The English do not have worse teeth than Americans, study proves

It is a common stereotype, propagated by characters such as Austin Powers: the British man with an abysmal set of chompers. But a new study comparing oral health in the US and England reveals that the oral health of Americans is no better than that of the English.

Man showing teeth
English oral health is not worse than American oral health, says a new study, dispelling the popular belief that the English have bad teeth.

According to the authors of the study, published in The BMJ‘s Christmas issue, the popular belief held by Americans that the English have terrible teeth dates back over a century, with toothpaste ads eulogizing American smiles.

But until now, there were no studies that directly compared oral health levels and inequalities between England and America.

As such, researchers from both the UK and the US used data from the English Adult Dental Health Survey (ADHS) and the US National Health and Nutrition Examination Survey (NHANES) to compare oral health and assess educational levels and income-related oral health inequalities.

The study authors note that the UK and US both share similar political systems, but the funding and delivery of health care is quite different.

In the UK, for example, dental care is mostly provided through the National Health Service (NHS), whereas in the US, dental insurance coverage is how care is delivered.

Study participants included adults aged 25 years and older. For analysis by education, there were samples of 8,719 English adults and 9,786 American adults. For analysis by income, the sample included 7,184 English participants and 9,094 American adults.

Americans missing more teeth than English participants

The researchers looked at outcomes including number of missing teeth, subject self-perception of oral health and oral impacts on daily life – including pain, difficulty eating, avoiding smiling and social effects.

Socioeconomic indicators included educational level and household income.

Results showed that the average number of missing teeth was higher in the US than in England, at 7.31 vs. 6.97, respectively. However, reporting of oral impacts on daily life was higher in England.

The study also showed evidence of oral health socioeconomic inequalities in both countries, but they were higher in the US than in England for all measures.

In the US, social inequalities are higher; Americans have different levels of access and treatment services than their British counterparts, and the authors say this fact may have contributed to their findings.

They add that “wider societal differences in welfare policies exist, with England having a more comprehensive range of ‘safety net’ policies, which may help to reduce oral health inequalities.”

In detail, adults in the lowest socioeconomic position had better oral health in England. Meanwhile, those at the top educational or income levels had better oral health in the US.

‘Wider educational and income-related oral health inequalities in the US’

Citing sugar consumption and smoking as other possible reasons for their findings, the researchers emphasize differences in welfare policies as the main contributing factor:


”In conclusion, we have shown that the oral health of Americans is not better than the English, and there are consistently wider educational and income-related oral health inequalities in the US compared with England.”

Despite the strength of their large sample size, the study authors point to some limitations. For example, they note that the comparability of subjective measures of oral health serve as a limitation, “as these are sensitive to cultural differences in reporting.”

Additionally, they note their analysis was limited to just one measure of oral health status – number of missing teeth – so it did not include any aesthetic or orthodontic outcomes, which could be a potential area for future study.

Medical News Today recently reported that some sugar-free drinks can also damage teeth. Authors from that study warned that a sugar-free label does not make a product tooth-friendly.