Introduction
Dental health is linked in a great way to the general health of the whole body. The idea behind good oral health is not just in having sparkling white teeth. Studies have linked bad body health to oral problems. This then calls for each one of us to cultivate or seek to have good oral health. People with good oral health have been found to enjoy life more than those with bad oral health. In short, oral health plays an important role in determining the level of contentment in a person’s life. If for once we could pause and think about the discomfort that a person with stinking rotting teeth faces in a crowd, then one would see the reason why it’s such a great cause of discomfort. (Wilkinson & Pickett 2009)
The changing lifestyles among Americans and the world as a whole have been a big cause of oral health disparities among many people. (Watt, Daly, & Fuller 1996) Studies show that most of these people are the poor in society and those who are disadvantaged in one way or the other. This paper seeks to look at the determinants of oral health inequalities in the society. It also discusses how good public health can change correct these inequalities. The paper aims to get all the players in the dental field to appreciate the role played by good oral health and hence stay committed to promoting it. (Wilkinson & Pickett 2009)
To better understand oral health inequalities in a community, it would be prudent to first look at the social arrangement in our society. Today’s society considers things like race, income, education and ones sex as important things. Many Americans today classify themselves based on these factors. If one has a high income, he will have good housing and good general health. They will also definitely have good oral health as opposed to those people on the lower cadre of the society. Classes therefore become an important factor in formalising oral health disparities in a society. (Wihtehead 1987)
Oral health disparities in reality mean the inequalities that exist in oral diseases and the poor dental health conditions that are prevalent in certain groups in the society. As discussed earlier on, these groups will in most cases be classified based on race, gender, the income bracket they are in and the level of education they have attained. If we base oral health disparities to visits that people accord doctors, we may not get a clear picture of the situation as it is. This would just be like the scenario where women visit dentists regularly than men but they fail to do so during the crucial period of pregnancy. (Watt, & Sheiham 1999, p.11)
In most cases, determinants that contribute a large part of oral health inequalities are complex and interrelate. A good example of this is where people in a lower income bracket will be found to stay in areas where they can not have an access to a dental clinic. The same bracket of people will also be found to have low education and hence they will possess behaviour and practices that do not lead to good oral hygiene. These people will also be found to live lower lifestyles than their counterparts with better education. This phenomenon clearly shows that oral health is a complex matter that cannot be dealt with deal with social health disparities the stakeholders should be willing to look at all the factors in play. (Todd, & Lader 1991)
Issues that lead to oral health inequalities
One of the key things that have led to oral health disparities is the inequality that exists in providing health insurance. Today, one can access dental health care and treatment from public dental care or private dental health insurance. Private insurance provides a more comprehensive health care. This comprehensive plan focuses mainly on the prevention and cure. The private health providers also give education on good oral health care among other things. On the other hand, public health care is less comprehensive and it only focuses on prevention. As it is, it’s only a small number of people who can access both the public and private oral healthcare. (Sheiham 1991, p.363)
Recent research shows that providing free dental insurance significantly reduces oral health disparities. This is true especially when it focuses on children and the poor in the society. One thing that we should however know is that it’s not only in providing free health insurance that we can significantly reduce oral health disparities. Factors like culture, education level, and beliefs among many others play a key role in preventing poor people from getting access to oral care. This case is more pointed among Americans and Indian communities that live in Alaska. This people are not able to access oral healthcare despite the fact that it’s provided free in that area. (Slade, et al 1996, p.90)
There is a big rift between the technology that is available in promoting oral health care and its implementation. This scenario has increased the disparity in oral health among many people in our society. Though there have been tremendous changes effected on the technologies for providing things like and water and eliminating diseases, very little has been done in the field of promoting oral health among communities. This is partly due to the fact that the community has not taken measures to allocate resources geared toward reducing oral health inequalities in the community. Considering that oral health is one of the key issues in society, it is unfortunate to realize that resources that should be geared toward promoting oral health are not being allocated fairly in our society. (Schou, & Wight1994, p.99)
Research shows that oral health providers are doing very little in looking for ways aimed at reducing inequalities in oral health. The areas that these stake holders should look into should be on looking for ways to develop preventive technologies that can be used to reduce the current health disparities. Things like fluoride varnish that prevent tooth decay have not yet been effectively used in the U.S. This is owing to the stringent rules imposed by the Food and Drug Administration. These are rules that are aimed at protecting the health of the people from chemicals that could harm their health. (Sprod, Anderson, & Treasure1996)
