Beyond Universal Coverage: The Magnitude of the Oral Health Equity Gap Between Socially Excluded Children and a Reference Paediatric Population Within a Single Spanish Setting.

BACKGROUND/

objectivesDental caries is socially patterned, but the magnitude of the inequality associated with social exclusion is difficult to quantify when populations are compared across different countries and health systems. This study estimated the oral health gap between socially vulnerable children attending escuelas singulares and a contemporaneous reference paediatric population attending university dental clinics within the same city and health-system context.

methodsA cross-sectional analytical study was conducted in 231 children aged 6-12 years in Valencia, Spain: 129 from two state-funded schools serving communities at high risk of social exclusion, hereafter referred to as escuelas singulares (Colegio Madre Petra,

resultsCaries experience was markedly higher in vulnerable children (global caries score 4.07 ± 3.44 vs. 0.61 ± 1.96;

conclusionsWithin a single high-income setting with formally universal health coverage, social exclusion was associated with a very large, graded excess of childhood caries that the measured behavioural differences alone were unlikely to explain, underscoring the role of social and structural determinants beyond individual behaviours. These cross-sectional findings are consistent with proportionate-universalism strategies (targeted, school-based preventive and restorative care embedded within the universal system), since formal coverage alone may be insufficient to achieve oral health equity.