Socioeconomic inequalities and the economic burden of dental caries: a longitudinal simulation analysis across forty countries.
10 affiliations
- 1Economist Impact, Hong Kong, Hong Kong.
- 2Economist Impact, London, UK. [email protected].
- 3Economist Impact, London, UK.
- 4Economist Impact, São Paulo, Brazil.
- 5NIHR Biomedical Research Centre Birmingham, The University of Birmingham, Birmingham, UK.
- 6Birmingham Community Healthcare NHS Trust, Birmingham, UK.
- 7Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY, USA.
- 8Periodontal Research Group, Dentistry, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK.
- 9Bristol Dental School, University of Bristol, Bristol, UK.
- 10Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
Abstract
Background
In 2024, World Health Organization (WHO) member states endorsed the Bangkok declaration, prioritising oral diseases within universal health coverage and non-communicable disease agendas, and calling for prevention-oriented, primary care-led systems. This study aimed to: (1) explore the healthcare costs of managing dental caries between the ages of 12 and 65 years across income quintiles in 40 countries, and (2) estimate the potential reduction in direct costs from non-targeted and targeted oral health-promoting interventions.Methods
A cohort simulation model was developed to estimate the direct costs of dental caries over time for different income quintiles across 40 countries. National-level DMFT (dentine threshold) data, the relative likelihood of receiving an intervention (such as a restorative procedure, tooth extraction and replacement), and clinically guided assumptions were used to populate the model. Private treatment costs in each country were used as a proxy to estimate the direct costs of dental caries. A hypothetical group of upstream and downstream preventive interventions were applied either uniformly across all income groups to reduce caries progression rates by 30% or in a "levelling-up" fashion with the greatest gains seen in the lowest income group.Results
The population-level direct costs of caries from 12 to 65 years of age varied between US$317.8 million in Slovenia to US$182.6 billion in China. The highest per-person costs were in Switzerland at US$51,932 and the lowest in Jordan at US$6,339. The per-person direct costs were highest in the lowest income quintile 40 countries. Inadequate preventative oral care for lower income groups results in 50% higher total treatment costs. With the uniform application of preventive measures across all income quintiles, the greatest reduction in per-person costs for caries management was seen in the lowest income quintile across all countries. With a levelling-up approach, cost reductions in the lowest income group ranged from US$4,083 in Vietnam to US$43,106 in Switzerland.Conclusion
Lower income groups experience a greater health and economic burden from dental caries. Early, targeted preventive interventions, such as twice daily brushing with fluoridated toothpaste, water fluoridation, oral health education, and school programs, within a life-course, equity-driven framework, can reduce costs, mitigate disease burden, and advance global oral health equity.
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BibTeX
@article{verma2026socioeconomic,
title = {{Socioeconomic inequalities and the economic burden of dental caries: a longitudinal simulation analysis across forty countries.}},
author = {Neeladri Verma and Gerard Dunleavy and Amanda Stucke and Shivangi Jain and Julia Maciel de Rodrigues and Joao Hofmeister and Moritz Kebschull and Iain Chapple and Nicola West and Nigel Pitts},
journal = {BMC public health},
year = {2026},
month = jul,
doi = {10.1186/s12889-026-28363-4},
url = {https://europepmc.org/article/MED/42897513},
note = {CC BY},
}
RIS
TY - JOUR
TI - Socioeconomic inequalities and the economic burden of dental caries: a longitudinal simulation analysis across forty countries.
AU - Neeladri Verma
AU - Gerard Dunleavy
AU - Amanda Stucke
AU - Shivangi Jain
AU - Julia Maciel de Rodrigues
AU - Joao Hofmeister
AU - Moritz Kebschull
AU - Iain Chapple
AU - Nicola West
AU - Nigel Pitts
PY - 2026
DA - 2026/07/01
JO - BMC public health
DO - 10.1186/s12889-026-28363-4
UR - https://europepmc.org/article/MED/42897513
AB - Background In 2024, World Health Organization (WHO) member states endorsed the Bangkok declaration, prioritising oral diseases within universal health coverage and non-communicable disease agendas, and calling for prevention-oriented, primary care-led systems. This study aimed to: (1) explore the healthcare costs of managing dental caries between the ages of 12 and 65 years across income quintiles in 40 countries, and (2) estimate the potential reduction in direct costs from non-targeted and targeted oral health-promoting interventions.Methods A cohort simulation model was developed to estimate the direct costs of dental caries over time for different income quintiles across 40 countries. National-level DMFT (dentine threshold) data, the relative likelihood of receiving an intervention (such as a restorative procedure, tooth extraction and replacement), and clinically guided assumptions were used to populate the model. Private treatment costs in each country were used as a proxy to estimate the direct costs of dental caries. A hypothetical group of upstream and downstream preventive interventions were applied either uniformly across all income groups to reduce caries progression rates by 30% or in a "levelling-up" fashion with the greatest gains seen in the lowest income group.Results The population-level direct costs of caries from 12 to 65 years of age varied between US$317.8 million in Slovenia to US$182.6 billion in China. The highest per-person costs were in Switzerland at US$51,932 and the lowest in Jordan at US$6,339. The per-person direct costs were highest in the lowest income quintile 40 countries. Inadequate preventative oral care for lower income groups results in 50% higher total treatment costs. With the uniform application of preventive measures across all income quintiles, the greatest reduction in per-person costs for caries management was seen in the lowest income quintile across all countries. With a levelling-up approach, cost reductions in the lowest income group ranged from US$4,083 in Vietnam to US$43,106 in Switzerland.Conclusion Lower income groups experience a greater health and economic burden from dental caries. Early, targeted preventive interventions, such as twice daily brushing with fluoridated toothpaste, water fluoridation, oral health education, and school programs, within a life-course, equity-driven framework, can reduce costs, mitigate disease burden, and advance global oral health equity.
SN - 1471-2458
ER -