The genesis of tooth decay can be traced back to infancy or early teenage age. The decay is usually as a result of a bacterium called mutans streptococci. Research shows that this bacterium can be easily transmitted from mothers to their children. This happens especially when a mother tastes food before giving it to young children. It can also be passed from other members of the family who might be infected by the same bacteria. This is just but one example through which dental diseases are carried on in the family and the community as a whole. This clearly shows that to eliminate the effects of this bacterium in a certain area, there is a need to insist on good oral health in the whole community. This approach should first focus on parents then the kids. This will be the only viable means of eliminating this certain type of bacteria in a certain area. (Sisson 2007, p.87)
The other factor that has in a great way promoted oral health inequalities is the difference in values and beliefs. While some people highly value the well being of their teeth, others find this to be a complete waste of time. For some people, the lack of money is the root cause for lack of dental hygiene. While these people would want to have good and strong teeth, their financial status limits or prohibits them from achieving this objective. A good example of this is in the way some people will visit dental clinics for regular check ups while others only visit a dentist when they have a dental problem. This is a problem that needs to be looked at if we are to achieve good dental health. (Sanders, Spencer, & Slade 2006, p.78)
Another factor that leads to dental health inequalities is the difference in beliefs of those who are working in the industry. While some of these people highly believe in maintaining good dental health, others have a different perception concerning the same. This is something that has to be addressed if we are to achieve good dental health. Some of the people in this industry may have the right attitude toward dental health but lack the means to achieve that goal. These are people like receptionists, drivers, and clerks among other people who in reality are not well paid and hence they can’t afford these services. (Sabbah, et al 2007, p.994)
Another thing that leads to dental health inequalities is the failure by medical schools to emphasize on the need of dental health in their institutions. Most students in dental schools just go through the motions of school but they fail to learn something that will change their way of viewing dental health. To them, the school is only meant to enhance their career but not something that will impact the world. It is not surprising to see that most dentists are one of the people who don’t maintain good care of their teeth. Most of these dentists are also only able to treat adults but not children. (Plamping, Bewley, & Gelbier 1985, p.263)
Another key factor that has led to inequalities in oral health is the existing differences in economic levels. As I had earlier pointed out, people on the lower economic scale can not afford the existing oral health insurance. This only leaves them with the public oral healthcare that does not cover everything. This denies them the opportunity for getting personalized treatment and the right medical care. The people also encounter myriad problems in trying to get this care. A visit to the doctors may need bus fare that may not be easily gotten. For those who are employed, getting their bosses to approve time off from work may be hard. Considering that to them many things are hard to come by, they will have other pressing needs that need money and this will most likely get priority over dental health care. These among a host of other problems prevent people from poor communities from getting access on oral healthcare. (Palmqvist 1986, p.135)
Looking at the healthcare itself, one does not fail to see that the system is discriminative to some people in the society. Some of the people in this category include the poor, ladies and marginal groups in the country. The oral health providers and who might be biased toward these groups of people in a big way prevent them from assessing oral healthcare. These stakeholders include dentists and other key players in the sector. Their business keeps people from assessing oral healthcare and hence leads to inequalities in oral healthcare. There is a need to change this to ensure that all people can access proper healthcare. (O’Brien 1994)
Most of the problems bedeviling our country today have their genesis in our political system. Looking closely, one does not fail to see the hand of politics in the current problems facing the inequalities in oral healthcare. Politicians in our country influence the provision of crucial services that shape our lives. Some of these decisions are on oral healthcare. These politicians determine how wealth and resources are distributed in our society. The unequal distributions of these resources are the root cause of the problems we are encountering today in this sector. This inequality in the distribution of resources has led to poverty among the minority groups. This has adversely affected their ability to access good dental healthcare. A good way that politicians can help in reducing the inequalities in the dental healthcare is by allocating money from the budget toward building facilities that provide dental healthcare. If our politicians would take the issue of dental healthcare seriously, we would be a step closer toward the reduction of dental health inequalities in the society. (Nadanovsky, & Sheiham 1995, p.236)
As I had mentioned earlier, the level of education in any given society plays a crucial role in determining the level of dental hygiene for that particular group of people. People with good education will land good jobs that are well paying. This will in reality enable them to afford the dental health insurance that is beyond reach for many people. People with little or no education find it hard to land jobs hence making it hard for them to afford the required fees in attaining oral health care. This makes education or the lack of it an important aspect that contributes to the promotion or reduction of oral health inequalities in the society. (López, Fernández, & Baelum 2006, p.185)
Still on the aspect of education, educated people have been found to appreciate good oral health unlike their counterparts who are not educated. This is due to the fact that educated people will have at one time during the cause of their education have been taught on the importance of good oral health. This makes them know the importance of maintaining good oral healthcare. Since they can interact and fit almost anywhere in the society, it will be easy for them to get the best oral healthcare that is available in the market. This fact among others makes education play an express role in reducing the oral health disparities in our society. (Kay, & Locker 1997)
