NYMC Student Theses and Dissertations

Date of Award


Document Type

Doctoral Dissertation - Restricted (NYMC/Touro only) Access

Degree Name

Doctor of Public Health


Public Health

First Advisor

Kenneth Knapp, PhD

Second Advisor

Adam Block, PhD

Third Advisor

Erin Bouldin, PhD


Background: Although previous research has found evidence that caregivers may suffer from adverse physical and mental health outcomes, little is known about the oral health and utilization of dental care services among caregivers. Caregivers may neglect their oral health due to care burden, stress and poor health and may be at a higher risk of oral diseases. This study analyzes differences in oral health and utilization of dental care services between caregivers and non-caregivers, controlling for sociodemographic characteristics, overall health status, smoking behavior and prevalence of chronic diseases considered risk factors for poor dental health.

Methods: The 2016 National Behavioral Risk Factor Surveillance System data was analyzed. The sample included 120,952 respondents, 24,152 (20%) of whom identified themselves as caregivers. Bivariate analysis and logistic regression were used to analyze two main outcomes: having one or more teeth removed, and whether the respondent visited a dentist in the past 12 months.

Results: Better oral health (no teeth removed) was associated with being relatively young, unmarried, non-Hispanic whites, better overall physical health, higher education and higher income. Respondents who visited a dentist in the past 12 months were likelier to be women, whites non-Hispanic, employed, health insured, those with higher income and education and better overall health. Caregivers were found to be likelier than non-caregivers to have had one or more teeth removed due to decay, gum disease including teeth lost due to infection but were no less likely to visit a dentist in the past 12 months compared to non-caregivers. One possible explanation for this seemingly contradictory finding – worse oral health as indicated by teeth removed due to disease but no difference in visits to the dentist – is that when a caregiver visits the dentist, compared to non-caregivers it is likelier to be due to an acute episode.

Conclusions: A significant association was found between caregiving and having one or more teeth removed due to dental diseases. Targeted interventions may improve caregivers’ oral health outcomes and utilization and calls for integration of oral health care and primary health care. Longitudinal studies should be conducted to study the trend of oral health status and dental care utilization in caregivers.

Available for download on Tuesday, December 31, 2024