Socioeconomic Disparities in Dental Caries Experience: The National Health and Nutrition Examination Survey 2011–2020

INTRODUCTION: Socioeconomic disparities in dental caries remain a substantial public health concern in the U.S. This study examined the associations between socioeconomic status indicators and dental caries experience in U.S. adults and assessed trends in SES-related disparities over time. METHODS: A cross-sectional study was conducted using data on adults aged ≥25 years from the National Health and Nutrition Examination Survey (NHANES) between 2011 and March 2020. Data were analyzed between 2024 and 2025. Caries experience was defined using the Decayed, Missing, Filled Teeth (DMFT) score from a standardized dental examination. SES indicators were operationalized using participants' self-reported responses. Multiple imputation by chained equations was employed to address missing data. Poisson models with a dispersion parameter were used to examine the associations between SES indicators and DMFT and to explore temporal trends in SES-related disparities in caries experience across 4 survey cycles. RESULTS: After adjusting for age, sex, and race/ethnicity, all SES indicators were significantly associated with caries experience. Individuals with lower income (risk ratio=1.27, 95% CI=1.24, 1.30), lower education (risk ratio=1.31, 95% CI=1.28, 1.33), unemployment (risk ratio=1.17, 95% CI=1.14, 1.19), food insecurity (risk ratio=1.13, 95% CI=1.11, 1.15), and no health insurance (risk ratio=1.09, 95% CI=1.06, 1.11) had higher DMFT scores than more advantaged counterparts. Dose-response relationships for income, education, and employment were observed, with progressively higher caries experience in lower SES categories. Analyses across NHANES cycles showed persistent SES-related disparities in caries experience, with no large changes in magnitude over time. CONCLUSIONS: Socioeconomic disparities in caries among U.S. adults persisted from 2011 to 2020, with consistently higher caries experience in disadvantaged groups. These findings highlight the need for targeted policies to reduce financial and structural barriers to dental care and address broader socioeconomic determinants of oral health.