Another factor that increases inequalities in oral healthcare is the issue of age. Children and the elderly are more vulnerable when it comes to getting oral diseases. The elderly particularly rely on the help of other people to get things done. The United States alone has well over thirty four million elderly people. These people usually suffer from numerous health complications and they are very sensitive to different clinical conditions. Their oral health needs to be taken care of in a very efficient way. Today, no set mechanism seeks to provide adequate oral care to the elderly. Most of the people in this group are pensioners who do not get much at the end of the day. This makes it hard for them to get personalized oral healthcare. This issue should be addressed with urgency if we are to achieve the required balance in oral healthcare. (Locker 1993, p.141)
As it was discussed earlier, the bacterium that causes tooth decay is easily transmitted between different people. Those in most risk of transferring this disease are parents to their children. Parents should therefore be taught on the importance of good oral healthcare. When parents have good dental hygiene it is most likely that this trend will be moved on to their children. It is therefore important for the government to set up modalities that seek to teach the importance of good oral healthcare to pregnant and nursing mothers. This would effectively reduce the number of transmission of oral problems between parents and children. This would in turn be a big step toward reducing the existing oral health inequalities. (Kay, & Locker 1996, p.233)
The government needs to come up with a study geared toward promoting good oral healthcare to people in some settings. A good example of this is for people in prison. A very recent research on the matter shows that many people in prison do not have an access to good oral healthcare. Most people in these correctional facilities take cigarettes which are not only bad for their general health but they are bad for their oral health. This is a big way to increase the existing inequalities in oral healthcare. If we as a nation are serious on reducing these inequalities this is a group that should not be ignored. (Jones, et al 1997, p.152)
The coming of technology has adversely affected our oral healthcare. Looking at the traditional way of living and the way people live today, one will not fail to notice the difference that exists between the dietary habits back then and that of today. Most people in our current society today smoke. Smoking has in a very big way been linked to poor oral health. The fact that many people are abusing alcohol is not helping the matter any better. Components in alcohol have been found to contribute largely to poor oral healthcare. (Greenberg, et al 1991, p.195)
Another key factor that increases or reduces oral diseases is like foods we take. Most of us today take sweetened foods that have been largely linked to numerous dental diseases. The practise is common among more vulnerable school kids. The fact is complicated by the fact that all of us have passed through school at one time or the other. If due care is not taken, we will be building a nation that is bedeviled by numerous oral problems. Taking foods that are rich in calcium have also been found to strengthen our teeth in a big way. The real challenge of this is that getting these foods is a real thorny issue for many people. These foods are expensive hence making them be out of reach for many people who are still suffering from the effects of the current global recession. Unless something is done and with urgency on changing our lifestyles, these inequalities will continue to exist. (Benzeval, Judge, & Whitehead 1995)
The Solution
As it is, there is a dire need for the government to come up with quick solutions on the factors that are causing these inequalities. By looking closely at these issues, we are bound to see the interrelation that exists between all of them. This makes it almost impossible to deal with one side of the issue without dealing with the other. The government should come up with ways to effectively deal with these issues once and for all. Failure to do this will see us dealing with a nation of weaklings who are unable to help themselves in any way. (Archeson 1998)
As we have seen, poverty is the key thing that leads to these inequalities. It is therefore important to come up with measures that seek to reduce the levels of poverty in the society. The government should provide opportunities geared toward emancipating all the members of the society. If all the people are empowered economically, so many things will change in this country. It is important to know that none of us wants to have bad oral health. The means to fight these diseases however deter many people from effectively attaining good oral healthcare. (Armfield 2007, p.121)
The Food and Drug Association should also allow fluoridisation since it has been found to reduce oral problems. Recent research shows that many people and especially children living in fluoridated area have a high chance of contracting oral diseases as compared to their counterparts in non fluoridated areas. This study has also shown that exposure to fluorine significantly reduces the chances of oral infections. This should be a wake up call to all the stake holders to do something before the situation gets out of hand. (Antunes, Narvai, & Nugent 2004, p.46)
Conclusion
Most problems that people experience today can be linked to poor oral healthcare. This calls for every one of us to rise and look for ways that we can use to reduce the inequalities existing in this field. The big onus however lies with the government that should come up with modalities to reduce the rate of poverty in our country since it is the root cause of the many inequalities existing in oral healthcare in our society. This should be done with urgency before we come to a point where the situation will have gone out of hand.
If this is to be achieved, all of us will have to play a vital role in achieving this objective. At the end of the day, we will only have ourselves to blame if we don’t rise and do something now. These efforts should come from individuals, the family and finally the government. If we fail to do this we will be raising children whose oral health will be highly compromised. A strong man will give his all toward building his country. On the contrary, someone who has problems in his health will not be so effective when it comes to nation building. Looking for ways to reduce the inequalities that exist in oral healthcare will be a good way to ensure that all of us are actively involved in nation building.
