ASSOCIATION OF MULTIDIMENSIONAL SOCIAL VULNERABILITY, ORAL HEALTH BEHAVIORS, AND UNTREATED DENTAL CARIES AMONG ADULTS: A POPULATION-BASED ANALYTICAL CROSS-SECTIONAL STUDY

Purpose: To examine the association between multidimensional social vulnerability and untreated dental caries among adults, and to determine whether oral-health behaviors and barriers to dental care explain or modify this association. The study is framed to move beyond single socioeconomic indicators by treating vulnerability as a cumulative, multidomain exposure. Design/methodology/approach: A population-based analytical cross-sectional design is proposed for adults aged 18 years and older. Social vulnerability is operationalized across economic stability, education/employment, food and housing security, health-care access, transportation and social context. Oral-health behaviours include tooth brushing frequency, fluoride toothpaste use, free-sugar exposure, tobacco use and dental attendance. Untreated dental caries is assessed clinically using standardized criteria. Survey-weighted prevalence estimates and multivariable regression models are recommended, with domain-specific, cumulative-index, interaction, sensitivity and mediation analyses. Findings: Recent evidence consistently indicates that adult caries is socially patterned: lower income and education, food insecurity, unaffordable dental care, lack of insurance and other social needs are associated with worse oral-health outcomes, while regular dental attendance, frequent tooth brushing and lower sugar exposure are generally associated with more favourable clinical profiles. Because no dataset or study output was supplied for this request, this manuscript does not fabricate numerical study findings; the Results section contains publication-ready reporting language and tables to be populated with actual estimates. Research limitations/implications: Cross-sectional designs cannot establish temporality and may be vulnerable to reverse causation, recall error and residual confounding. Nevertheless, a multidimensional social-vulnerability framework can identify groups experiencing clustered disadvantages and clarify pathways through access and behaviour. Practical implications: Findings from the completed analysis can guide risk-stratified preventive services, safety-net dentistry, integration of social-needs screening in dental settings, and interventions that reduce financial, transportation and information barriers. Social implications: A vulnerability-based approach reframes untreated caries as a condition shaped not only by individual behaviour but also by accumulated social and structural constraints. This can support proportionate universalism and equity-oriented oral-health policy. Originality/value: The proposed study integrates cumulative social vulnerability, modifiable oral-health behaviours and clinically assessed untreated caries in a single analytical framework, permitting assessment of direct, mediated and effect-modified pathways.