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08:47
Oral Health Assessment by Lay Personnel for Older Adults
Published on: February 2, 2020
Multiple Marginalization: Quantifying Intersectional Inequalities in Utilization of Dental Care.
Nasir Z Bashir1, Gustavo H Soares2, Fabio Leite3
1MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
Journal of Public Health Dentistry
|July 15, 2026
Summary
Adolescent dental care access is unequal, especially for Black and sexual minority youth. Intersectional factors like sex, race, ethnicity, and sexual identity significantly impact dental visit likelihood, highlighting disparities in oral health equity.
Area of Science:
- Public Health
- Health Disparities Research
- Adolescent Oral Health
Background:
- Inequitable utilization of regular dental care is a primary driver of oral health outcome disparities.
- Adolescent oral health is significantly influenced by access to dental services.
Purpose of the Study:
- To investigate inequalities in adolescent dental care utilization.
- To examine these inequalities at the intersections of sex, race and ethnicity, and sexual identity.
Main Methods:
- Analysis of pooled data from the national Youth Risk Behavior Survey (2021-2023) with 27,692 participants.
- Application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) across 20 intersectional strata.
- Assessment of two dental service utilization outcomes: not visiting a dentist in the past 12 months and never having visited a dentist.
Main Results:
- Substantial heterogeneity in dental visit patterns was observed across intersectional strata.
- Sex, race and ethnicity, and sexual identity collectively explained 93%-97% of the between-stratum variance.
- Individuals in certain intersectional groups faced significantly higher odds of not visiting a dentist (35% increase) or never visiting a dentist (108% increase).
Conclusions:
- Adolescent dental attendance inequalities are substantial, particularly affecting Black and sexual minority individuals.
- Intersectional identities play a critical role in shaping disparities in dental care access.
- Findings suggest inequalities are largely additive across intersectional strata under MAIHDA assumptions.
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