Evidence summary: do people living in deprived areas define oral health differently from people who live in less deprived areas?

Key Points

• Deprived areas: city, urban, rural or suburban areas which are characterised by relative economic impoverishment and by accompanying physical and social decay.

• Oral health: the optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease.

Abstract

Since August 2009, members of the Primary Care Dentistry Research Forum (http://www.dentistryresearch.org) have taken part in an online vote to identify questions in day-to-day practise that they felt most needed to be answered with conclusive research. The question which received the most votes formed the subject of a critical appraisal of the relevant literature. Each month a new round of voting takes place to decide which further questions will be reviewed. Dental practitioners and dental care professionals are encouraged to take part in the voting and submit their own questions to be included in the vote by joining the website.

This paper details a summary of the findings of the fifth critical appraisal. The results of the critical appraisal conclude that there is a lack of evidence relating to perceptions of oral health in deprived areas. There were no studies identified that have compared the perceptions of oral health among people from deprived areas with those from non-deprived areas in the UK.

Background

'An unacceptable and growing chasm exists in the UK between those with good and poor dental health'.¹ Poor oral health has long been linked with socioeconomic status.^2,3 Increasingly, classification of individuals according to census data on the level of material deprivation in their neighbourhood is the measure used.⁴

The recent Marmot Review,⁵ which highlights the wider determinants of health, evidences a social gradient in general health: the lower a person's social position, the poorer their health. Solutions predicated upon universal fairness and justice are increasingly proposed,⁶ with local-level (individual and community) participatory decision-making.

Understanding peoples' views and attitudes is important to designing policies for health improvements. Aspects of oral health perception have been explored in relation to general health,⁷ specific population groups^8,9,10,11 or quality of life,¹² or in people with differing dental health status.¹³ It appears that 'oral health is subject to highly variable personal values and attitudes'¹⁴ such that 'in the eyes of the patient, good oral health can vary from absence of pain to the desire for a perfect smile'. So, are these variations in perception of oral health associated with living in a deprived or non-deprived area?

Perceptions of oral health may be collected using qualitative research methods that include open questions. To explore the specific context this review question poses, the qualitative data on respondents' oral health perceptions would need to be analysed using any index of respondents' socioeconomic status, and with a comparative analysis.

Aim

This review aimed to identify, evaluate and summarise primary research studies which report the views or perceptions of oral health of people living in UK deprived areas or households, and in comparison with those living in non-deprived areas or households.

Review Method

An initial search was made of Ovid MEDLINE(R) (1950 to week 3, January 2010) using the search terms socioeconomic factors or poverty areas; oral health, or attitude, or perception, or beliefs towards health, or self-concept; focus groups, interviews, questionnaires; UK. One hundred and fifty-two papers were identified and all 152 were excluded.

Further searches included CEBD, Cochrane Oral Health Group, CRD, ADA, TRIP database, National Library for Public Health, DARE, NHS Evidence, social sciences databases (Science Direct, ASSIA (CSA), Web of Science, EBSCO, SwetsWise), and individual journal searches including Evidence-Based Dentistry and the Journal of Evidence-Based Dental Practice. Three papers were identified and three excluded.

Findings

One hundred and fifty-five titles and abstracts arising from the web-based searches were screened. Fourteen potentially relevant papers were retrieved as full text and reviewed. Ultimately none of these 14 papers provided relevant findings.

We could find no studies that have compared the perceptions of oral health among people from deprived areas with those from non-deprived areas in the UK. Nor could we find any studies which just reported the perceptions of oral health of people in deprived areas in the UK when accessed using open question data collection approaches.

A recent study in Montreal, Canada, reported upon how people on social assistance perceive and experience oral health, and their strategies to improve oral health.¹⁵ Although non-comparative and therefore not addressing this review question, it illustrates the potential to apply qualitative, open research methods, in this case focus groups and semi-structured interviews with thematic analysis, to access insights into oral health perceptions in a group defined by social status.

Conclusion

There is a clear gap in our knowledge of the variations in individuals' and communities' perceptions of oral health, including within and between different areas, to support policy developments aimed at 'meeting the oral health needs of the population effectively'.¹⁶