adolescents in Gangneung, South Korea. BMC Oral Health. 2018;18(1):68. DOI: https://doi.org/10.1186/s12903-018-0533-3
World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. Geneva: World Health Organization; 2022.
Schwendicke F, Dorfer CE, Schlattmann P, Foster Page L, Thomson WM, Paris S. Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res. 2015;94:10–18. DOI: https://doi.org/10.1177/0022034514557546
Kaufman J. Social epidemiology. In: Rothman K, Greenland S, Lash T, editors. Modern epidemiology. 3rd ed. Philadelphia, PA: Wolters Kluwer. Lippincott Williams & Wilkins; 2008. p. 532–48.
Widström E, Eaton KA. Oral healthcare systems in the extended European Union. Oral Health Prev Dent. 2004;2(3):155–94.
Sisson KL. Theoretical explanations for social inequalities in oral health. Community Dent Oral Epidemiol. 2007;35:81–8. DOI: https://doi.org/10.1111/j.1600-0528.2007.00354.x
Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet. 2019;394:249–60. DOI: https://doi.org/10.1016/S0140-6736(19)31146-8
Congiu G, Campus G, Luglie PF. Early childhood caries (ECC) prevalence and background factors: a review. Oral Health Prev Dent. 2014;12(1):71–6.
Novak A, Pelaez, M. What is adolescent behavioral development? In: Novak A, Pelaez M, editors. Child and adolescent development. A behavioral systems approach. London: Sage Publications, Inc.; 2014. p. 463–92.
Curtis AM, Cavanaugh JE, Levy SM, VanBuren J, Marshall TA, Warren JJ. Examining caries aetiology in adolescence with structural equation modelling. Community Dent Oral Epidemiol. 2018;46(3):258–64. DOI: https://doi.org/10.1111/cdoe.12359
Bernabé E, Delgado-Angulo EK, Murasko JE, Marcenes W. Family income and tooth decay in US children: does the association change with age? Caries Res. 2012;46(3):221–7. DOI: https://doi.org/10.1159/000337389
Skeie M, Sen A, Dahllöf G, Natland Fagerhaug T, Høvik H, Klock KS. Dental caries at enamel and dentine level among European adolescents – a systematic review and meta-analysis. BMC Oral Health. 2022;22(1):620. DOI: https://doi.org/10.1186/s12903-022-02631-2
Cunha M, Cruz A, Martins-Pfeifer C, Costa SM, Abreu M. Caries and socioeconomic factors in adults (19–60 years old): an updated systematic review of observational studies. Int J Environ Res Public Health. 2026;23(1):112. DOI: https://doi.org/10.3390/ijerph23010112
Nóbrega J, Dantas E, Ferreira-Filho JC, Limao N, Rodrigues-de-Melo AC, Protasio AP, et al. Contextual social inequities and occurrence of dental caries in adolescents: a systematic review. Oral Health Prev Dent. 2017;15:329–60.
Reisine ST, Psoter W. Socioeconomic status and selected behavioral determinants as risk factors for dental caries. J Dent Educ. 2001;65:1009–16. DOI: https://doi.org/10.1002/j.0022-0337.2001.65.10.tb03443.x
Piko BF, Fitzpatrick KM. Socioeconomic status, psychosocial health and health behaviours among Hungarian adolescents. Eur J Public Health. 2007;17:353–60. DOI: https://doi.org/10.1093/eurpub/ckl257
Currie CE, Elton RA, Todd J, Platt S. Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey. Health Educ Res. 1997;12:385–97. DOI: https://doi.org/10.1093/her/12.3.385
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. DOI: https://doi.org/10.1186/s13643-016-0384-4
Bramer WM, Giustini D, de Jonge GB, Holland L, Bekhuis T. De-duplication of database search results for systematic reviews in EndNote. J Med Libr Assoc. 2016;104:240–3. DOI: https://doi.org/10.3163/1536-5050.104.3.014
United Nations. Human development index (HDI) [Internet]. [cited 2026 Feb 25]. Available from: www.countryeconomy.com>hdi
Klein H, Palmer C, Knutson J. Studies on dental caries: I. Dental status and dental needs of elementary school children. Pub Health Rep. 1938;53:751–65. DOI: https://doi.org/10.2307/4582532
Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. 2013 [cited 2026 Feb 25]. Available from: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
Mejàre I, Stenlund H. Caries rates for the mesial surface of the first permanent molar and the distal surface of the second primary molar from 6 to 12 years of age in Sweden. Caries Res. 2000;34:454–61. DOI: https://doi.org/10.1159/000016623
World Health Organisation. Oral health surveys. Basic methods. 4th ed. Geneva: World Health Organization; 1997.
