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Determinants in Oral Health Inequalities


Dental health is a key ingredient to the general health of a person. Oral diseases and inequalities are constant occurrences that usually affect ones wellness. These inequalities also account for financial and other costs that in most cases lower ones standard of living. Tooth disorders in most cases do not differ from other ailments that affect other parts of the body. These disorders usually bring about hurting and affect ones daily routines like eating or even disrupt our sleeping patterns. Lack of good oral health can cause one to have a poor performance in many areas of life. These oral diseases can also lower ones self-esteem to a point where one may completely lack confidence in life. People who have oral problems have been found to have difficulty in getting and keeping a job. It is interesting to learn that despite the existence of the obvious demerits of bad dental health, little or nothing is being done to promote good oral health. (Stoyanova 2003, p. 2) This paper seeks to look at the existing inequalities in dental health. The paper also proposes ways that can be used to reduce these inequalities.

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A study done in 1999 showed that reducing health disparities had become one of the top issues in health policies in the UK. (Watt, & Sheiham1999) According to the study, the Labour Government undertook to look at the inequalities that existed in the health sector at that time. The government did this by setting up a commission headed by Sir Donald Acheson. (Watt, & Sheiham1999) This clearly showed that the government acknowledged that there existed serious disparities in assessing oral health in Britain. Though there has been a considerable improvement in providing dental health to the young people and children, a lot still needs to be done in this field. Overall, caries among children has considerably reduced over time. (Archeson, 1998)

Though this is the case, reports still show that big inequalities exist between people in different social classes. These disparities also exist between people in different regions of England. These inequalities are also prevalent in children who have not gone to school among marginal groups. These inequalities are mainly caused by the consumption of extrinsic sugars contained in non-milk. On the other hand, the improvements that have been witnessed in addressing these disparities have been in the use of toothpaste that contained fluoride. Another thing that greatly helped in reducing the existing disparities was an improvement of the economic, social and other factors that affect the lives of the people. (Watt, & Sheiham1999)

Another report titled, Inequalities in Health The Black Report that was published in 1980 showed that there existed great inequalities in the general health of the British people. This report indicated that the existing inequalities were not directly related to the shortcomings of the NHS, but was because of the social inequalities that influence people’s income, the level of education, the dietary habits among people and the working conditions that were prevalent in different groups of the society. The report recommended the setting up of policy measures in the society to address these inequalities. The recommendations of the report that was supposed to see the existing inequalities solved permanently were trashed by the Secretary of State for Social Services. As it is, very few copies of the report reached the public domain. (Townsend, & Davidson 1982) This clearly shows that politicians in a way contribute to the disparities in oral health. Considering the negative implications brought about by oral diseases, it is a pity that politicians have decided to politic the issue instead of addressing it.

The British Dental Association (BDA) has also admitted that there is a big gap between those with good and poor dental health. Just like in other earlier reports, BDA links these disparities to the low socio-economic status and the case of poor oral health that exists between different people. In realizing this, the report calls for more preventive than curative care. The report also recommends that more attention should be given to those who are physically disadvantaged, the old and those in prison. The report identifies the use of alcohol and tobacco as some of the biggest contributors of oral health disparities. It recommends that there should be strategies geared toward emancipating and promoting good oral health among different groups of people. (Walmsley 2009)

Factors that contribute to oral health disparities


Political factors are among determiners that have led to disparities in oral health. Politicians are the main decision makers in our society. They influence provision of important services including oral health services. They also formulate policies that can either improve the welfare of disadvantaged sections of our communities or deteriorate them further. Unequal distribution of wealth and resources in our society is something that has been created and enhanced by our politicians. This has increased levels of poverty in minority groups limiting their capacity to access oral health services. Our politicians can implement policies that could reduce health disparities in our society. One way in which they can do this is by allocating financial resources in the budget to build and furbish dental hospitals in these areas. (Patrick et al) Decisions that politicians make will therefore be reflected on the wellbeing of various groups in the society. This includes a reflecting of the oral health of affected groups. The lack of commitment on the part of politicians can best be seen in the neglect of the Black Report by the then Secretary of State for Social Services. (Townsend, & Davidson 1982) There have also been many other instances when our politicians have shown lack of commitment toward reducing oral health disparities among people in our country.


