Author names: Duangsuwan J., Hansrani V., Michalakis K., Jurasic M.M., Kaye E.
Duangsuwan J, Hansrani V, Michalakis K, Jurasic MM, Kaye E. Impact of educational level on tooth loss and edentulism: a systematic review. Br Dent J. 2026 Feb 6.
doi: 10.1038/s41415-025-9197-y
Background
Tooth loss is a major public health concern, with an estimated worldwide prevalence of around 7% in all adults, and over three times as much in individuals aged 60 years and older, with ~660 million people estimated to be edentulous by 2050.
While caries and periodontitis are the major culprits when it comes to tooth loss among adults, socioeconomic factors have emerged as major indicators of tooth loss risk. These include measures such as education, income, employment and social networks.
Methods
The team searched PubMed for observational studies between January 2000 and August 2022, using different key search terms to screen for educational level and tooth loss. The papers were then screened with the following inclusion criteria:
- Population: adults aged 18 and older
- Exposure: educational level or years of schooling
- Comparison: higher or lower levels of educational attainment
- Outcome: number of teeth or status of dentition, either by self-report or clinical examination
- Year of publication: January 2000-August 2022
- Published in English
- Study type: epidemiologic study
Results
Thirty studies covering 735,576 individuals across 15 countries met the inclusion criteria. Most were cross-sectional (90%), and 77% of studies were deemed to be of good quality. The findings were strikingly consistent. People with no formal education or only primary education had 2.02 to 4.93 times higher odds of edentulism, 1.79 to 5.85 times higher odds of retaining fewer than 20 teeth (the threshold for a functional dentition), and 1.2 to 2.1 times greater odds of tooth loss compared with more educated groups. Results for secondary education were mixed, often showing elevated but not always statistically significant risk. Completion of a university degree was associated with a decrease in the odds of edentulism or tooth loss by roughly 20–55%. Several studies also linked parental education to offspring tooth loss, though this association was generally weaker than an individual’s own education.
Discussion
The authors make the point that education isn’t directly the cause of edentulism itself, but more of a proxy for a multiple complex factors, including unhealthy behaviours such as smoking and high-sugar intake, plus oral health literacy, income, and access to a dentist. People with less schooling tend to visit the dentist less, are more likely to live in “dental deserts” with few affordable providers and often end up choosing a cheap extraction over a pricier restoration.
Their recommendation is to start oral health education early, ideally in primary school, and to increase literacy with regards to nutrition, smoking and oral hygiene.
The bottom line is that educational disadvantages undoubtedly share an association with tooth loss, and the least educated are the most at risk, giving policymakers a solid case for targeted action.
Research Summary Written By: Abdul Aseri, University of Birmingham – BDS 2