Adverse consequence of malocclusion with the highest correlation with a patient's socio-economic status

 # Which adverse consequence of malocclusion has the highest correlation with a patient's socio-economic status and access to dental care, rather than the malocclusion's severity alone?

A. Functional lateral mandibular shift

B. Increased risk of incisor trauma

C. Pathologic attrition leading to dentin exposure

D. Early and severe development of dental caries

The correct answer is D. Early and severe development of dental caries

Crowding and irregular alignment in malocclusion create plaque-retentive areas that hinder effective oral hygiene, elevating caries risk by 1.5–2.5 times, but this consequence is disproportionately amplified in lower socioeconomic status (SES) populations due to confounding factors like high-sugar diets, limited fluoride exposure, infrequent professional cleanings, and poor access to preventive care—resulting in DMFT scores 20–50% higher in low-SES groups regardless of malocclusion severity alone. Cross-sectional studies in vulnerable cohorts (e.g., refugees) confirm that while malocclusion traits like IOTN grades 3–5 correlate with poorer OHI-S (P<0.001), the caries burden (e.g., 92% prevalence, SiC=8) is exacerbated by SES-driven barriers, with systematic reviews showing inverse SES-caries gradients (lower SES: DMFT ~3.05 vs. upper ~3.1, but prevalence up to 2x higher). In contrast, functional shifts (A) and attrition (C) are primarily biomechanical and severity-dependent with minimal SES modulation; incisor trauma (B) shows inconsistent or null SES associations (e.g., higher in educated mothers, P=0.03, but no income link).