The Main Determinants of Oral Health Inequalities - Essay Example

of ORAL HEALTH INEQUALITIES INTRODUCTION TO ORAL HEALTH AND ORAL HEALTH INEQUALITIES According to Department of Health 2004, oral health is an important part of human body and its care is equally important as compared to any other body part. According to CDA, oral health is defined as the “standard of health of the oral and related tissues which enables an individual to eat, speak and socialize without active disease, discomfort, or embarrassment and which contributes to general well-being.” The above definition clearly mentions that oral health can only be attained when an individual is free from any kind of disease or discomfort. Further he faces no problems in communicating, eating, speaking and socializing within the society. Just as healthy body contributes in creating sound mind, similarly oral health is essential in maintaining a healthy body (Audobato, 2009). Due to this it can be stated that oral health and healthy body have a positive connection with each other. Surgeon David reported oral health as ‘silent epidemics’ and emphasized on the importance of oral health by creating a strong connection of oral health with other diseases. A human mouth is the main portal of a human body and bacteria which is present in the mouth causes and creates different systematic conditions. According to the doctors, dentists and physicians every part of the body is linked with each other. Thus if any problem exists in the mouth area then it causes adverse affects all over the body (Donaghy, 2006). An oral health disease also causes harmful effects on the physical and psychological well beings of the people and this further affects the overall quality of life. According to the study conducted in America it has been stated that 23% of 65-74 year age group suffer from severe periodontal diseases. But not all of them get cured because this facility is not provided to all as 5 % of the aged Americans live in long-term care facility where the this facility is not provided to them, thus inequality in oral health prevails. Generally individuals are reluctant in getting their oral problems cured because of the general cost associated with oral health, i.e. oral health issues are expensive to cure. The cost factor is the biggest factor for individual’s unwillingness all over the world. Thus, Oral health knowledge and awareness is not only important for the well being of the individuals but also for the well being of the society. A large population today enjoys all the services of dental and they are being taken care of their every oral health related problem. But with deep grief there still exists a true population who are being deprived from availing such medical care services. Alone in UK lies example where many individuals are deprived thus leading to poor dental health among them. Even though there has been a lot of improvement in this sector but inequality still remains to a large extent. According to the survey conducted by ADULT Dental Health 1998 it has been reported that oral health problems exist because of deprivation of oral health facilities in some specific areas. Inequalities are not just prevalent in UK, but it crosses over to Scotland, Wales, northern Iceland and a lot of parts of England. In Scotland it has been researched that dental diseases are maintaining caused due to deprivation. In Wales, 50 % oral health inequality exists. Oral health inequalities are present all over the world in all groups of ages, from the very small child to the elder most people in the society. ORAL HEALTH DISEASES There are a lot of wrong perceptions in related to oral health, as a larger population just believes that oral health are related to just cavity fillings. Oral health issues vary with the intensity level, such as periodontal (several forms of gum diseases), burning mouth syndrome, Clept lip and palate, dry mouth (Xerostomia), fillings (amalgams), Fluoride, genetics, saliva and salivary gland disorders, sealants, taste disorders, TMJ disorders (Temporomandibular Joint and Muscle Disorders) and other tooth decay are some of the common oral health issues that dentists face every day in their life. Gingivitis is another common dental problem and is a type of a gum disease that causes inflammation to the gums. Generally children are often faced with gingivitis and other cavity problems. Similarly women are also faced with oral health problems; American Dental Association 2006 compiled a report in which it stated that women and girls often experience mild cases of gingivitis at the time of puberty and menses. Apart from the gum and cavity problems often people are faced with mouth sores and infections, such as thrush (Candidiasis), Oral Hairy Leukoplakia and mouth ulcers. Some of the major and complex oral health problems are oral cancer. It has been researched that approximately 35,000 Americans every year are diagnosed with oral cancer in their mouth or part of the throat. Generally oral cancer is caused by extensive use of alcohol or tobacco. But this disease can easily be identified and cured but for only those people who have regular dental check-ups. The basic symptoms of oral cancer are formation of soars, swelling, numbness in the mouth or throat or even when an individual faces difficulty in eating or swallowing eatables. This disease can easily be cured but regular check up is extremely important. But above all, the risk can be attained by avoiding tobacco products, moderate consumption of alcohol, eating and including some natural compounds in the diet such as dietary selenium, folate, vitamin A, C and E. These nutrients have helped in cancer developments. While lifestyles, ethnic and other genetic susceptibility have also acted as modifying factor which are helping in guiding the patients care. The oral cancer can be diagnosed and detected through observation, biopsy and now through a recent new technology ‘Chemoluminescent light’ (Scuibba, 2001). But at a general approach, this disease can be handled by spreading awareness by launching different awareness programs all over the world. Students are