Dental inequality: what is it and why does it exist?

What causes tooth decay?

The fact is that, in modern times with our knowledge of dental care and our access to toothpaste containing fluoride, tooth decay should not be a common complaint. But sadly, a survey of 5-year-olds carried out by Public Health England in 2017 showed that almost a quarter were suffering from tooth decay.

One of the main causes of tooth decay is sugar - something that is used excessively in modern diets. Another cause is lack of brushing - and/or not using a toothpaste containing fluoride.

Finally, it’s important for children to visit the dentist regularly - Public Health England advises we take them as soon as their first tooth appears, and every six months after that.

Dental inequality occurs when one or all of these factors are unavoidable because of a child's circumstances.

What is the impact of tooth decay?

When tooth decay becomes advanced, children may need to have the affected teeth removed. According to a report by Nuffield Trust in 2017, "almost 9 out of 10 hospital tooth extractions among children aged 0 to 5 years are due to preventable tooth decay and tooth extraction is still the most common hospital procedure in 6- to 10-year olds."

Having bad teeth can lead to problems with stress and anxiety. According to Public Health England, 38% of children reported having sleepless nights because of dental pain. Others are too embarrassed to laugh or smile.

Tooth problems may also lead to children missing school due to time taken because of pain, or for treatment and recovery.

Finally, dental problems may lead to additional issues later in life. These can range from the psychological distress caused by the impact of poor teeth on overall appearance to an impact on life chances - for example, when it comes to employment prospects.

The poor diet that may be a contributing factor to tooth decay can also lead to other so-called lifestyle diseases such as obesity and type 2 diabetes.

Armed with this information, it's easy to assume that simply focusing more on our children’s dental health should solve the problem. However, dental inequality means that not all of us have the opportunity to care for our teeth as we might wish.

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So why in the 21^st century does dental inequality exist?

Lack of access

Missing dental check-ups can mean that smaller problems in dental hygiene are not picked up and treated quickly, leading to more advanced tooth decay. Sometimes this happens because parents do not realise the importance of regular dental check-ups but, for some, regular visits to an NHS dentist may be impossible.

A Faculty of General Dental Practice statement in 2019 claimed that "only 60% of children see an NHS dentist each year." This means that 40% of children are not getting the recommended amount of dental care and supervision. And it may not be down to the lack of trying - a BBC report in 2019 estimated that 1.45 million people had "tried and failed to get an NHS appointment in two years" due to lack of availability in their local area.

Lack of brushing

As parents, many of us are used to telling our children to brush their teeth, or encouraging them to be thorough with their dental hygiene. But the truth is that not all children have the opportunity to practise proper dental care - simply because they do not have access to a suitable brush or toothpaste.

"The biggest change in dental disease ever was in the 1970s when they put fluoride in toothpaste," says Katie Davis, dentist and founder of Habox, a company dedicated to supporting children's dental health. "But children from lower socio-economic backgrounds don't necessarily have access to this every day."

It's also important for parents to supervise when younger children brush their teeth to ensure they are thorough, something that parents who are working long hours may not find easy to do.

High-sugar diet

We all know that sugar is bad for us, but that doesn't mean those who develop tooth-decay are always careless with their sugar consumption. In modern times, many products - even those claiming health benefits - can have high sugar content. And these may be marketed in a way that makes it difficult for parents to make sensible choices.

"Even parents trying their absolute best can still be confused as to what's the right thing to do," explains Davis. "A lot of snacks are marketed to parents as healthy, but still have a high sugar content."

On the face of it, reducing instances of childhood tooth decay should be straightforward. However, tackling dental inequality needs to be a government priority, according to Davis. "The fact is that dental decay is a completely preventable disease, which really in the 21st century should be completely eradicated. We need to break down barriers - we need to take the focus off it being people's fault."

In addition, as well as improving access to NHS dentists, Government intervention is needed when it comes to diet. "We need a decent sugar policy. When it comes to dental decay, sugar is the cause," explains Davis.

It's a sobering thought that something so preventable can still be so rife in the UK in the 21^st century, and dentists and other health professionals believe that tackling this kind of inequality should be a government priority.