Tooth retention has been one of the main aims of oral care which in turn could have contributed to the social oral health divide. To investigate this issue further, data collected for a group audit was used to study the reasons for tooth extraction for patients attending for routine treatment at four dental practices. The practices served populations in areas with different levels of deprivation in South Wales. In 558 teeth extracted over 417 visits, the reasons for extractions were: caries 59%, periodontal disease 29.1%, pre-prosthetic 1%, wisdom teeth 4.6%, orthodontic 5.5%, trauma 1.2%, patient request 2.4% and 6.2% other reason. The number of extraction visits per day within the group of dental surgeons varied with three practitioners performing more than three extraction visits per day while one practitioner had only 0.51. These reasons did not significantly depend on levels of deprivation. However, significantly more teeth were extracted for caries in the most deprived group in comparison to the least deprived. Therefore, could there be a case for appropriate extractions in the quest for equitable care?

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This paper provides a novel approach to monitoring oral health outcomes in general dental practice. The approach has the potential to impact on social inequalities in oral health. The approach allows general practitioners, who wish to deliver services to impact on community oral health, to do so without the burden of current disincentives.

This paper explores the reasons for multiple caries in children from the viewpoint of clinical practice, namely General Dental Practitioners (GDPs) and their teams, to identify obstacles to reducing inequalities in caries experience. The context of the research is the distribution of dental caries in UK communities where disease prevalence correlates with deprivation and these sub-groups are not attending for dental care on a regular basis. A focus group of dentists, along with individual interviews with dentists and dental support staff were chosen to explore the perceptions of GDPs, Dental Therapists, and Dental Nurses. The content analysis of the data highlighted six main themes. These included sugar, in terms of the amount, availability and the marketing of it; socioeconomic associations with dental caries experience; the dentists’ role; the National Health Service (NHS) dental contract in terms of time-constraints in meeting targets and finally, the management of the child with multiple caries. This research suggests that there are possible barriers to the delivery of equitable care to populations. These include availability and access to GDPs along with the perceptions held by GDPs. Training aimed to develop a targeted behavioural approach towards deprived sub-groups is required in order to avoid unintended social exclusion.