Why do poor adults rate their oral health poorly?

Background: The reasons why socioeconomic circumstances are associated with oral health are not well understood. This study investigated whether psychosocial factors might play an explanatory role. Methods: Cross-sectional survey data were used from the 1999 Natonal Dental Telephone Interview Survey together with information from an accompanying questionnaire sent to adult interviewees. Household income and self-rated oral health were assessed with single items and life dissatisfaction, personal constraint and percieved stress were evaluated with standard psychometric scales. Bivariate associations were tested using chi-square and ANOVA and odds ratios estimated for low self-rated oral health using logistic regression. Results: Response to the questionnaire was 64.6 percent and analysis was limited to dentate adults (n = 3678). Low household income was positively associated with low self-rated oral health . Higher dissatisfaction with life, personal constraint and percieved stress scores were associated with low income and with low self-rated oral-health. After adjusting for gender, age, income and missing teeth, adults with high personal constraint scores had greater odds of low self-rated oral health (OR 1.26; 1.10-1.43) as had adults with higher perceived stress scores (OR 1.69; 1.34-2.13). Conclusion: Psychosocial factors are important in understanding pathways between socioeconomic position and oral health status.