Exploring Oral Health Disparities in the 2022 BRFSS: The Impact of Rural/Urban Status and Adverse Childhood Experiences

Abstract

Objectives

To examine the association between rural/urban status, adverse childhood experiences (ACEs), and oral health outcomes, specifically focusing on inadequate dental visits and significant tooth loss.

Methods

Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), including 79,571 U.S adults from 12 states, was analyzed. Inadequate dental visits were defined as having last visited a dentist more than one year ago. Significant tooth loss was defined as the loss of six or more permanent teeth due to decay or gum disease. Multivariable logistic regression models were applied to assess the effects of rural/urban status and ACEs on both outcomes, adjusting for sociodemographic factors.

Results

Rural residents had higher odds of reporting inadequate dental visits (AOR: 1.17, 95% CI: 1.07–1.29) and significant tooth loss (AOR: 1.36, 95% CI: 1.21–1.53) compared to urban residents. ACEs were significantly associated with both outcomes, with individuals reporting 4 or more ACEs showing the highest prevalence of inadequate dental visits and significant tooth loss. Although no statistically significant interaction between rural/urban status and ACEs was found, rural residents generally had worse oral health outcomes than their urban counterparts.

Conclusions

Both rural/urban status and ACEs independently contribute to oral health disparities, with rural populations facing greater challenges in maintaining oral health. The findings emphasize the need for targeted interventions that address geographic and psychosocial determinants, particularly in rural areas, and highlight the importance of trauma-informed care in dental practice.