{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:34:51Z","timestamp":1787236491487,"version":"build-2736575974"},"reference-count":28,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"VICTOR BABES UNIVERSITY OF MEDICINE AND PHARMACY TIMISOARA"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiologia"],"abstract":"<jats:p>Background\/Objectives: Oral diseases are among the most prevalent non-communicable diseases and impose a substantial public health burden across Europe. Although general total health expenditure may reflect health-system capacity, it does not specifically measure oral healthcare financing, and evidence regarding its association with population-level oral health remains limited. The objective of this study was to assess the association between total health expenditure and oral health outcomes in European countries. The primary focus was on dental caries prevalence, while a secondary exploratory analysis examined edentulism. Methods: Using publicly available international databases, an ecological, unbalanced country-level panel dataset was constructed. The main caries model included 153 country-year observations from 25 European countries during 2015\u20132021. An extended model incorporating practicing dentist density included 109 observations from 20 countries. Two-way fixed-effects regression models with country and year effects and country-clustered standard errors were applied. Edentulism was examined using exploratory cross-sectional OLS models for 2019. Results: In the main model, higher total health expenditure (\u03b2 = \u22120.00305, p = 0.027) and GDP per capita (\u03b2 = \u22120.00024, p = 0.021) were associated with lower caries prevalence. In the extended model, only GDP per capita remained statistically significant (\u03b2 = \u22120.00028, p = 0.021), whereas total health expenditure, tertiary educational attainment, and practicing dentist density were not significantly associated with caries prevalence. No statistically significant associations were observed in the exploratory edentulism analyses. Conclusions: Total health expenditure and GDP per capita were negatively associated with caries prevalence in the main country-level model, although the expenditure association was not maintained in the restricted extended sample. These ecological findings do not establish causality and require confirmation using more complete, oral-health-specific data.<\/jats:p>","DOI":"10.3390\/epidemiologia7040116","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:57:53Z","timestamp":1787230673000},"page":"116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investments and Outcomes in Oral Health in Europe: Health Expenditure and the Prevalence of Dental Caries"],"prefix":"10.3390","volume":"7","author":[{"given":"Cassandra","family":"Lupita","sequence":"first","affiliation":[{"name":"Department of Oral Pathology, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magda-Mihaela","family":"Luca","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Faculty of Dental Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6702-6463","authenticated-orcid":false,"given":"Anca-Cristina","family":"Perpelea","sequence":"additional","affiliation":[{"name":"Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iulia","family":"Muntean","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edida","family":"Maghet","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2942-3715","authenticated-orcid":false,"given":"Oana Ramona","family":"Lobon\u021b","sequence":"additional","affiliation":[{"name":"Finance, Business Information Systems and Modeling Department, Faculty of Economics and Business Administration, West University of Timisoara, 300115 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra-Cristina","family":"Maroiu","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, Faculty of Dental Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6375-4705","authenticated-orcid":false,"given":"Laura-Cristina","family":"Rusu","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0140-6736(19)31146-8","article-title":"Oral diseases: A global public health challenge","volume":"394","author":"Peres","year":"2019","journal-title":"Lancet"},{"key":"ref_2","unstructured":"GBD 2021 Oral Disorders Collaborators (2025). 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