Oral health inequalities concerning socially vulnerable population groups in the United Kingdom: a scoping review.

To determine income inequalities in both perceived oral health and oral health-related behaviours and the role oral health-related behaviours in explaining income inequalities in perceived oral health among Sri Lankan adolescents. The sample included 1,218 fifteen-year-olds selected from 48 schools in the Colombo district using a stratified cluster sampling technique. Data were collected by means of questionnaires to both adolescents and their parents. Perceived oral health status was the oral health outcome considered while oral health-related behaviours included brushing frequency, use of dental services in the preceding year and consumption of sugary food/drinks and fruit/vegetables. Tooth brushing frequency, use of dental services in the preceding year and consumption of fruit/vegetables were associated with perceived oral health status. Also, the trends in perceived oral health and all oral health behaviours across ordered income groups were statistically significant. However, it was evident from the Poisson regression models that the effect of income on perceived oral health did not attenuate significantly following adjustment for oral health behaviours. This study demonstrated that oral health behaviours were associated with perceived oral health and also the existence of income gradients in perceived oral health and oral health behaviours. However, oral health behaviours were not accountable for the observed income gradients in perceived oral health.

The Brazilian National Oral Health Policy has increased access to dental services for the Brazilian population. However, it is not clear whether there has been a reduction in oral health inequalities in the country. The aim of the study was to investigate the evolution of socioeconomic inequalities in oral health, the use of oral hygiene products, and the use of dental services in the adult population of Brazil between 2013 and 2019. Data from the Brazilian National Health Survey conducted in 2013 (n = 60,202) and 2019 (n = 88,531) were used to calculate the slope index of inequality (SII) and relative index of inequality (RII) in terms of schooling and family income per capita. The dependent variables were the use of a toothbrush, toothpaste, and dental floss, functional dentition, use of dental services at least once in life, use of dental services in the previous year, and use of dental services for preventive care. Inequalities in the use of oral hygiene products and the use of dental services reduced between 2013 to 2019. However, functional dentition maintained the same levels of inequality in terms of schooling (RII = 1.6) and income (RII = 1.3). Schooling inequalities in the use of preventive dental care increased (SII = 33.3 in 2013, SII = 38.9 in 2019). This study underscores the need to reorient the Brazilian National Oral Health Policy in order to reduce tooth loss and improve the use of dental services for preventive care in the most vulnerable groups. Despite improvements in the use of dental services and oral hygiene products, socioeconomic inequalities in oral health persist in Brazil.

BackgroundSocioeconomic status and oral health care habits may change throughout adult life. This calls for age-stratified analyses of oral health in the adult population to uncover differences that could be of importance for organizing adequate oral health care services. The aim of the present study was to describe self-reported oral health in different age groups in a general adult population in Norway, and to explore associations between self-reported oral health and age groups, sociodemographic factors, use of dental services, number of teeth and dental caries.MethodsWe used data from a cross-sectional study of almost 2000 Norwegian adults, 20–79 years old. The study included both a structured questionnaire and a clinical examination to assess sociodemographic variables, use of dental services, self-reported oral and general health as well as dental caries and number of teeth. For analysis, the participants were divided into three age groups: young adults (20–29 years), middle-aged adults (30–59 years), and senior adults (60 years and older). Differences among groups were analyzed by cross-tabulation, and logistic regression analyses were used to assess associations between variables.ResultsForty-eight percent of the participants rated their oral health as good. Almost half of the participants had at least one carious tooth, with the highest caries prevalence among the young adults. To be caries free was strongly associated with reporting good oral health among the young and middle-aged adults. One third of the senior adults had fewer than 20 teeth, which was associated with reporting moderate or poor oral health. Less than half of the young adults reported regular use of dental services, and 40% of them had postponed dental visits for financial reasons during the past 2 years. Regardless of age group, having to postpone dental visits for financial reasons or having poor-to-moderate general health were associated with high odds for reporting moderate or poor oral health.ConclusionsThat there were important age-group differences in self-reported and clinical measures of oral health and in the use of dental health services demonstrates the importance of age-stratified analyses in oral health research. Many adults, especially among the young, faced financial barriers for receiving dental health services, which was associated with poorer self-reported oral health. This argues for a need to revisit the financing of oral health care for adults in Norway.

