Integrating oral health into Universal Health Coverage in Europe: A cross-sectional ecological analysis of services and outcomes.

Integration of oral health within Universal Health Coverage (UHC) remains uneven across Europe, and comparative evidence linking statutory dental coverage and public financing with oral health outcomes is limited. This study assessed relationships between integration of essential oral health services within UHC and prevalence of untreated dental caries and self-reported unmet need for dental care across European countries. A cross-sectional ecological analysis was conducted using publicly available, country-level data for 34 WHO European Region countries (indicator years 2019-2023). Outcomes were untreated dental caries prevalence (≥5 years) and self-reported unmet dental need (≥16 years). Explanatory variables were public per capita dental expenditure (United States dollars), dentists per 10,000 population, statutory dental coverage model (comprehensive/partial = reference; limited = contrast), and public share of total dental spending (%). Descriptive statistics summarized health system indicators; 2 multiple linear regression models estimated associations. Across 34 countries, median unmet need was 1.58% (interquartile range 0.56-3.97%) and untreated caries 35.41% (interquartile range 31.61-38.15%). Health system inputs varied widely: median per capita dental expenditure = USD 97.8 (10-493.7); dentist density = 7.9 per 10,000 (1.1-17.7); public share = 32.8% (0.3-72.4). Model 1 (untreated caries): R2 = 0.371; F(4, 29) = 4.27; P = .008. Higher public per capita dental expenditure was associated with lower caries prevalence (B = -0.045; 95% confidence interval [CI]: -0.074 to -0.015; P = .004). Limited statutory coverage (vs comprehensive/partial) was associated with higher caries (B = 6.505; 95% CI: 2.526-10.483; P = .002). A higher public share of dental spending correlated positively with caries prevalence (B = 0.210; 95% CI: 0.095-0.326; P < .001). Dentist density showed no association (P = .705). Model 2 (unmet dental need): R2 = 0.370; F(4, 29) = 4.27; P = .007. Limited statutory coverage (vs comprehensive/partial) was associated with higher unmet need (B = 5.735; 95% CI: 2.396-9.075; P = .001). Other predictors were not significant (all P > .35). Broader statutory dental coverage was associated with lower unmet dental need, and greater public per capita dental expenditure with lower untreated caries prevalence. Workforce density alone was not predictive. Expanding prevention-oriented essential dental benefits and strengthening financial protection are central to achieving equitable oral health within UHC.