Alm A, Wendt LK, Koch G, Birkhed D, Nilsson M. Caries in adolescence – influence from early childhood. Community Dent Oral Epidemiol. 2012;40:125–33. DOI: https://doi.org/10.1111/j.1600-0528.2011.00647.x
Bernabé E, Stansfeld SA, Marcenes W. Roles of different sources of social support on caries experience and caries increment in adolescents of East London. Caries Res. 2011;45:400–7. DOI: https://doi.org/10.1159/000330370
Brondani B, Knorst JK, Ardenghi TM, Mendes FM, Brondani MA. Community and individual socioeconomic inequalities and dental caries from childhood to adolescence: a 10-year cohort study. Community Dent Oral Epidemiol. 2024;52:540–9. DOI: https://doi.org/10.1111/cdoe.12950
Costa LR, Vettore MV, Quadros LN, Rebelo Vieira JM, Herkrath A, Queiroz AC, et al. Socio-economic status, psychosocial factors, health behaviours and incidence of dental caries in 12-year-old children living in deprived communities in Manaus, Brazil. J Dent. 2023;133:104504. DOI: https://doi.org/10.1016/j.jdent.2023.104504
Gerdin EW, Angbratt M, Aronsson K, Eriksson E, Johansson I. Dental caries and body mass index by socio-economic status in Swedish children. Community Dent Oral Epidemiol. 2008;36:459–65. DOI: https://doi.org/10.1111/j.1600-0528.2007.00421.x
Hall-Scullin E, Whitehead H, Milsom K, Tickle M, Su TL, Walsh T. Longitudinal study of caries development from childhood to adolescence. J Dent Res. 2017;96:762–7. DOI: https://doi.org/10.1177/0022034517696457
Julihn A, Ekbom A, Modeer T. Migration background: a risk factor for caries development during adolescence. Eur J Oral Sci. 2010;118:618–25. DOI: https://doi.org/10.1111/j.1600-0722.2010.00774.x
Källestål C, Fjelddahl A. A four-year cohort study of caries and its risk factors in adolescents with high and low risk at baseline. Swed Dent J. 2007;31:11–25.
Llena C, Calabuig E, Sanz JL, Melo M. Risk factors associated with carious lesions in permanent first molars in children: a seven-year retrospective cohort study. Int J Environ Res Public Health. 2020;17:1421. DOI: https://doi.org/10.3390/ijerph17041421
Lu HX, Wong MC, Lo EC, McGrath C. Trends in oral health from childhood to early adulthood: a life course approach. Community Dent Oral Epidemiol. 2011;39:352–60. DOI: https://doi.org/10.1111/j.1600-0528.2011.00611.x
Ortiz FR, Reyes LT, Ardenghi TM. Social economic disadvantage and untreated dental caries: findings from a cohort study in adolescents. Caries Res. 2022;56:179–86. DOI: https://doi.org/10.1159/000525238
Page LA, Thomson WM. Dental caries in Taranaki adolescents: a cohort study. N Z Dent J. 2011;107:91–6.
Peres MA, Liu P, Demarco FF, Silva AER, Wehrmeister FC, Menezes AM, et al. Income trajectories affect treatment of dental caries from childhood to young adulthood: a birth cohort study. Braz Oral Res. 2018;32:e36. DOI: https://doi.org/10.1590/1807-3107bor-2018.vol32.0036
Pilecco RO, Godois L, Maroneze M, Ortiz F, Ardenghi T. Factors associated with the number of filled teeth in adolescents from public schools: a cohort study. Braz Oral Res. 2019;33:e124. DOI: https://doi.org/10.1590/1807-3107bor-2019.vol33.0124
Saethre-Sundli HB, Wang NJ, Wigen TI. Do enamel and dentine caries at 5 years of age predict caries development in newly erupted teeth? A prospective longitudinal study. Acta Odontol Scand. 2020;78:509–14. DOI: https://doi.org/10.1080/00016357.2020.1739330
Schmoeckel J, Santamaria RM, Splieth CH. Long-term caries development in schoolchildren and the role of educational status. Quintessence Int. 2015;46:409–15.
