A new article published by the Lancet Commission on Oral Health, in collaboration with the International Center for Equity in Health (ICEH), establishes a direct connection between social welfare regimes and the prevalence of edentulism (total tooth loss). The research demonstrates that the State’s role in tackling inequalities systematically impacts the oral health of the population.

The State’s Role in Oral Health

The study shows that the magnitude of inequalities varies according to the social protection regime—which encompasses access to education, healthcare, housing, and assistance for the vulnerable. Across all analyzed regimes, individuals in the lowest wealth quintile showed the highest prevalence of edentulism.

However, the disparity is much more pronounced in liberal models, where the market is the primary provider of welfare. In these countries, the poorest individuals are, on average, 20 times more likely to lose all their teeth than the wealthiest.

In contrast, in social-democratic regimes—found in countries that prioritize universal social protection, such as the Nordic nations—the risk of tooth loss among the poorest drops drastically to 3.3 times that of the wealthiest.

Methodology and Global Comparison

The research analyzed a comprehensive dataset of 117,397 individuals (aged 20 and older) residing in 40 countries. This global comparison was made possible by the health survey data standardization process led by ICEH researchers Aluisio J. D. Barros and Francine S. Costa.

The work highlights the importance of understanding political structure as a fundamental social determinant of health. By standardizing data across diverse nations, ICEH has provided unprecedented insight into how different State models shape the clinical reality of their citizens.

The full study can be accessed in The Lancet Regional Health – Europe via DOI: 10.1016/j.lanepe.2025.101578