Another major determinant that affects oral health patterns in the society is differences in education levels in the society. People with higher levels of education will most certainly acquire employment thus enhancing their financial capacity and can therefore afford quality and comprehensive health services. Those with no education or with low levels of education on the other hand will find it hard to secure well paying jobs and are therefore likely to remain poor limiting their financial capacity that is mirrored in their accessibility to oral health services. (Kay, & Locker 1997)

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Educated people appreciate the necessity of good oral health when compared to the uneducated. In the course of their education, they have been taught extensively on oral health at one time or another. They know the importance of good health and self-image, which is closely related to good oral health. Their capacity to confidently interact and fit in the society enables them to seek the most appropriate health medication services and new oral technologies. Education therefore plays a direct role in oral health. Lack of it has contributed to oral health disparities in our communities. (Kay, & Locker 1997)

A classic example that demonstrates oral health education and education in general goes a long way in reducing oral health disparities was a study done by the Department of Preventive Dentistry at the University of Edinburgh. The study carried out on 5-year-old school pupils was geared toward evaluating the effects of an oral health campaign carried out in 1991. The study took at random around 500 children from different primary schools around Edinburgh. A clinical test was done on every pupil before the exercise began. A repeat test was done two and four months respectively after the exercise. The exercise involved distributing toothbrushes and toothpaste to every pupil. The students were encouraged to constantly brush their teeth. During the second and third examination, the organizers realised that there was an increase in plaque scores at every stage per individual pupil. This clearly shows how oral education can be used to reduce oral health inequalities among school going pupils. (Schou, & Wight 1994, p.98)


Some habits and lifestyles, which vary among people in the society, are enemies of good oral health. Practice of these habits and lifestyles by segments of our community has increased disparities in the oral health of our society. Cigarette smoking for example is a major contributor of oral infections and diseases in our society. This especially affects poor communities that will maintain this practice without going for oral check ups. (Greenberg et al 1991) Most of them cannot afford quality cigarettes whose effects on oral health are lesser. Alcohol abuse is also contributing to poor oral health in the society. Most of the people who abuse alcohol are also likely to have a poor oral health condition. This also applies to people who abuse hard drugs like cocaine. (Smith 1994) The British Dental Association (BDA) in its 2009 report also emphasized the role played by cigarettes and alcohol in causing oral health disparities. This then calls for the people to be educated on the risks of living certain lifestyles. (Walmsley 2009)

The elderly and children

People at different ages and stages in life experience disparities in oral health. The most affected groups in this category whose oral health is generally poor include children and the elderly. Considering the elderly (people who are over sixty-five years in age), most of them are dependants and rely on other’s services and resources to accomplish tasks. There are over thirty five million elderly people in the United States. Members of this group suffer from many health complications and have a sensitive clinical condition. Their oral health needs utmost monitoring and care. Currently, there is no mechanism to provide adequate oral care to elderly dependants whose population ratio keeps increasing due to an increase in life expectancy and a decrease in birth rate. A good number of elderly dependants may not have enough financial resources to afford quality care homes. These are some factors that have led to poor oral health among the elderly. Although the general health of the elderly is bound to deteriorate, measures can be taken to minimize this as much as possible. Studies that have been undertaken on the subject also point out that oral inequality among the aged people increases with years. This calls for more care to be taken on this group of people in the society. (Palmqvist 1986)

On their part, children depend mostly on their parents for the provision of oral health services. Poor concern for oral health on the side of parents will directly affect children’s oral health. Apart from providing resources needed for their children’s oral care, parents are expected to guide and supervise their children to practice dental hygiene practices like brushing the teeth regularly. Since they are likely to be closer to their children than anyone, parents with oral infections can easily spread the bacterial agent for oral infections to their children. Moreover, children inherit parent’s values, cultures and beliefs. These children thus perpetuate beliefs and practices that do not promote good oral health. This trend maintains and promotes oral disparities in the society. (O’Brien, 1994)

People with special needs

People with special needs like the physically disabled for example are also dependant to their families, their communities and their neighbors to carry out some duties and access services. This group of people is therefore disadvantaged in many respects. Some members of this group cannot even carry out or will carry out with a great difficulty routine oral hygiene practices like brushing the teeth. They also suffer from lack of information on oral health. Blind people for example may need special means of providing information on oral health like writing it in Braille. In general, this group needs special attention to promote their oral health, which may not be forthcoming. This has led to poor oral health among this group of enhancing oral disparities in our society. (Benzeval, Judge & Whitehead 1995)

People in specific settings like those in prison for example are also likely to suffer from oral health problems. Several studies have shown that majority of prisoners have poor oral health. It has also been shown that people in prison are averagely four times more likely to suffer from untreated diseases and ailments. Most people in prison smoke cigarettes, abuse alcohol and suffer from mental problems. This puts them in a precarious position in relation to their general healthy, which includes oral health. (Walmsley 2009)

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Moreover, an increasing number of inmates have overwhelmed our prisons. It is has become unable to provide necessary facilities that include adequate space for prisoners and provision of medical services. The provided medical services focus more on treatment of oral diseases rather than on prevention, which is more important in promoting oral health. There are also inadequate personnel specializing on the oral health of prisoners. Besides, these medical personnel may not be dedicated on their work compared to practitioners working outside of prisons. These and other factors have led to poor oral health among inmates who are part of our society. When released from prison, they may carry over their dental conditions to the society without ever taking measures to improve their dental health. (Walmsley 2009)

