The High Cost of Dental Inequalities
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- Published: Tuesday, 23 July 2024 20:36
- Written by Peter Ingle
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Both the outgoing government and the incoming administration have made clear that there are clear priorities for NHS dentistry. Many efforts are focussed upon dealing with priority groups, those with dental emergencies, and reducing inequalities. A recent study has driven home the frequent connection between all three concerns.
Children living in areas with high levels of deprivation are three times more likely to have severe tooth decay that requires a dental extraction in hospital, compared with children living in more affluent areas.
These findings come from a team at Queen Mary University of London and were published in BMJ Public Health. GP and hospital records for 600,000 children between the ages of five and sixteen living in North East London were analysed. Over the five-year study period, one in 200 children had at least one tooth removed under a general anaesthetic. Most of those children had multiple teeth extracted. Aside from the human misery there is the avoidable waste of an overstretched hospital service dealing with a disease that is both preventable, and in its earlier stages, treatable in a much less invasive and traumatic way.
As well as a difference between income groups, there were ethnic variations. Compared with children from White British ethnic groups, those with a White Irish background were twice as likely, and those from Bangladeshi and Pakistani backgrounds nearly 1.5 times more likely, to need extractions under GA. Children living with obesity were found to be less likely to require a dental extraction than children with healthy weight, and the authors have called for further research to try to replicate, and understand, this finding.
The researchers also examined the data by North East London borough, comparing rates of children’s dental extractions with access to NHS general dental practitioners. After adjustments were made for deprivation and ethnic group, the highest risk of hospital dental extraction was for children in Tower Hamlets, which also has the lowest GDP attendance in North East London. Children in Redbridge, Havering, and Barking & Dagenham, which have the highest proportion of five-year-olds accessing general dental practitioner services, had the lowest risk of hospital extraction.
It was already known from the 2022 National Dental Epidemiology Programme (NDEP) oral health survey that only 13% of decayed teeth in five-year-old children in London had been filled.
Vanessa Muirhead, Co-author and Reader and Honorary Consultant in Dental Public Health at Queen Mary, said: "Sadly, our findings demonstrate wide socioeconomic and ethnic inequalities related to access to dental care and outcomes. Tooth extraction is a last resort, but when families have difficulty accessing timely preventive and treatment services, dental problems can progress until children need more serious and costly interventions such as multiple tooth extractions under general anaesthesia."
The Dean and Director of the Institute of Dentistry at Queen Mary, Christopher Tredwin, commented: "This research highlights clear oral health inequalities, which we are also acutely aware of through our longstanding service of the local community. In partnership with Barts Health NHS Trust, the Queen Mary Institute of Dentistry opened a new dental outreach clinic in Kenworthy Road, Homerton, earlier this year. It is now providing quicker and easier access to dental care in the local area, while our dental and therapy students learn to treat children in these primary care settings.”
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