This study compares oral health status and its inequality among education groups across seven study sites in five countries: Erfurt, Germany; Lodz, Poland; Yamanashi, Japan; New Zealand; and Baltimore and the Lakota and Navajo Indian Health Service sites in the United States. The data, from the International Collaborative Study of Oral Health Outcomes, were collected through personal interviews and clinical examinations. The research group measured the study sites' overall oral health, examining the percentage of the population with five or more missing and two or more decayed teeth. The group also assessed the magnitude of inequality among education groups by using indices of excess morbidity. Baltimore had the lowest percentage (10.8 percent) of decayed teeth and second lowest percentage (17.3 percent) of missing teeth, but the greatest indices of excess morbidity (79.2 percent for missing, 73.1 percent for decayed). Lodz, by contrast, had the worst overall dentition status (75.3 percent for missing, 70.3 percent for decayed) but the lowest inequality indices (10.6 percent for missing, 13.8 percent for decayed). This study demonstrates the need for policymakers in the study countries to consider not only overall levels but also the distribution of oral health, and it presents various challenges for oral health professionals in designing and implementing oral health programs.
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