Overall, oral health was poorand social inequalities were apparent in Birmingham and Solihull. Large numbersof children had dental issues and those who were classed as most deprived weremore likely to have more decayed and missing teeth, and fewer filled teeth;implying a poorer preventative care and standard of treatment. More studiesshould be carried out at this level and compared to national data of the 2013CDHS to highlight the areas most in need of care. A focus of preventative care andevidence based interventions should be implemented to support the wholepopulation but aimed on those most in need to combat inequalities which wouldultimately improve the oral health of the general population. ConclusionThere are strengthsassociated with this study.
The study was carried out by a single consultant soresults were consistant and all the data was quantitative, and consequently,there was not any self-reported bias. However, the results from this studyshould be used with a degree of caution as the sample size was small and notnecessarily representative of the population as there was only one mostdeprived female involved, possibly skewing the data set. On top of this, theextent of decay was not stated, as it is in other studies with initial stagedecay and obvious decay experience being used in the 2013 Child Dental HealthSurvery (CDHS).11 Looking at the CDHS may provide more accurateinformation on oral health and inequalities in the population studied. It would also be good to note thatas this was a cross-sectional study, making a causal relationship between age,sex and deprivation to oral health and inequalities is not possible. Furtherstudies should be carried out to obtain more data on these relationships.
One point to note is that dentalservices are becoming increasingly unbalanced since the proportion of privatedental care is increasing. This could negatively effect attempts to reduce oralhealth inequalities in the UK including Birmingham and Solihull.9Reducing inequalities is alarge aim. This can be achieved through a multitude of upstream, midstream anddownstream interventions. An upstream approach can involve influencing localand national government policies10 which has evidence of anencouraging impact on inequalities without being too costly; proportionateuniversalism8 should therefore be taken into account. Increasedfunding could be targeted at the more deprived populations with dental servicesbecoming more easily accessible. This should then begin to balance outattendace rates and standard of care between deprivation levels. Peer oral health workers is aneffective, inexpensive midstream approach on tackling inequality.
10The workers will have an important role in educating communities on oral healthand promoting skills in this area, as well as facilitating access to dentalservices. This is a simple method to implement which has a large impact on thecommunities involved. Despite being costly, targetedcommunity-based fluoride varnish programmes can help reduce decay; a largescaled problem in deprived communities. This downstream tactic has strongevidence of effectiveness and an encouraging impact on equalities10,especially if it is combined with the idea of proportional universilasm. The interventions mentioned focus oneducation and preventative care which has an important role to balancing outinequalities found in dental care.It is clear that there aresocio-economic inequalities in oral health. This is demonstrated by the mostdeprived children having the lowest proportion of DMFT score of 0 (Table 2).
Less deprived children have an increased attendance to dental clinics as wellas finding it easier to access private and NHS dental practices.8,9 ManyNHS practices are only willing to accept private patients as demand for NHSservices is overwhelming and this can be viewed as inequalities to the standardof care received. Additionally, more deprived students are significantly morelikely to consume high levels of sugary drinks2 which have adetrimental impact on their oral health. The data shows that cariesincrease with age, and in terms of detrimental behaviour, males and femalesdrink similar amounts of alcohol but alcohol consumption increases largely from12-years-old to 15-years-old2, with smoking having a similar trend.5Both of these behaviours increase because adolescents gain more independencethrough these years and more likely to try new actions without parentalobservation. Smoking and drinking have both been shown to increase oral healthproblems.6,7The findings of this studyhave highlighted key problems of oral health of children in Birmingham andSolihull.
More importantly, inequalities in the standard of care within thepopulation were also apparent. Females tend to have better oralhealth, as they are more likely to brush their teeth twice a day.2This can be linked to females feeling that their oral conditions will impacttheir daily life more than males.3 Despite having more decayedteeth, males also have fewer fillings. Some may argue that this dispalysinequalities in care between genders, but these results could be due topreviously filled teeth having to be extracted as males have more missingteeth. Furthermore, females are more likely to exibit health-seeking behaviourand visit their primary care provider4, incuding dentists, resultingin females recieveing more fillings which prevent tooth loss.DiscussionA total of 500 school children took part with 280 males and220 females. Overall, oral health was poor with approximately four-fifths ofthe school children sampled (78% and 85% of 12-year-olds and 15-year-oldsrespectively) having a DMFT score of at least 1.
The differences between age groups was mainly due to the mean of decayedteeth rather than the means of missing or filled teeth (Graph 1). Ateach age group, females faired slightly better than the males with the overallmean DMFT scores being 1.90 and 2.35 respectively (Graph 2). Changesin deprivation level depicted variances in oral health as well with 73% ofleast deprived, 89% of the middle group and 86% of most deprived childrenhaving a DMFT score of at least 1.
However, these percentages change to a clearerpattern of 9%, 23% and 31% when looking at DMFT scores of 4 or more. This trendis further reinforced when looking at mean DMFT scores as from least deprived,middle group and most deprived the values are 1.57, 2.38 and 2.66 respectively(Graph 3).
Concentrating on the standard of care,differences by deprivation displayed clear signs of inequalities. Upon further analysisof the results in Table 1, it was found that the most deprived students have52% more decayed teeth but just over a quarter (28%) of the number of fillingswhen compared to the least deprived group. These inequalities are alsodemonstarted by 50% of people with a DMFT score of 7 and 75% of people with aDMFT score of 8 were classed as most deprived (Table2). ResultsEach child involved in the study had the number of decayed,missing and filled teeth counted alongside their level of deprivation.
Thesevalues enabled the decayed, missing and filled teeth (DMFT) score to becalculated by adding up the individual components. Mean averages werecalculated, to two decimal places where appropriate, by the sum of DMFT scoresdivided by the number of children in the group. Based on a representative sample of school children aged 12and 15 from Birmingham and Solihull, the study used data collected from adental public health consultant. Age, sex and deprivation level divide thesample group and full details of this breakdown can be found elsewhere (Table1). MethodologyDespite being easily preventable, tooth decay in England isthe most common disease in young people with tooth extractions being the largestcause of hospital admission for children up to the age of nine1.
Thisarticle compares clinical data collected from a cross-sectional study with the informationgathered from a locally representative sample of school children in Birminghamand Solihull. The study has obtainedvaluable data on the aspect of oral health in young people at a much more locallevel. This article also considers social deprivation levels and how thisaffects oral health.Introduction