advised to get their regular check up every six months so that even if any oral health issues are arising they could be cured at the right time. Students are also advised to brush their teeth two times a day and after every 3-4 months they are advised to change their tooth brush. Using of floss and rinsing your mouth should be made regular. The students who had dry mouth were suggested to use artificial saliva. But among all the best part is to do self-assessment of your mouth, check for any discrepancies and if one finds any then the best action is to get it checked as soon as possible (Nevollo, 2004). Oral Health Inequalities in Children Even then, today a large population of the children is deprived of the basic knowledge and dental services and due to this they experience dental problems. As mentioned early that children alone account to a large population who experience tooth decay, gum infections and gravities. The statistics of the deprived population varies with different countries (Armfield, 2007).According to Children health survey 2003 the finding stated the clear distinction of oral health inequality. The reports revealed that children in the deprived areas of UK experienced more tooth decay as compared to the children who were studying in non-deprived areas. Further, the study elaborated that 60 percent of five year old and eight year old primary students in the deprived areas accounted to 60 percent and 70 percent of tooth decay in their primary milk teeth. While on the other hand, non-deprived areas the situation was quite better as only 40 percent and 55 percent primary experienced bad tooth decay. According to another survey children of age range 1-4 years were facing oral health inequalities as 40 % of the manual social class children faced decay problems while in the non manual areas oral health diseases were only 16% (Watt & Sheiham, 1999). In Scotland, deprivation categories or DepCat scores have been established; this index has been established to measure the relationship between social deprivation and dental decay in children. The DepCat score runs from DepCat1, i.e. most prosperous to Depcat 7 least prosperous. National Dental Inspection Programme 2006 found out that 60 percent children in the non-deprived areas experienced no tooth decay while only 31 percent of the children from DepCat 7 had no tooth decay experience. Due to this the Scottish government strongly believed and highlighted and emphasized on the standards of oral health and implemented an action plan better health better care. Further the report stated that children who experience tooth or oral health issues in their child hood often experience problems even in their adult life. So to prevent bad tooth decay preventions should be made and due to this a child should establish good habits in terms of its diet and should take proper precautionary measures from its early age (Antunes, Narvai &Nugent, 2004). In Wales oral health inequality presents between the two social classes, i.e. the deprived children belong to the lower class while children from the high class have teeth and gums. Thus to remove the poverty gap, dental targets are set in Wales for 2020 under the strategy “eradicating child poverty in Wales-measuring success’. National child oral health improvement programme introduced a smile programme and super pilot tooth brushing scheme was also introduced in north and east south Wales. The social inequality gap had increased 1983- 1994 from 0.9 to 1.4 among the 15 yr old children. But there are severe periodontal diseases present in children of Asian and African Caribbean as compared to other developed countries (Watt & Sheiham, 1999). Inequalities also exist on the basis of ethnic minority groups and new immigrant community because this group is not aware of the dental issues. Periodontal disease and dental trauma are the two main dental conditions that are causing inequality among the social class and ethnicity, as individuals living in the lower social class areas suffer from more intense periodontal disease than as compared to the higher classes. Similar programmes were carried out in Northern Iceland where in 2003 fluoride toothpaste scheme was aimed at schools and children. Different dentists, organizations, breakfast clubs, schools started different healthy programmes to promote oral health in children and also reduce the inequalities among the children. Due to this some of the leading dentists call for free service because the |N|HS doctors believe that helping reduce oral health would benefit the whole society (Brindley, 2008). Oral Health Inequalities in Older People With the change in technological advancements in the field of medicine and other improvements in have lead to high life expectancy, falling birth rates and high growth in aged population. It has been estimated that by 2020 the number of aged people will rise from 15.percent to 18.9 percent. But only a small portion of the population can account to earn their own living while the rest of them are dependant on nursing and the care homes ( Lopez, Fernandez & Baelum, 2006). Due to this two types of older people are prevalent in the society, one who are living in their own homes and second who are dependent on the clinical needs of the government or other care homes. Among these two classes of older people oral health inequalities are also present. National Diet and nutrient survey of older people demonstrated that older people who were living on their own living had better healthy conditions than as compared to the ones living in institutions. Similar is the case with oral health problems thus it can be stated that oral health inequalities also exist in the older population as well. But different organizations are trying to eliminate this gap by providing the dependent population the essential services and oral treatments. NHS and residential oral care in Sheffield programme are making a lot of contribution by collaborating between senior dentists oral health promotions and dental public health so that the elder population could he delivered with training, screening and dental treatment programmes. Another