The number of asylum seekers and immigrants arriving in European countries is growing explosively. The aim of this pilot study was to investigate self-reported oral health, oral health habits, dental fear and use of dental health care services among asylum seekers and immigrants in Finland. The interview study carried out in 2012 comprised 38 participants (18 males and 20 females) from 15 different countries, nine of whom were asylum seekers and 29 immigrants. The youngest participant was 17 and the oldest 53 years old. Each interview took approximately 30 min. The participants reported high need for dental treatment. Compared with the immigrants, the asylum seekers reported significantly more frequently dental pain and other symptoms and were less satisfied both in getting a dental appointment and in the quality of treatment they had received. All the asylum seekers and almost half of the immigrants found it difficult to get an appointment. The immigrants were more aware of good oral health habits than the asylum seekers. The asylum seekers suffered from dental fear more often than the immigrants. Despite the small number of participants, our interview-based study indicates that asylum seekers and immigrants have need for acute and basic dental treatment and health education.

Knowledge of the possible pathways linking socioeconomic status (SES) to oral health-related behaviours can improve the understanding of inequalities in oral health. Therefore, in this study, it was investigated whether social capital mediates the relationship between SES and oral health behaviours. Through a cross-sectional study, data were analysed from participants aged ≥60 years from the Brazilian National Health Survey 2019 (n=21 575). Structural equation modelling was used to test the direct and indirect pathways from a latent variable for SES to a latent variable for oral health behaviours: daily flossing, toothbrushing frequency and the use of dental care services. The maximum likelihood estimator was used for complex samples with robust standard errors, and the final model demonstrated an adequate fit. The findings demonstrated that a higher SES was directly associated with better oral health-related behaviours (standardized coefficient [SC]: 0.82; [90% CI: 0.78-0.85]) and indirectly via structural social capital (SC: 0.05; [90% CI: 0.02-0.07]). The total effect of SES on oral health-related behaviours was (SC: 0.87, [90% CI: 0.85-0.89]). The findings demonstrate that structural social capital in older Brazilian adults might partly mediate the pathways to socioeconomic inequalities in oral health behaviours. However, there is a direct effect on oral health behaviours, reinforcing the hypothesis that SES is associated with oral health, based on paths that link income inequality to oral health.

To compare the prevalence of poor self-reported oral health (SROH) and dental service-use in a representative sample of Canadian residents, and to identify associations between SROH and psychosocial determinants of health at baseline of the Canadian Longitudinal Study on Aging. Data from baseline interviews from 2010 to 2015 involving 93% of 51388 adults (n=47761) were weighted to compare the prevalence of oral health characteristics adjusted for age, sex, socioeconomics, general health and residence. SROH was assessed as 'excellent', 'very good', 'good', 'fair' or 'poor', and dichotomized as 'fair/poor' and 'good/very good/excellent'. Multivariable logistic regression was used to assess the association of fair/poor oral health with psychosocial determinants of health. Most participants reported 'good/very good/excellent' oral health (92.5%), natural teeth (92.0%) and dental service-use in the previous year (79.6%), yet over 10% had discomfort when eating. Reports of 'fair/poor' oral health were significantly more frequent among participants who had dental concerns, had low socioeconomic status, smoked tobacco or reported poor general health. Dental service-use and tooth loss differed by province. The odds of poor/fair SROH were high (odds ratio ≥1.5) among participants who avoided foods, did not use dental services frequently, had low incomes, smoked tobacco, were depressed, felt unhealthy or had multiple chronic conditions, but by neither sex or age. There were no interprovincial differences. Most Canadian residents feel in good oral health and use dental services. Oral health inequality is evident between different socioeconomic groups and between healthy and unhealthy people. SROH is strongly associated with socioeconomic and general health status but not with place of residence. However, there were substantial differences in reports of tooth loss and dental service-use across provinces.

