Associations of social determinants of health with oral pain in U.S. adults: A cross-sectional study on the mediating role of cost-related barriers to dental care

Objective Oral pain is a common and clinically relevant symptom that reflects unmet oral health needs and may be shaped by broader social and healthcare access-related factors. The study aimed to investigate the association between a composite Social Determinants of Health (SDoH) score and oral pain among U.S. adults. Methods This cross-sectional secondary analysis included 14,245 adults aged 30 years and older who participated in the National Health and Nutrition Examination Survey during 2011–2018. Weighted binary logistic regression models were used to evaluate the association between SDoH score and oral pain. Receiver operating characteristic curves were used to evaluate the discriminatory performance. Mediation analyses were performed to quantify the indirect associations. Results Participants with oral pain had significantly higher and more adverse SDoH scores compared with those without oral pain (2.94 ± 0.08 vs. 1.94 ± 0.05, P < 0.001). In fully adjusted logistic regression models, participants in the highest SDoH burden category had 2.79-fold higher odds compared with those in the lowest burden category ( P < 0.001). All eight individual SDoH components were independently associated with oral pain (all P < 0.001). The addition of SDoH components significantly improved model discrimination for oral pain compared with a demographic-only model (AUC 0.654 vs. 0.574, Z test P < 0.001), although the overall discriminatory ability remained limited. Mediation analyses showed that cost-related barriers to dental care accounted for 31.0% of the observed association between SDoH score and oral pain ( P < 0.001). Conclusions Higher social disadvantage, as captured by a composite SDoH score, is associated with increased odds of oral pain among U.S. adults. Cost-related barriers to dental care may partly explain this association, suggesting that dental affordability and access should be considered in efforts to reduce oral pain disparities.