Developing an Original Theoretical Framework for Oral Health Equity in Nigerian Federal States

Oral health equity across Nigerian federal states is shaped by intersecting structural determinants including health system capacity, socioeconomic conditions, cultural practices, and geographic access, and developing an original theoretical framework to model this complex equity landscape represents a significant contribution to dental public health science. This study developed an original Oral Health Equity Framework for Nigerian Federal States, drawing on theoretical analysis, empirical grounding across six states, and expert validation. A theory-building methodology was employed, combining systematic review of oral health equity frameworks (68 publications from 2018 to 2024), empirical multi-state data analysis using NDHS and WHO oral health survey data, and structured consultations with 30 dental public health specialists, health economists, and social epidemiologists. Systematic review confirmed that existing frameworks inadequately theorise the role of subnational governance quality in oral health equity, the intersectionality of poverty and cultural dental health beliefs in northern Nigeria, and the geographic access dimension specific to Nigeria's federal structure. The original Nigerian Oral Health Equity Framework proposes four equity dimensions: structural equity (health system capacity), geographic equity (physical access to dental services), social equity (socioeconomic and educational determinants), and cultural equity (alignment of services with community beliefs and practices). Each dimension includes measurable indicators, benchmark standards, and policy leverage points. Expert validation by 22 specialists confirmed the framework's theoretical originality and practical policy utility. Recommendations include federal adoption as the basis for an annual oral health equity monitoring report.

Keywords: oral health equity, theoretical framework, Nigerian states, dental public health, social determinants