Diya (Year 12)
Editor’s note: Diya, now in Year 13, wrote this informative essay during the course of Year 12. Dental health disparities in the UK are influenced by socioeconomic and geographical factors, affecting individuals’ well-being and access to care. The essay explores causes of these disparities and proposes strategies to improve equitable dental health access. CPD
Dental health disparities are extremely prevalent in the UK, impacting an individual in many aspects of their life, including their well-being and life quality. These disparities are reinforced by low socioeconomic mobility and geographical factors in the UK. This essay aims to underpin the underlying factors contributing to these disparities, explore strategies to mitigate them, and in turn promote equitable access to dental health care.
Preventative measures can often aid individuals from the exacerbation of oral health problems, such as a diet rich in vitamins, minerals and fresh fruit and vegetables. However, people from a low socioeconomic background are more likely to be deterred by the high costs needed to access these foods and even routine check-ups, in turn leading to delayed treatment. Since the expensive label attached to dental work, often discourages people from booking an appointment, therefore the treatment turns out to be more painful and expensive than planned, and these people may experience higher rates of dental caries, periodontal disease and tooth loss (Kelly et al, 2017) reaffirming the cycle of dental disparity. Furthermore, individuals with lower socioeconomic status may have restricted knowledge and awareness of their teeth and their impact on their general health. Therefore may not grasp the significance of these general oral hygiene practises. (Watt et al, 2019) Moreover, there is a higher probability these individuals may partake in risky behaviour, such as smoking, contributing to an increase in dental caries and periodontal disease.
Shortages of dental professionals and services in rural areas of the UK account for the regional disparity of dental health. Since limited transportation and long travel times mean that individuals residing in remote areas often encounter difficulties in travelling to dentists. Due to them being so far, this results in postponed dental visits. Even if these rural areas have a dental clinic, these may have inadequate staffing, poor dental technology and facilities. Therefore access to these dental luxuries may only be by people living in highly populated areas. For example, rural Scotland and coastal communities in the UK, have limited access to dental facilities and dentists. Due to dentists having fewer career opportunities in these regions, therefore recruiting and retaining staff can be hard. Also, coastal communities including Cornwall and Wales, may have further restricted access to dental services due to seasonal fluctuations in the population as there are increased residents and visitors in the summer, meaning that an already thin amount of dental health is pushed to the limit, furthering the problem.
Nevertheless, there are many opportunities and strategies that the government can impose to alleviate the disparities within dental care. An example of this is including comprehensive and engaging oral health education in schools so that students are informed about their teeth and instil the importance of oral hygiene, healthy foods and regular dental check-ups. (Public health England, 2020)Furthermore, sliding fee scales and financial assistance should be implemented and utilised more frequently so dentistry should not become a ‘rich person’s luxury’ and not accessible to individuals of a lower income and socioeconomic background. (Hobdell et al, 2003)Therefore, these income-based subsidies may lift barriers to dental care for many so that families and individuals feel they have more support from the government to access dental care.
Furthermore, the government implementation of water fluoridation supplies could be the most effective public health measure the UK could impose to prevent dental caries across all economic and social backgrounds. By implementing a low dose exposure of fluoride through drinking water taps, enamel would become stronger and teeth would become more resistant to bacteria attacks. Community water fluoridation provides equitable access to dental health as it can reach large populations across the UK. It is also cost-effective and can provide significant savings in dental treatment costs for people. By taking preventative measures, fluoridation aids in reducing the financial burden and has a long-term impact resulting in better oral health and fewer dental treatments in the future. Furthermore, water fluoridation has a population level improvement, and large communities’ dental health would improve. (Public Health England, 2014) For example, in Birmingham water fluoridation was implemented in 1964, further studies reveal that there are significant reductions to the rate of dental caries of children living in Birmingham, to other areas where there is limited water fluoridation. A study published by the British Dental Journal indicates that the children found in fluoridation areas of Birmingham had 38% fewer damaged teeth compared the children in non-fluoridation areas. (British Dental Journal, 2000)
For geographically isolated individuals or groups of people, tele dentistry could be initiated, which includes access to preventative and basic dental care, initiated through a video call and can provide dental care to places with limited access to dental clinics. These video calls could lead to simple advice given to the individual or further referrals to specialists. (Nasseh et al, 2015) In addition, local authorities could employ mobile dental units in these geographically isolate places, and staffed by dental professionals to deliver basic dental treatments to communities with limited access to dental care.
Governments should aim to retain their staff working in these rural areas, in order to not further exacerbate the imminent problem of staff shortages. Furthermore, the government may offer financial incentives to dentists who choose to work in more remote areas of the UK. (NHS England, 2019) Dentists could see the opportunity as more lucrative and therefore reside and work in these rural areas. Therefore, this would lead to an increased spread of dentists across the countryside and geographically isolated areas across the UK. For example, in Cornwall and Wales, where the population increases in the warmer months, to provide a greater bonus for the dental staff who move to these coastal communities in the summer months to serve the increased population.
Socioeconomic and geographical factors continue to impact national dental health outcomes in the UK, pronouncing the need for a change to the oral health care system. By implementing evidence-based strategies, such as water fluoridation and financial incentives to dentists, access to dental care will be improved to reduce disparities and improve oral health outcomes for all populations. I hope that this multifaceted approach to diminishing disparities in dentistry eliminates many factors preventing individuals from seeking support for their dental health.
References
́Connor, R.O., Landes, D. and Harris, R. (2023) ‘Trends and inequalities in realised access to NHS primary care dental services in England before, during and throughout recovery from the COVID-19 pandemic,’ British Dental Journal [Preprint]. https://doi.org/10.1038/s41415-023-6032-1.
Evans, S. (2017) BDA launches its manifesto for the General Election – Dentistry.co.uk. https://dentistry.co.uk/2017/05/16/bda-manifesto-general-election/.
Inequalities in oral health in England: summary (2021). https://www.gov.uk/government/publications/inequalities-in-oral-health-in-england/inequalities-in-oral-health-in-england-summary.
Watt, R.G. et al. (2019) ‘Ending the neglect of global oral health: time for radical action,’ The Lancet, 394(10194), pp. 261–272. https://doi.org/10.1016/s0140-6736(19)31133-x.
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