Those at Risk
Oral health inequalities remain a significant public health problem in England. Poor oral health disproportionally affects vulnerable and socially disadvantaged individuals and groups in society. There is clear and consistent evidence for social gradients in the prevalence of dental decay, tooth loss, oral cancer, self-rated oral health, oral hygiene, and service use. Fluoridation plays a role in reducing dental inequalities with differences in dental decay less pronounced in fluoridated areas. Differences in access to dental services may partly explain social inequalities in dental decay, whilst smoking plays a role in inequalities in periodontal disease.
Risk factors for developing dental disease, shown in Table 1 include both modifiable behaviours and non-modifiable socioeconomic and cultural factors. Many of the causes of poor oral health are the same ones that cause other disease- ‘common risk factors’.
| Dental Hygiene | Poor dental hygiene is the main cause of gum disease and is also implicated in dental decay. |
|---|---|
| Fluoride exposure | Fluoride prevents tooth decay. People are usually exposed to fluoride from toothpastes and mouthwashes and potentially from their water. |
| Diet | |
| Tobacco | Tobacco use increases the risk of oral cancers. |
| Alcohol | When drunk in large quantities alcohol increases the risk of oral cancers |
| Age | Young children living in deprived areas have higher rates of dental decay. Comorbidities, physical limitations and cognitive changes in older age can lead to poor oral health. |
|---|---|
| Gender | Middle-aged males who smoke and drink more than the recommended safe levels are at greater risk of oral cancer. |
| Socioeconomic status | Health inequality is a common feature in dental disease; high levels of dental disease tend to affect those in low income families and those living in socially deprived conditions. |
| Diabetes | People with diabetes are more prone to gum disease and premature loss of teeth. |
| Mental health | Adults living with dementia may experience difficulties in maintaining good oral health. Those living with bulimia may have problems with excessive tooth wearing due to the acidic pH of their mouth. |
| Ethnicity | Asylum seekers and eastern European communities have poorer oral health compared to the general population. |
| Learning disabilities | Surveys of the dental health of adults with learning disabilities show that poor oral hygiene and a high prevalence of gum disease are common. |
| Refugees | Studies have indicated a high prevalence of oral disease and unmet oral healthcare needs in refugees, often exceeding the levels experienced by the most disadvantaged communities of the host country. |
The Sheiham and Watt common risk factor approach, shown in Figure 1, is a framework used to summarise the different factors at play which are common to oral disease as well as other chronic diseases.
Figure 1
