Socioeconomic disparities in adolescent gingival diseases: Mediating through modifiable oral health knowledge and practices

BACKGROUND: Multilevel socioeconomic disparities in adolescent gingival health remain understudied. We quantified economic determinants to guide equitable oral health policies. METHODS: Using data from the Fourth National Oral Health Survey in China, we analyzed questionaries and oral examinations from adolescents across seven Sichuan regions. Logistic regression was conducted to evaluate the economy-gingival status association. Structural equation model (SEM) was performed to explore pathways linking macro-regional, meso-family, and micro-individual factors to gingival status. Counterfactual mediation model was used to identify the potential mediators. RESULTS: Among 7113 adolescents, 49.9% exhibited bleeding on probing (BOP) and 70.9% exhibited dental calculus (DC). After adjustments, non-agricultural family participants had 23.3% lower BOP and 11.3% lower DC odds than agricultural families. Adolescents with parental education (middle or high vs. low) showed 19.6% or 25.8% lower BOP risk. Adolescents in fast-developing regions showed 16.4% lower BOP odds, while those in high-economic-level regions had 24.7% higher BOP and 20.3% higher DC odds. SEM identified significant pathways from regional economic development speed, household type, oral health knowledge, and brushing to DC, and from regional economic level, regional economic development speed, household type, and brushing to BOP (p < 0.05). Counterfactual mediation analyses showed that gains in oral health knowledge and brushing associated with the reduction in gingivitis risk. CONCLUSIONS: Adolescent gingival health socioeconomic inequalities showed indirect associations through modifiable factors, specifically oral health knowledge and brushing. The findings recommended prioritized oral health resource allocation to disadvantaged regions and households, with literacy promotion and theory-informed behavioral interventions.