For many of us, going to the dentist is as simple as making an appointment and showing up. And so, maintaining our oral health can be to some extent, as simple as just doing what the dentist tells us to. 

For others however, it is not that simple. This is because in many countries including the UK, there are factors that create oral health inequalities. Although dental disease is thankfully decreasing on the whole, not all parts of society are facing equal reduction of conditions such as dental caries, periodontal disease and oral cancer. Oral diseases are disproportionately prevalent in poor and socially disadvantaged groups of society from early childhood through to old age.  

In this blog, I am going to provide an overview to the factors contributing to these inequalities, the initiatives in place to reduce them, and an idea of what we as dental students and dental professionals can do to make a difference.   

WHAT ARE THE FACTORS CONTRIBUTING TO ORAL HEALTH INEQUALITIES? 

Socio-Economic Status – Only 70% of children in Scotland’s most deprived areas show no signs of decay compared with almost 90% in the most affluent areas. Reasons for these differences can include lack of access to a dentist and lack of education about maintaining good oral health.  

• Access – In 2013, 18% of parents of children on free school meals found it difficult to find an NHS dentist compared with 11% of parents of those who were not. When children don’t visit the dentist regularly, their dental disease isn’t diagnosed and treated as early as it should be. Dentists also can’t advise these patients on how to prevent these conditions from occurring in the first place. Children who are on free school meals (those from lower income households and areas) are therefore less likely to develop habits that would maintain good oral health compared with children of higher socioeconomic status.  
• Education – Patients of lower socioeconomic status are more likely to have behaviour that can lead to poorer oral health including smoking, suboptimal oral hygiene and sugary snacks (especially as children) compared with those of higher socioeconomic status. One factor that could contribute to this is lack of education on what is good for oral health. People may not know the extent of the effects of these risk factors on their oral health, and so their behaviour may continue.   

Social Exclusion and Lack of Social Support – This category includes homeless and vulnerable patients who are not as integrated into society, therefore may have issues receiving appropriate oral healthcare and information.  

• Disability – Approximately 1 in 3 adults with learning disabilities have unhealthy teeth and gums and they have higher rates of untreated decay than adults in the general population. A major contributor to this is irregular attendance to the dentist and therefore lack of active and preventative treatment. Patients with learning disabilities may find it much more difficult to maintain good oral hygiene – they may need assistance brushing their teeth and may also consume foods with high sugar content. Lack of appropriate support can then contribute to poorer oral health in this group of society.  

Thus, the main goals when trying to reduce oral health inequalities are: – improving access and education to those of lower socioeconomic status, as well as providing support to those who are socially excluded.

WHAT IS BEING DONE TO REDUCE THESE INEQUALITIES? 

Oral health inequalities have been known to be around for some time now. Some of the measures that have been put in place with the goal of reducing them are as follows. 

• ‘Childsmile’ and ‘Designed to Smile’ – The ‘Childsmile’ programme in Scotland is a great initiative which helps to improve the oral health of young school children. It organises daily supervised toothbrushing for nursery and some young primary school children (in areas of greatest needs), and free dental packs for toothbrushing at home among many other features. ‘Designed to Smile’ is essentially the same thing in Wales with the same goal of reducing oral health inequalities  
• Fluoridation of Drinking Water – In many parts of England, fluoridating drinking water has proven to reduce dental caries particularly in the most socially deprived areas. Fluoride strengthens the enamel and increases the threshold of acidity that it breaks down at, therefore preventing tooth decay. Major reasons that fluoridation resulted in such a reduction in oral health inequalities is because it is of no extra cost to the patient, everyone with fluoridated water has access to it daily, and it does not require patients to actively understand or remember to use it. However, not all parts of the UK and the world are fluoridated, as there are differing opinions and concerns about it. 
• Common Risk Factor Approaches – Actions have been taken to encourage a change in the behaviour of the public towards taking better care of their oral health. These include the sugar tax (levy) of soft drinks and a ban on vending machines in some schools. While these changes are not targeted particularly at those with poorer oral health, it would have a great effect on these groups as they are the ones that tend to consume a lot of sugary foods and drinks. 

WHAT CAN I AS A DENTAL STUDENT OR DENTAL PROFESSIONAL DO TO HELP BRIDGE THE GAP? 

It’s all well and good to know about oral health inequalities, but it is our duty to play our part to fix this where we can. Finding out where the problem lies is a good place to start. Looking at stats for your region in terms of which groups of people have poorer oral health including higher rates of dental caries, periodontal disease and oral cancer can help you see how this can be tackled in that particular area. I have come up with some ideas of practical steps you can take to make a difference.   

1. Get involved and raise awareness! – Support community campaigns and programmes for oral health such as ‘Mouth Cancer Awareness Month’ or ‘National Smile Month’ with organisations such as the ‘Oral Health Foundation’. This can make a difference in helping people who need it most and can be done through fundraising, donating and educating. This can be achieved through social media, initiatives in your university, or even in your local community via visiting schools and speaking to the general public. 
2. Get to know your patients– What I mean by this is to identify road-blockers in their lives that are preventing them from taking good care of their oral health. This may be physical disabilities and poor manual dexterity skills, depression or a lack of understanding and therefore motivation. Finding out what is causing them to neglect their oral health, may help you help them to improve it by finding solutions to these other issues. For example you can refer them to their GMP for therapy for their depression, make modified toothbrush handles to fit the patient’s needs, or even try some motivational interviewing to try to change their perspective and give them a better insight into the importance of maintaining good oral health. 
3. Volunteer to Help the Disadvantaged – Organisations such as ‘Work the World’, ‘Bridge2Aid’ and ‘Dentaid’ facilitate dental professionals and sometimes dental students in treating those who are most in need of dental care, nationally and around the world. It is not only helping to reduce oral health inequalities, but it can be the experience of a lifetime and I highly recommend it!