Oral health disparities and food insecurity in working poor Canadians

Objectives: This study explored oral health disparities associated with food insecurity in working poor Canadians. Methods: We used a cross-sectional stratified study design and telephone survey methodology to obtain data from 1049 working poor persons aged between 18 and 64 years. The survey instrument contained sociodemographic items, self-reported oral health measures, access to dental care indicators (dental visiting behaviour and insurance coverage) and questions about competing financial demands. Food-insecure persons gave 'often' or 'sometimes' responses to any of the three food insecurity indicators used in the Canadian Community Health Survey (2003) assessing 'worry' about not having enough food, not eating enough food and not having the desired quality of food because of insufficient finances in the previous 12 months. Results: Food-insecure working poor persons had poor oral health compared with food-secure working poor persons indicated by a higher percentage of denture wearers (P < 0.001) and a higher prevalence of toothache, pain and functional impacts related to chewing, speaking, sleeping and work difficulties (P < 0.001). Fewer food-insecure persons rated their oral health as good or very good (P < 0.001). Logistic regression analyses showed that oral health disparities between food-insecure and food-secure persons related to denture wearing, having a toothache, reporting poor/very poor self-rated oral health or experiencing an oral health impact persisted after adjusting for sociodemographic factors and access to dental care factors (P < 0.05). Food-insecure working poor persons reported relinquishing goods or services in order to pay for necessary dental care. Conclusions: This study identified oral health disparities within an already marginalized group not alleviated by access to professional dental care. Working poor persons regarded professional dental care as a competing financial demand.