Oral health inequalities impose a substantial burden on society and the healthcare system across Canadian provinces. Monitoring these inequalities is crucial for informing public health policy and action towards reducing inequalities; however, trends within Canada have not been explored. The objectives of this study are as follows: (a) to assess trends in income-related inequalities in oral health in Ontario, Canada's most populous province, from 2003 to 2014, and (b) to determine whether the magnitude of such inequalities differ by age and sex. Data representative of the Ontario population aged 12years and older were sourced from the Canadian Community Health Survey (CCHS) cycles 2003 (n=36,182), 2007/08 (n=36,430) and 2013/14 (n=41,258). Income-related inequalities in poor self-reported oral health (SROH) were measured using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) and compared across surveys. All analyses were sample-weighted and performed with STATA 15. The prevalence of poor SROH was stable across the CCHS cycles, ranging from 14.1% (2003 cycle) to 14.8% (2013/14 cycle). SII estimates did not change (18.7-19.0), while variation in RII estimates was observed over time (2003=3.85; 2007/08=4.47; 2013/14=4.02); differences were not statistically significant. SII and RII were lowest among 12- to 19-year-olds and gradually higher among 20- to 64-year-olds. RII was slightly higher among females in all survey years. Absolute and relative income-related inequalities in SROH have persisted in Ontario over time and are more severe among middle-aged adults. Therefore, oral health inequalities in Ontario require attention from key stakeholders, including governments, regulators and health professionals.

BackgroundPotentially Traumatic Events (PTEs), such as accidents, childhood neglect or abuse, can affect mental and physical health. The study investigated the association between PTEs and self-reported oral health (SROH), focusing on cumulative exposure to multiple events, the types of events, and the timing of exposure.MethodsData were collected from the seventh survey of the Tromsø Study, which invited all residents over 40 in Tromsø, Norway. A total of 21,069 participants took part, comprising 47,5% male and 52,5% female respondents, who completed assessments of PTEs and SROH. Chi-square (Χ²) tests evaluated unadjusted associations, and a series of logistic regression models were employed to investigate the association of PTEs with poor SROH, controlling for sociodemographic variables, emotional distress, and oral health-related behaviours.FindingsThe likelihood of reporting poor SROH was higher among those who experienced more PTEs, and this relationship persisted after adjusting for sex, age, socioeconomic status, oral health-related behaviour, dental anxiety, emotional distress and adverse dental events. Subsequent analyses differentiated the associations by type and timing (before and after age 18) of events. Interpersonal events involve direct interactions with others (e.g., abuse, bullying), while impersonal events refer to broader circumstances (e.g., accidents, natural disasters). Adverse dental events, classified as impersonal events, demonstrated the strongest association with poor SROH. The associations between interpersonal events and poor SROH varied more depending on covariates than impersonal events. The association strengthened when adjusting for sociodemographic factors but weakened when accounting for oral health behaviours, dental anxiety, and emotional distress. Notably, impersonal events occurring before age 18 were consistently associated with poor SROH across all models.ConclusionsExperiencing multiple PTEs throughout life is associated with poor SROH. Among the various PTEs, adverse dental events showed the strongest association with poor SROH, emphasising the importance of addressing dental care’s emotional and psychological aspects, particularly in paediatric settings, to support long-term oral health outcomes.Clinical trial numberNot applicable.

