The poorest people in society have eight fewer teeth by their seventies than the richest, one of the biggest studies of its type ever undertaken has revealed.

It has long been known that there is a strong link between people’s socioeconomic position and their oral health, but the new paper published today in the Journal of Dental Research has shown the full extent of the problem.

Oral health can be measured in many ways but this study, a collaboration between Newcastle University, Newcastle upon Tyne NHS Foundation Trust, UCL and the National Centre for Social Research, showed it was substantially worse among the poorest 20% of society compared with the richest for all of the measures the research team used. This has potential knock on effects to others areas of health. For those over 65 years old, the least well-off averaged eight fewer teeth than the richest, a quarter of a full set of teeth.

More than 6,000 people aged 21 and over, from all income groups and regions of the UK (not Scotland) were involved in the study, funded by the ESRC with data taken from the recent UK Adult Dental Health Survey.  Those with lower income, lower occupational class, higher deprivation and lower educational attainment generally had the worst clinical outcomes, including having more tooth decay, gum disease, and tooth gaps, as well as having less teeth overall.

Despite these social differences, oral health is improving and the oral health of young British adults overall is much better than it used to be. However, previously published research by the same team showed that whilst the young had much healthier mouths than their predecessors, when asked how good or bad their own oral health was and how it affected them, the social divisions between rich and poor were very evident, and even more  pronounced  than in older people. The poorest young people were very aware of their poor health and much more likely to rate their oral health as bad or say that it affected their day to day life than the wealthiest.

Oral Health

Professor Jimmy Steele CBE, Head of the Dental School at Newcastle University, and lead author said: “It’s probably not a big surprise that poorer people have worse dental health than the richest, but the surprise is just how big the differences can be and how it affects people. Eight teeth less on average is a huge amount and will have had a big impact for these people. From our data it is hard to say which specific factors are driving each of the differences we are seeing here, but there is probably a real mix of reasons and it is not just about, for example, the availability of treatment.

“Although the younger generation have much better oral health than their parents ever did, the differences between rich and poor are very considerable and young people are particularly aware when they do not have a healthy mouth. The risk is that as health gets better overall the differences just get greater and poorer people lose out.”

Dr Georgios Tsakos, Senior Lecturer at the Department of Epidemiology and Public Health at UCL, added: “In terms of the younger adults, we showed that it is not only being poor that affects their perceptions about their oral health and quality of life, but educational attainment can also make a major difference. This has profound implications for policy as intervening in earlier life could have a significant long term effect on oral health.”

John Wildman, Professor of Health Economics at Newcastle University Business School, the Principal Investigator on the ESRC study, said: “Inequalities in oral health have not received the attention that they deserve. Our study is an attempt to redress this balance. Oral health contributes hugely to everyday wellbeing and addressing these inequalities may result in considerable improvements in quality of life for large numbers of individuals.”

Finally, Professor Richard Watt, Head of the Department of Epidemiology and Public Health at UCL, commented on the important policy implications of this research: “Inequalities in oral health require urgent action by organisations such as Public Health England – in particular more needs to be done to tackle the underlying causes of oral diseases such as sugary diets.”

Teeth loss

Sixty-eight year old Sidney Alcock, of Washington, Tyne and Wear, has been a shoemaker all his life, but was also a keen trombonist in a brass band.

He lost all his teeth at a young age due to suffering from gum disease, primarily caused by poor oral hygiene, and has struggled ever since. He has never smoked regularly and says he didn’t have too much sugar in his diet.

“You can’t play the trombone without any teeth”, he said. “I have had false teeth but they don’t last, so losing my teeth has made a big impact on my life. It costs a lot of money for false teeth.

“When I was young we didn’t have milk or eggs, or much other dairy, we had to eat powdered eggs. I’m sure that has had an impact on how good my teeth were.”

published on: 18 November 2014