Inequalities in dental pain: Evidences from a systematic review and a longitudinal study

Abstract

Dental pain, a debilitating condition influenced by various social determinants, represents a significant public health issue with profound impacts on individuals' quality of life. This dissertation examined the effect of social, racial, and gender inequalities on the prevalence of dental pain through a systematic review with meta-analysis and a longitudinal analysis using data from the 1982 Pelotas Birth Cohort. The review included 18 observational studies, identified across six databases up to February 2024, and revealed that individuals with low income were 79% more likely to report dental pain (OR=1.79; 95% CI: 1.39–2.30), while low education increased the risk by 27% (OR=1.27; 95% CI: 1.06–1.52). Racial minorities faced a 26% higher risk (OR=1.26; 95% CI: 1.18–1.33), with significant differences observed between subgroups. The longitudinal analysis, which utilized data from 607 participants of the 1982 Pelotas Cohort, identified two trajectories of dental pain: low prevalence (46.7%) and high prevalence (53.5%). Men were more likely to follow the low-prevalence trajectory (56.2%) compared to women (48.8%), whereas Black (58.1%) and Indigenous (70.0%) participants experienced higher prevalence of dental pain in contrast to White participants (54.5%). Measures of inequality indicated significant reductions in dental pain associated with household income (SII: −0.17; 95% CI: −0.31 to −0.04; p=0.012; CIX: −0.06; 95% CI: −0.11 to −0.01; p=0.013) and maternal education (SII: −0.15; 95% CI: −0.29 to −0.01; p=0.036; CIX: −0.06; 95% CI: −0.10 to −0.01; p=0.024). Thus, this dissertation provides robust evidence on the mechanisms influencing inequalities in dental pain, highlighting that public policies aimed at improving oral health cannot succeed without addressing the inequities perpetuated by the systemic structures of exploitation.