References List
Antunes LJF, Narvai PC, Nugent ZJ. 2004, ‘Measuring inequalities in the distribution of dental caries’, Community Dent Oral Epidemol, vol. 32, pp. 41–48.
Armfield, J.M. 2007, ‘Socioeconomic inequalities in child oral health: a comparison of discrete and composite area-based measures’, Journal of Public Health Dentistry, vol. 67,no.2,pp. 119-125.
Archeson, D. 1998, Independent Inquiry into Inequalities in Health, Stationery Office Chairman, London.
Benzeval M, Judge K, & Whitehead M. 1995, Tackling inequalities in health: An agenda for action, London: Kings Fund.
Greenberg R S, Haber M J, Scott Clark W, Brockman E, Liff JM, et al. 1991, ‘The relation of socioeconomic status to oral and pharyngeal cancer’, Epidemiology, vol. 2, pp.194–200.
Jones C, Taylor G, Woods K, Whittle G, Evans D, Young P. 1997,’Jarman underprivileged area scores, tooth decay and the effect of water fluoridation,’ COM Dent Health,vol.14,pp. 150-160.
Kay L, Locker D. 1996, ‘Is dental health education effective? A systematic review of current evidence’, Com Dent Oral Epidemiol, vol. 24, pp. 231–235.
Kay L, Locker D. 1997, Effectiveness of oral health promotion, Health Education Authority: a review, London.
Locker, D. 1993, ‘Measuring social inequality in dental health services research: individual, household and area-based measures’, Com Dent Health, vol.10,pp 139–150.
López R, Fernández O, Baelum V. 2006, ‘Social gradients in periodontal diseases among adolescents,’ Community Dent Oral Epidemiol, vol. 34, pp. 184–196.
Nadanovsky P, Sheiham A. 1995, ‘The relative contribution of dental services to the changes in caries levels of 12 year-old children in 18 industrialized countries in the 1970s and early 1980s’, Com Dent Oral Epid, vol. 23, pp. 231–239.
O’Brien M. 1994, Children’s dental health in the United Kingdom 1993, London: HMSO.
Palmqvist S. 1986, ‘Oral Health patterns in a Swedish population aged 65 and above’, Swedish Dent J; Suppl, vol. 32, pp. 1–140.
Plamping D, Bewley R N, & Gelbier S. 1985, ‘Dental health and ethnicity’, Br Dent J, vol.158, pp. 261–263.
Sabbah W, Tsakos G, Chandola T, Sheiham A, Watt RG. 2007, ‘Social gradients in oral and general health’, J Dent Res, vol. 86, pp. 992–996.
Sanders AE, Spencer AJ, Slade GD 2006, ‘Evaluating the role of dental behaviors in oral health inequalities’, Community Dent Oral Epidemiol, vol. 34,pp. 71–79.
Sisson, K.L. 2007, ‘Theoretical explanations for social inequalities in oral health’, Community Dentistry & Oral Epidemiology, vol.35, no.2, pp. 81-88.
Sisson, K.L. 2007, ‘Theoretical explanations for social inequalities in oral health’, Community Dent Oral Epidemiol, vol.35, no.2, pp.81-88 available from: PM: 17331149.
Sprod A, Anderson R, Treasure E. 1996, Effective oral health promotion. Literature Review, Cardiff, Health Promotion Wales.
Schou L, Wight C. 1994, ‘Does dental health education affect inequalities in dental health?’ Com Dent Health, vol.11, pp. 97–100.
Slade GD, Spencer A J, Davies M J, Stewart J F. 1996, ‘Influence of exposure to fluoridated water on socioeconomic inequalities in children’s caries exposure’, COM Dent Oral Epidemiol,vol.24,pp. 89–100.
Sheiham A. 1991, ‘Public health aspects of periodontal diseases in Europe’, J Clin Periodontology, vol.8, pp.362–369.
Todd J E, Lader D. 1991, Adult dental health 1988 United Kingdom, London: HMSO.
Watt, R. & Sheiham, A. 1999,’ Inequalities in oral health: a review of the evidence and recommendations for action’, Br Dent J, vol.187, no.1, pp. 6-12 available from: PM: 10452185
Watt R G, Daly B, Fuller S 1996, Strengthening oral health promotion in the commissioning process, Manchester, Eden Bianchi Press.
Wihtehead, M.1987, The Health Divide. Inequalities in the 1980s, Health Education Authority, London.
Wilkinson RG, Pickett K.E. 2009, The Spirit Level: why more equal societies almost do better, Penguin Group: England, London.