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Demographic and socio-economic correlates of dental pain among adults in the United Kingdom, 1998 A. Pau, R. E. Croucher and W. Marcenes British Dental Journal 2007; 202: E21

Editor's summary

Dental pain is a common complaint and can significantly affect the quality of life of the sufferer, particularly if the pain is ongoing and untreated. Being unable to eat normally without experiencing pain is distressing and naturally affects the patient's wellbeing over a period of time, and dental pain is therefore increasingly being recognised as being an important factor in oral health status. Given that it is acknowledged that inequalities in oral health and access to dentists exist in the UK, it is perhaps surprising that no studies have so far looked at whether experience of dental pain also varies across different demographics. This paper by Pau et al. is the first to report the demographic and socio-economic distribution of dental pain in the UK.

By analysing data from the 1998 Adult Dental Health Survey, the study found that 28% of the sample reported dental pain. The study also attempted to characterise those respondents with dental pain who perceived that they had a need for dental treatment but did not use dental services, in order to assess whether inequality existed. Men, younger adults and those in a manual social class were shown to be most likely to fall into this category, with those in the manual social class significantly more likely to report dental pain, a perceived need for treatment and dental non-attendance after controlling for age and gender.

The paper therefore confirms the existence of demographic and socio-economic inequalities in oral health and dental access in the UK and adds further to the body of evidence suggesting that barriers to access, whether perceived or experienced, exist amongst some groups. These barriers must be identified in order to provide dental services that are equally available to all. One wonders how many more studies will be required before those responsible for planning our dental health services finally sit up and take notice.

The full paper can be accessed from the BDJ website ( www.bdj.co.uk ), under 'Research' in the table of contents for Volume 202 issue 9.

Rowena Milan, Journal Editor

Author questions and answers

Why did you undertake this research?

Increasingly, dental pain is regarded as an important indicator of oral health status and quality of life. However, its epidemiology is poorly documented. This paper reports the results of an analysis carried out on some dental pain data collected in the UK 1998 Adult Dental Health Survey. This analysis was carried out to describe the distribution of dental pain according to sex, age groups and socio-economic status as measured by occupation. Amongst people reporting dental pain in the previous twelve months, the analysis also sought to profile those who did not use professional dental services and those who perceived a need for dental treatment if they were to visit a dentist tomorrow. The reasons for undertaking this analysis were to explore and demonstrate inequalities in the distribution of dental pain, access to professional dental care and perceived treatment need, and to emphasise the need to address these issues.

What would you like to do next in this area to follow on from this work?

To follow on from this work it is crucial to explore why younger male adults from lower socio-economic groups are less likely to use professional dental services for their dental pain, so that interventions may be designed to improve access for this group of people. This should include an evaluation of the socio-cultural circumstances in which dental attendance is practised and the impact of the health system on dental attendance. Further research is also necessary to validate whether self-reported perceived need for dental treatment is correlated to dental need as determined by clinical examination. Since most dental pain is a consequence of caries, it is important to identify strategies to prevent caries in this vulnerable group.

Comment

The need for treatment to prevent pain or the need to have someone who can deal with it is one of the reasons why dental practices exist. This paper puts a figure on oral pain; 28% of adults in the previous 12 months had it according to the most recent Adult Dental Health Survey. Oral pain in a quarter of the population every year is a public health problem, but as the potential end point of dental disease, it is also fundamentally important for primary dental care.

This paper takes a very direct and straightforward approach to investigate the 'who' of toothache. Who gets it? The slightly misleading answer seems to be 'younger people from manual backgrounds'. This combination identifies a section of the population who do not use health services and who tend to have poor oral health behaviours, so preventing pain and delivering pain relief is something of a challenge. However, it would be wrong to interpret these findings as relating only to this group. A lot of people in all population groups suffered from oral pain, and oral pain is the most consistent negative influence on oral health related quality of life.1 This research is a start, but if we are going to reduce pain we will need to know the what, the where, the why, and perhaps particularly the 'how much does it cost?'

For clinicians, one of the consistent irritations of epidemiological research in orofacial pain is a lack of a clear diagnosis. 'Painful aching in the mouth' could cover a number of conditions that are not toothache at all, not least temporomandibular disorders. The data are necessarily imprecise and it is difficult to draw any firm conclusions about treatment needs. This lack of precision might not matter too much at this stage. From the point of view of the patient, what matters is the pain, and there is clearly still an awful lot of it.