Socio-economic and rural-urban inequalities in parent-reported oral health status among children and adolescents in the United States, 2016–2021

Background The 2021 National Institute of Dental and Craniofacial Research describes rural populations as vulnerable to oral health disparities. Parents of children and adolescents residing in rural areas report greater healthcare needs for their children than parents of children in urban areas. Differences in oral health status between children and adolescents living in rural and urban areas, as reported by their parents, were assessed. Methods A pooled repeated cross-sectional analysis of 2016–2021 U.S. National Survey of Children’s Health data for children and adolescents aged 1–17 years ( n = 225,443) was conducted. Parent-reported oral health was categorized as good (excellent/very good/good) or poor (fair/poor). Weighted descriptive and bivariate analyses were performed, followed by logistic regression adjusting for key demographic, socioeconomic, insurance, and healthcare access factors. Results Approximately 33%, 55%, and 12% lived in urban, suburban, and rural regions, respectively. 94% of parents reported that their children had good oral health, while the other 6% reported that their children had poor oral health. In adjusted analyses, parents of children living in rural areas reported their children had lower odds of good oral health than those of children living in urban areas. Conclusion Significant rural–urban disparities in parent-reported oral health persist among U.S. children and adolescents, with rural residence independently associated with poorer oral health status. These findings suggest the need for targeted public health strategies and health system interventions to address geographic inequalities and improve oral health outcomes for children living in rural communities.