Austin Powers bites back.

Objective To compare oral health in the US and England and to assess levels of educational and income related oral health inequalities between both countries. Design Cross sectional analysis of US and English national surveys. Setting Non-institutionalised adults living in their own homes. Participants Oral health measures and socioeconomic indicators were assessed in nationally representative samples: the Adult Dental Health Survey 2009 for England, and the US National Health and Nutrition Examination Survey 2005-08. Adults aged ≥25 years were included in analyses. Main outcome measures Number of missing teeth, self rated oral health, and oral impacts on daily life were outcomes. Educational attainment and household income were used as socioeconomic indicators. Age standardised estimates of oral health were compared between countries and across educational and income groups. Relative and absolute inequalities were measured using the relative index of inequality (RII) and the slope index of inequality (SII). Results The mean number of missing teeth was significantly higher in the US (7.31 (standard error 0.15)) than in England (6.97 (0.09)), while oral impacts were higher in England. We found no difference in self rated oral health between the two countries. There was evidence of significant social gradients in oral health in both countries. Consistently higher RII and SII values were found in the US than in England, particularly for self rated oral health. RII estimates for self rated oral health by education were 3.67 (95% confidence interval 3.23 to 4.17) in the US and 1.83 (1.59 to 2.11) in England. In turn, SII values were 42.55 (38.14 to 46.96) in the US and 18.43 (14.01 to 22.85) in England. Conclusions The oral health of US citizens is not better than the English, and there are consistently wider educational and income oral health inequalities in the US compared with England. [ABSTRACT FROM AUTHOR]