type of inequality among the older population exists, i.e. disparity is made on the basis of the disposable income of the wealthier older people to the poor section of the population. The wealthier population could fund their own dental treatments while the lower population would be unable to attain dental services. Older patients generally need dental services in retaining their natural teeth and the dental problems such as root caries and dry mouth. Some older population would also acquire and take advantage of the cosmetic procedures while the others would even fail to avail the basic dental treatments. But efforts are being made to eliminate all such oral inequalities and efforts are made to accommodate all the older population. Due to this Oral Health care for older people 2020 Vision stated certain recommendations through which all older people will be accommodated and all their oral health issues would be resolved. Thus efforts will be made on the national level to eliminate oral inequality among the older population. Inequalities in Ethnic Group Inequalities also exist on the basis of ethnic minority groups and new immigrant community because this group is not aware of the dental issues. Periodontal disease and dental trauma are the two main dental conditions that are causing inequality among the social class and ethnicity, as individuals living in the lower social class areas suffer from more intense periodontal disease than as compared to the higher classes (Watt & Sheiham, 1999). Generally the minority section of the population in any country faces inequalities, but there has been an opposite trend seen in UK as the children of Asia and Afro-Caribbean origin had almost the same decay problems as compared to the White. Due to this it can be stated that there is no difference in oral health among the minority ethnic groups. While national, regional, district inequalities prevail in the market, due to this health inequalities especially oral health inequalities present. In United Kingdom, inequalities are more prevalent in the older children (Watt & Sheiham, 1999). According to the study conducted in Britain, a Black report was generated that emphasized and concluded that even in Britain inequalities existed in terms of social classes and geographical regions. These inequalities and differences were seen mainly in oral health. Different inequalities existed not only within the Britain boundaries but inequality prevails among different countries. As most of the countries especially developing nations like Africa and South Asian countries have limited access to treatment services such as oral cancer, and even the minor services are not provided to the general public. Further the results showed a clear rise in the oral diseases among he most highly and the least socio-economically developed nations. Among the most destructive diseases periodontitis and oral cancer had the highest contribution. And according to the study conducted it was revealed that dental plague, smoking and alcohol consumption had a strong association. Due to this in the developing nations where there is poor access to water, tooth brush and toothpastes have high dental plague. The reason behind this inequality is that the service treatments are not prevalent in these areas. Similarly like periodontal disease smoking and alcohol consumption, oral cancers also have strong association with them. Further, while referring to inequalities among the nations it would be very important to mention that not only individual variations accounts for inequality but if society structure issues also make a contribution in reducing disparities in oral health (Hobdell et al, 2003). Adult male and female Generally, there is not much difference between the two genders, as both male and female have 21 or more teeth, i.e. both 80 % have similar figures. Further, the mean number of missing teeth males and females is also similar, i.e. 7.6 for males and 7.9 for females (Watt & Sheiham, 1999). But it is stated that females have less periodontal disease than males. Further, twenty five percent of the females were edentulous while males only accounted to 16% (Watt & Sheiham, 1999). Smoking/ alchohol/ oral hygyine DETERMINANTS OF ORAL HEALTH INEQUALITIES Even though there has been so much advancement made in the field of medicine and oral health but still social inequalities prevail in the market dividing the world into two halves deprives and non-deprived areas. Social inequality is the most unjust and unfair and they should be minimized to achieve better results. According to Sisson (2007) there are four major causes of social inequalities in oral health, i.e. the materialist explanation, culture/behavioral explanation, life course perspective and psychosocial perspective. Materialistic explanation refers to role of external environment and those certain external factors which cannot be controlled. This approach emphasizes on the fact that income and education are not directly responsible for inequalities in health but individual position in the social structure are the key determinants that lead to inequalities. In referring to the dental services materialistic factors are linked in two ways, i.e. the cost of the treatment and the cost incurred in accessing the treatment. Social inequality is remains as perspective to the dental services provided to the industrialized countries, where as the non-industrialized areas population neither get access to the services neither they can afford to avail the dental treatments. This inequality also prevails when comparing the developing countries with the developed countries, where most of the citizens of the developing countries cannot even afford the high cost of treatment due to this they are face and suffer from complex situation in oral health. Further Sisson links the behavior to the healthy conditions. Often people who are engaged in low socioeconomic backgrounds damage their health more as compared to higher socioeconomic backgrounds. The indulge themselves in health damaging behaviors such as poor diet, lack of exercise, smoking, high consumption of alcohol, thus