Tagliaferro EP, Pereira AC, Meneghim Mde C, Ambrosano GM. Assessment of dental caries predictors in a seven-year longitudinal study. J Public Health Dent. 2006;66:169–73. DOI: https://doi.org/10.1111/j.1752-7325.2006.tb02575.x
Tan SHX, Teo YY, Tan MHX, Gao X. Childhood factors and dental caries in the permanent dentition: findings of an 8-year study under a nationwide school dental service. Int Dent J. 2021;71:508–15. DOI: https://doi.org/10.1016/j.identj.2021.01.008
Wang K, Pang L, Fan C, Cui T, Yu L, Lin H. Enamel and dentin caries risk factors of adolescents in the context of the International Caries Detection and Assessment System (ICDAS): a longitudinal study. Front Pediatr. 2020;8:419. DOI: https://doi.org/10.3389/fped.2020.00419
Warren JJ, Van Buren JM, Levy SM, Marshall TA, Cavanaugh JE, Curtis AM, et al. Dental caries clusters among adolescents. Community Dent Oral Epidemiol. 2017;45:538–44. DOI: https://doi.org/10.1111/cdoe.12317
Hugoson A, Koch G, Helkimo AN, Lundin SA. Caries prevalence and distribution in individuals aged 3–20 years in Jönköping, Sweden, over a 30-year period (1973–2003). Int J Paediatr Dent. 2008;18:18–26. DOI: https://doi.org/10.1111/j.1365-263X.2007.00874.x
Costa SM, Martins CC, Bonfim Mde L, Zina LG, Paiva SM, Pordeus IA, et al. A systematic review of socioeconomic indicators and dental caries in adults. Int J Environ Res Public Health. 2012;9:3540–74. DOI: https://doi.org/10.3390/ijerph9103540
Paez A. Grey literature: an important resource in systematic reviews. J Evid Based Med. 2017;10(3):233–40. DOI: https://doi.org/10.1111/jebm.12266
Turck D, Bohn T, Castenmiller J, de Henauw S, Ildico Hirsch-Ernst K, Knutsen H, et al. Tolerable upper intake level for dietary sugars. EFSA J. 2022;20(2):e07074. DOI: https://doi.org/10.2903/j.efsa.2022.7074
Larson NI, Miller JM, Watts AW, Story MT, Neumark-Sztainer DR. Adolescent snacking behaviors are associated with dietary intake and weight status. J Nutr. 2016;146:1348–55. DOI: https://doi.org/10.3945/jn.116.230334
Ericsson JS, Östberg AL, Wennstrom JL, Abrahamsson KH. Oral health-related perceptions, attitudes, and behavior in relation to oral hygiene conditions in an adolescent population. Eur J Oral Sci. 2012;120:335–41. DOI: https://doi.org/10.1111/j.1600-0722.2012.00970.x
Gautam N, Dessie G, Rahman MM, Khanam R. Socioeconomic status and health behavior in children and adolescents: a systematic literature review. Front Public Health. 2023;11:1228632. DOI: https://doi.org/10.3389/fpubh.2023.1228632
Östberg AL. Adolescents’ views of oral health education. A qualitative study. Acta Odontol Scand. 2005;63:300–7. DOI: https://doi.org/10.1080/00016350510020061
Borstmann EDS, Brondani B, Knorst JK, Siqueira BDP, Lima LS, Ramadan YH, et al. Association between depression, anxiety, and stress and oral health-related quality of life in adolescents. Braz Oral Res. 2025;39:e109. DOI: https://doi.org/10.1590/1807-3107bor-2025.vol39.109
Fejerskov O. Pathology of dental caries. In: Fejerskov O, Nyvad B, Kidd E, editors. Dental caries disease and its clinical management. 3rd ed. Chichester, West Sussex: John Wiley & Sons, Ltd.; 2015. p. 49–81.
Broadbent JM, Thomson WM, Poulton R. Trajectory patterns of dental caries experience in the permanent dentition to the fourth decade of life. J Dent Res. 2008;87:69–72. DOI: https://doi.org/10.1177/154405910808700112
Mejàre I, Stenlund H, Zelezny-Holmlund C. Caries incidence and lesion progression from adolescence to young adulthood: a prospective 15-year cohort study in Sweden. Caries Res. 2004;38:130–41. DOI: https://doi.org/10.1159/000075937
Bajekal M, Jan S, Jarman B. The Swedish UPA score: an administrative tool for identification of underprivileged areas. Scand J Soc Med. 1996;24:177–84. DOI: https://doi.org/10.1177/140349489602400309
Psaki SR, Seidman JC, Miller M, Gottlieb M, Bhutta ZA, Ahmed T, et al. Measuring socioeconomic status in multicountry studies: results from the eight-country MAL-ED study. Popul Health Metr. 2014;12:8. DOI: https://doi.org/10.1186/1478-7954-12-8
Sacre H, Haddad C, Hajj A, Zeenny RM, Akel M, Salameh P. Development and validation of the Socioeconomic Status Composite Scale (SES-C). BMC Public Health. 2023;23:1619. DOI: https://doi.org/10.1186/s12889-023-16531-9
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