BackgroundAccess to, and use of, dental health services in Brazil have improved since 2003. The increase of private health care plans and the implementation of the “Smiling Brazil” Program, the largest public oral health care program in the world, could have influenced this increase in access. However, we do not yet know if inequalities in the use of dental health services persist after the improvement in access. The aims of this study are to analyze socioeconomic differences for dental health service use between 2003 and 2008 in São Paulo and to examine changes in these associations since the implementation of the Smiling Brazil program in 2003.MethodData was obtained via two household health surveys (ISA-Capital 2003 and ISA-Capital 2008) which investigated living conditions, lifestyle, health status and use of health care services. Logistic regression was used to analyze associations between socioeconomic factors and dental services use. Additionally, trends from 2003 to 2008 regarding socioeconomic characteristics and dental health service use were explored.ResultsOverall, dental health service use increased between 2003 and 2008 and was at both time points more common among those who had higher income, better education, better housing conditions, private health care plans and were Caucasian. Inequalities in use of dental health care did not decrease over time. Among the reasons for not seeking dental care, not having teeth and financial difficulty were more common in lower socioeconomic groups, while thinking it was unnecessary was more common in higher socioeconomic groups.ConclusionsThe Brazilian oral health policy is still in a period of expansion and seems to have contributed slightly to increased dental health service use, but has not influenced socioeconomic inequalities in the use of these services. Acquiring deeper knowledge about inequalities in dental health service use will contribute to better understanding of potential barriers to reducing them.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1928-y) contains supplementary material, which is available to authorized users.

While the impact of the coronavirus disease (COVID-19) pandemic on health inequalities is documented, oral health has been absent from this discussion. This commentary highlights the potential impacts of the COVID-19 pandemic on oral health inequalities in England in February 2021. It includes a literature review, Public Health England and Kantar Worldpanel sales data on health behaviours and analysis of NHS dental services data. Purchasing data indicate, except for smoking, increases in health-compromising behaviours. Since the resumption of dental services, NHS general dental service use modestly recovered among adults but not children by October 2020. There are clear inequalities among children and older adults, with more deprived groups having lower uptake of dental service use than more affluent groups. Oral cancer referrals and hospital admissions for tooth extractions in children dramatically declined, with the latter primarily affecting children in more deprived areas. Many oral health programmes in schools and care homes were disrupted or suspended throughout this period. All these indicate that oral health inequalities have widened due to the COVID-19 pandemic. An oral health plan of action requires prioritising long-term investment in public health programmes and transforming commissioning pathways to support those with the greatest needs to access oral healthcare services.

Chronic disease and use of dental services in Australia

Complex associations exist among socioeconomic status (SES) in early life, beliefs about oral health care (held by individuals and their parents), and oral health–related behaviors. The pathways to poor adult oral health are difficult to model and describe, especially due to a lack of longitudinal data. The study aim was to explore possible pathways of oral health from birth to adulthood (age 38 y). We hypothesized that higher socioeconomic position in childhood would predict favorable oral health beliefs in adolescence and early adulthood, which in turn would predict favorable self-care and dental attendance behaviors; those would lead to lower dental caries experience and better self-reported oral health by age 38 y. A generalized structural equation modeling approach was used to investigate the relationship among oral health–related beliefs, behaviors in early adulthood, and dental health outcomes and quality of life in adulthood (age, 38 y), based on longitudinal data from a population-based birth cohort. The current investigation utilized prospectively collected data on early (up to 15 y) and adult (26 and 32 y) SES, oral health–related beliefs (15, 26, and 32 y), self-care behaviors (15, 28, and 32 y), oral health outcomes (e.g., number of carious and missing tooth surfaces), and oral health–related quality of life (38 y). Early SES and parental oral health–related beliefs were associated with the study members’ oral health–related beliefs, which in turn predicted toothbrushing and dental service use. Toothbrushing and dental service use were associated with the number of untreated carious and missing tooth surfaces in adulthood. The number of untreated carious and missing tooth surfaces were associated with oral health–related quality of life. Oral health toward the end of the fourth decade of life is associated with intergenerational factors and various aspects of people’s beliefs, SES, dental attendance, and self-care operating since the childhood years.

