Beyond Access: Racial Differences in Income-Related Gains in Tooth Retention by Dental Care Context

Abstract Objectives To test whether the association between household income and tooth retention differs by race/ethnicity and whether this interaction varies by reason for the most recent dental visit among US adults. Methods We analyzed 13,190 adults in the National Health and Nutrition Examination Survey (2009–2018). Survey-weighted linear regression estimated interactions between household income and race/ethnicity in models of tooth retention, stratified by reason for last dental visit. Results Higher income was associated with greater tooth retention across groups, but income- related gains were larger for Non-Hispanic White adults than for Non-Hispanic Black and Mexican American adults, particularly in problem-focused care settings. In problem-focused visits, each higher income category was associated with 0.5 additional teeth among White adults (95% CI = 0.4, 0.6) versus 0.2 (95% CI = 0.0, 0.4) among Black adults and 0.1 (95% CI = −0.1, 0.3) among Mexican American adults. Racial differences were attenuated in routine check-up contexts. Conclusions Income-related gains in tooth retention differed by race/ethnicity and dental care context. Public Health Implications Expanding access alone may be insufficient to reduce racial inequities in oral health.