Inequalities in oral health: a review of the evidence and recommendations for action

Abstract

Reducing inequalities in health has become one of the main health policy issues in the late 1990s. The Labour Government set up an independent inquiry into inequalities in health under Sir Donald Acheson to make recommendations on approaches to reducing health inequalities. This paper reviews the evidence on inequalities in oral health in Britain. Dramatic improvements in dental health in children and young adults have taken place in the past 30 years. The levels of caries in permanent teeth of children is low. Widening inequalities in oral health however exist between social classes, regions of England, and among certain minority ethnic groups in pre-school children. The main social class and minority ethnic differences in dental caries is in pre-school children. Wide district and regional differences also exist in prevalence of caries in young children. The area differences relate very strongly to deprivation. In adults the differences in decay experience is less unequal than in children but there are marked social class inequalities in edentulousness. Dental caries decreased in all social classes in the United Kingdom. The main causes of the inequalities are differences in patterns of consumption of non milk extrinsic sugars and fluoridated toothpaste. Improvements in oral health that have occurred over the last 30 years have been largely a result of fluoride toothpaste and social, economic and environmental factors. Oral health inequalities will only be reduced through the implementation of effective and appropriate oral health promotion policy. Treatment services will never successfully tackle the underlying cause of oral diseases.

Multiple Socioeconomic Factors and Dental Caries in Swedish Children and Adolescents

“…Schwendicke et al [2015] concluded in their review that diagnoses of caries and treatment methods could not explain the unequal distribution of caries and speculated that the association between low SES status and high caries experience might be stronger in developed countries [Schwendicke et al, 2015]. This could be explained by individuals with a high SES employing preventive care more often than those with a lower SES [Watt and Sheiham, 1999].…”

“…However, the distribution in caries prevalence is skewed; that is, a large proportion of children and adolescents are free from caries, but among those with the disease, the burden is substantial [Watt and Sheiham, 1999;Do, 2012;Kramer et al, 2016].…”

“…Socioeconomic factors have been noted as contributing to inequalities in dental health [Watt and Sheiham, 1999;Marmot and Bell, 2011] even if the primary cause of the disease is biological [Marsh and Nyvad, 2008]. Literature reviews have identified related socioeconomic factors, such as education, occupational status, income, and migration background [Schwendicke et al, 2015;Kumar et al, 2016].…”

Oral hygiene status in a general population of Iran, 2011: a key lifestyle marker in relation to common risk factors of non-communicable diseases

“…In the other side, oral diseases rank as the fourth most expensive diseases to be treated in almost every country (22). Globally, the greatest burden of oral diseases is on the socially marginalized and poor people (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). To tackle this public health issue in favor of human's life OH should be taken into consideration (34)(35)(36)(37)(38)(39).…”

Ungleichheit in der Mundgesundheit

“…und dem Zugang zu Versorgungssystemen [26]. Die Tatsache, dass eine sozial ungleiche Verteilung im (Mund-)Gesundheitszustand der Bevölkerung weltweit besteht, wurde in verschiedenen Studien bestätigt [16,38].…”