Impact of educational level on tooth loss and edentulism: a systematic review

Objectives To systematically review the association between education and tooth loss.Methods We performed an electronic search of PubMed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines with a focused PICO (population/problem, intervention, comparison, outcome) question: are adults with low educational attainment more prone to tooth loss than adults with higher education? Observational studies published between 2000-2022 examining adults ≥18 years with clinical or self-reported tooth loss were included. Quality of the reports was established using the Newcastle-Ottawa Scale.Results We identified 30 studies (735,576 individuals) across 15 countries. The majority were cross-sectional (90%) and rated as low/moderate quality (67%). Educational level was assessed as years of schooling or categorical attainment. Tooth loss was measured through clinical examination (53.3%) or self-report (46.7%). Primary education or less was consistently linked to higher likelihood of edentulism (odds ratio [OR] range: 2-4.9), fewer remaining teeth (OR range: 1.2-5.8), and greater tooth loss (OR range: 1.2-2.1) relative to higher levels. A university degree significantly reduced the odds of edentulism or tooth loss (OR range 0.3-0.75) compared to lower levels.Conclusions Lower educational attainment is associated with increased tooth loss. These findings provide a foundation for developing evidence-based policies and targeted interventions to address tooth loss in vulnerable populations.