Dietary Habits

Nutrition habits directly affect people’s oral health. Intake of sugary foods promotes bacterial activity in the mouth. These bacteria are agents for oral diseases. School going children are especially vulnerable since most of them like buying many sweets that could deteriorate their oral health. (Bentley, Mackie & Fuller 1994) For one to have good health, one needs to take a balanced diet continuously that provides all the nutrients required by the body. This applies to oral health too. Foods rich in calcium for example are necessary for having strong and health teeth. Good health will enhance the body’s capacity in fighting oral diseases. Populations that cannot afford or do not take all required nutrients in their meals are therefore likely to suffer from oral infections. (Gregory, Foster, Tyler & Wiseman 1990)

The way forward

To fight oral health inequalities in the society, the government, involved organizations and individuals need to develop public health strategies that would see a reduction in oral health inequalities in our society. Such strategies should work to address issues discussed above which have led to these disparities. As observed, most determiners that have led to oral health inequalities are complex and interrelated. This explains why there is a very big gap between those with good oral health and those without. A primary contributor to poor oral health is poverty among affected communities. This has led to the formation of a complex web of other interrelated factors that have led to poor health including oral health among affected communities. (Kay & Locker 1997) The World Health Organization (WHO) through a chatter signed in Geneva realizes the need for having equal health opportunities for all people. (World Health Organization 1986)

Developing and implementing policies and measures to fight poverty therefore form the core of fighting oral diseases in affected communities. This can be done for example by increasing economic opportunities of affected communities. Since education is a major determinant of a person’s economic capacity in our society, provision of affordable and quality education in these communities will achieve multiple results by enhancing their economic capacity besides promoting their knowledge including in oral hygiene. (Sprod, Anderson & Treasure 1996)

Fluoridisation has been proven as an effective method in fighting oral diseases and decreasing disparities in oral health. This is especially true because this practice can be used to target communities in specific areas. Research has shown that about 15 percent more children do not have oral health –problems in fluoridated areas as compared to non-fluoridated areas. (Slade, Spencer, Davies & Stewart 1996) The same studies on the effects of exposure to fluoride on reducing oral health problems have shown that fluoride exposure can lead to a reduction in oral infections by half in a span of ten years. Exposure to fluoride can be achieved by treating water with fluoride and establishing campaigns like supervised brushing of teeth in schools among other measures (Jones etal 1997)

Improving accessibility to oral health care services in affected communities is also necessary in fighting disparities in oral health in our society. This includes building dental hospitals in these areas and furnishing them with the necessary equipment and personnel. Provision of oral health services should be tailored to meet the needs of affected communities. (Beal 1990) This may require doing things like taking doctors who can easily interact and understand targeted communities in their areas. This may include dentists who share some values and practices with affected communities like having the same descent for example. (Brown, Schaid & Johns, 2000) It would also be important to provide financial support, which should be directed in education programs that should educate affected communities on the importance of oral hygiene so that they access provided oral health services. (Sanders, Spencer & Slade 2006)

To effectively fight disparities in oral health, we need to take advantage of existing new technologies that can be used to fight oral infections. We also need to promote research on new technologies that can be used to reduce disparities in oral health. Dental professionals provide a direct link between people and dental medication. These should therefore be used in implementing these new technologies. Technologies like fluoride varnish are affordable to most people, and effective in fighting and preventing oral diseases. (Florida Health Science Center 2000) Unfortunately, these technologies are not used at the clinical level in promoting good oral health. Some dentists are not even aware of these technologies. Many people also lack information on these available technologies and are thus unable to utilize them. It would be important to implement measures that would promote the use of these technologies in fighting oral infections as one way of reducing disparities in oral health. (CSDH 2008)


As observed, poverty is the primary cause of oral health disparities in our society. Poverty reduces the quality of life and the general wellbeing of people. Measures to fight oral health disparities should therefore begin by eliminating poverty in our society. Targeting vulnerable groups like minorities and people with special needs like children, the elderly and those with physical disabilities are also necessary to fight oral disparities in our society. These need special measures and provision of special services to effectively meet their needs. Specialized medical care for the elderly for example is necessary.

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With a vibrant and domineering culture and lifestyle emerging in the United States, care needs to be taken so that some society groups are not isolated. This will ensure that are actively involved in policies that promote their wellbeing including their oral health. This is what may have affected minority groups like Latinos and African Americans negatively in various respects including their general and oral health.

Our politicians wield a lot of power on allocation of resources including the important education and economic resources and policymaking and could therefore be the biggest catalysts when it comes to matters such as those of oral health. These should play a deliberate role in ensuring and promoting good oral health for every one.

Ensuring good oral health for every one is a challenge that needs to be met by all. The health care sector plays a crucial role in this endeavor since it provides a direct contact with patients. It can therefore be used to educate and meet special needs of affected communities to reduce and or eliminate oral health disparities in our society.

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