To utilise Andersen's behavioural model for health services' use as the theoretical framework to examine direct and indirect relationships between population characteristics, oral health behaviours and periodontitis and oral health impacts. The model was tested in a general adult population (n=1,886) in Norway, using structural equation modelling. Socioeconomic status, sense of coherence (SOC), dental anxiety, perceived treatment need, oral health behaviours and oral health impact profile (OHIP-14) were collected through questionnaire. Periodontal examinations consisted of full-mouth recordings. Andersen's model explained a large part of the variance in use of dental services (58%) and oral health-related impacts (55%), and to a less extent periodontitis (19%). More social structure and stronger SOC was related to more enabling resources, which in turn was associated with more use of dental services. More use of dental services was related to more periodontitis and more periodontitis was associated with increased oral health impacts. A stronger SOC was associated with less oral impacts. There was no association between use of dental services and oral health impacts. The result demonstrated complex relationships between population characteristics, oral health-related behaviours and oral health outcomes. Socioeconomic factors and smoking were main predictors of periodontitis. Regular dental visiting habits did not, however, reduce the likelihood of periodontitis.

The use of dental services is low among older adults, particularly among vulnerable or disadvantaged groups from various countries. Nonetheless, there is a gap in the literature regarding the factors that contribute to inequalities in the use of dental services. This study aimed to evaluate socioeconomic inequalities in recent and preventive use of dental services among older adults in Brazil and evaluate the factors contributing to these inequalities. This cross-sectional study used data from the 2019 Brazilian National Health Survey. The dependent variables were the use of recent and preventive dental services (among those who reported using dental services within one year prior to the interview). Socioeconomic status was measured by education level [no formal education vs. some education] and household per capita income [low (≤ 1 minimum wage [MW]) vs. higher (≥ 1MW)]. Explanatory variables included socioeconomic factors [education, household per capita income]; demographic characteristics [sex; age; living alone; rural residence]; general health status [limitations in basic activities of daily living (BADL); multimorbidity]; and oral health [use of prostheses; self-rated oral health; number of teeth; difficulty eating due to teeth or prostheses; dental insurance]. The Oaxaca-Blinder two-fold decomposition for binary outcomes was used to assess the factors contributing to educational and income-related inequalities in the use and preventive use of dental services. Participants with no formal education and those in the lowest income group had lower recent and preventive use of dental services. The number of teeth was the most significant contributing factor for the observed inequality, accounting for 30.6-51.8% of its increase across models. Difficulty eating made the second largest contribution to the explained inequality gap for preventive use and rural residence contributed to widening the gap for both outcomes. Socioeconomic inequalities in recent and preventive use of dental services among older adults are mainly explained by the number of remaining teeth, but other demographic, oral health, and health service factors play a role.

Prisoners have worse oral health and greater unmet dental treatment needs than the general population. However, little is known about the impact of the mouth, or attitudes such as dental indifference and consequent patterns of dental service use in this disadvantaged group. The aim was to determine whether dental indifference was associated with the oral health-related quality of life (OHQoL) of prisoners using Andersen's behavioural model of service utilization as the theoretical framework. The sample was male prisoners aged 20-35years attending three prisons in the north of England. Participants took part in interviews and oral examinations. The variables were selected to populate Andersen's model including: predisposing characteristics (socioeconomic status), enabling resources (dental indifference and dental attendance patterns before prison), perceived need (perceived treatment need, satisfaction with appearance of teeth, global rating of oral health), evaluated need (number of decayed teeth), health behaviours (use of dental services while in prison) and health outcomes (OHQoL). Structural equation modelling was used to estimate direct and indirect pathways between variables. Of the 700 men approached, 659 completed the interview and clinical examination. Worse OHQoL was associated with less dental indifference (i.e. greater interest in oral health), previous regular use of dental services, perceived need for treatment and use of prison dental services. The number of decayed teeth and predisposing factors such as qualifications and employment did not predict OHQoL. Dental indifference was related to the OHQoL of prisoners in addition to previous regular use of dental services, a perceived need for treatment and use of dental services while in prison. Dental services in prisons might incorporate methods to address dental indifference in their attempts to improve oral health. The findings also have general implications for the assessment of population oral health needs.