Oral health is an integral component of general health. Still, too many older adults in the U.S. have no access to dental care while also suffering from disproportionate rates of oral diseases. Little has been done to address social determinants of oral health at a national level. The goal of this dissertation was to investigate the link between socioeconomic status (SES) and three indicators of oral health among U.S. older adults: (1) utilization of dental services, (2) untreated dental caries, and (3) permanent tooth loss. These outcomes mark the progression of poor oral health that begins with access to routine dental care, then advances to dental caries, and reaches the terminal outcome of permanent tooth loss. Our theoretical framework drew upon concepts from Elder’s (1974) Life Course Framework, Link and Phelan’s (1995) Theory of Fundamental Causes. and Cockerham’s (2005) Health Lifestyle Theory.

Cross-sectional data from the (2013-2018) National Health and Nutrition Examination Survey (NHANES) were used to assess variations in oral health-related outcomes among adults aged 50 years and older. Key findings revealed that participants with lower levels of education and income were less likely to have regular dental check-ups, had a higher likelihood of untreated dental caries, and faced an elevated risk of permanent tooth loss compared to those with higher SES. These disparities linked to SES were particularly pronounced in adults over 80 years of age with limited educational attainment. Furthermore, escalating levels of food insecurity and having infrequent dental care were both associated with fewer permanent teeth, a higher risk of untreated dental caries, and a greater probability of complete tooth loss.

The consequences of oral diseases are life-altering. Older U.S. adults are especially vulnerable to these challenges, influenced by a combination of social, behavioral, and clinical factors over their lifespan. Unfortunately, research in this area is scarce, while public programs such as Medicare do not even offer basic dental coverage. Thus, understanding critical social drivers of oral health is imperative for enhancing dental outcomes for current and future generations.