this leads them to higher level of disease and low quality life. Similarly, cultural factor stands opposite to the behavior approach and offsets the understanding because according to this theory the cultural norms of behavior determine the behavior choices. Thus this proves that behavior approach can only be used when culture would let it, i.e. cultural norms of behavior influence the behavior patterns of an individual. Further in the life course perspective explains that health inequalities result from the interaction of materialistic, behavioral, and psychosocial factors. (Sander et al, 2006). According to these perspective two popular models, i.e. the accumulation model and critical periods/ latent affect model stands. The psychosocial perspective believes that all health inequalities result due to psychological stress which is experienced in different phases between different socioeconomic groups. This theory further states that all individuals who belong to lower socio economic background experience high stress, high negative events, low social support from society and family, less control in their personal and professional life, low job security, live in high crime area and the trust element in also very low. Stress causes a direct and indirect effect on the lives of the individuals but the indirect stress causes more severe psychological stress that damages the health of an individual (Sisson, 2007). There are different determinants of oral health inequalities, such as Socio-economic factors are the key determinants of oral health inequalities. These include deprivation, age, gender, ethnicity, environment, psycho-social, poverty and lifestyle. STRATEGY TO REDUCE ORAL HEALTH INEQUALITIES Reduction in oral health inequalities can only be attained when the main causes of oral health disease are tackled properly. Thus the first step in reducing oral health inequalities is to first understand and recognize the oral health wide determinants, i.e. from individual lifestyle factors to environmental factors (Crosse, 2009). There are different methods to reduce oral health inequalities, as referring to the materialistic aspect where non-industrialized population or the developing nations cannot afford the dental or oral treatment. So keeping in view the high cost of treatment associated with dental health treatment a cost effective remedy can prove to be effective for the patients, i.e. use of water fluoridation. This method prevents dental care and this is a natural and environmental determinant which would not manipulate the social structure of the individuals. This technique does not even include the income and education perspective because it is a political and ethical issue and thus it can help in reducing oral health inequalities. Further water fluoridation is a very effective prevention strategy in reducing oral health inequalities in population because fluoride could be targeted through water fluoridation, tooth brushing campaigns, fluoride rinses or it could be added to milk. In all these ways the biggest advantage would be that it would easily reachable to the society without changing the lifestyle. Similarly Brazil also implemented t the water fluoridation to its water system. In 1990’s high level and high intensity of dental care prevailed in Sao Paulo the most populous and industrialized Brazilian state. According to the gathered information from 237 towns in Sao Paulo 40% of the town was indulging in oral health related problems. But the indices decreased when the Brazilian government implemented the water fluoridation in the tap water thus there was a major reform occurred in its oral health system. Further, oral health education was provided to the general public thus increasing the dental care and preventive dental treatments to children. (Antunes et al, 2004) Inequalities in the oral dental can also be removed through consumption of fluoridated toothpastes and non-milk extrinsic sugars, i.e. NMES. Thus implementing this strategy would minimize the inequality from the social, economic and environmental factors as well. Further more heath inequalities can also be reduced by implementing effective and appropriate oral health promotion policy. Implementing health related public policies would identify the key social and societal variables and thus it would improve the population. Societies inequalities can be minimized through improving the overall general quality of living and as well improve the population health as well. Due to their low disposable income of the older population they should be provided free dental check ups so the gap of inequality could be reduced (Brindley,2007).The general population standards could be increased through successful child development strengthens the community cohesion, enhance self-fulfillment, increase the socioeconomic well being and modulate the hierarchical structuring (Hodel et al, 2003). Some of the other factors in reducing oral health inequalities is through creating awareness among the younger generation by introducing different healthy public policies, developing personal skills, reorienting health services and strengthening the community action. According to different researches it is stated that integrating oral health promotions with the generic health promotions is the most effective and efficient method. As promoting oral health reduces oral health inequalities to a high extend. (Crosse, 2009).WHO health promoting schools, Schools meals campaign and school nutrition action groups (SNAG) are making huge contribution in decreasing the oral health problems and likewise they are also making efforts to decrease the inequalities related to oral health. The department of education is enhancing and expanding its health promoting schools programs by including all schools in the socially deprived locations. (Watt & Sheiham, 1999). NHS Cambridge shire and NHS Peterborough are the primary care trusts are also making efforts in improving the oral health to reduce oral health inequalities. Due to this they are expanding their treatment services so everyone can get access to the oral health facilities (Crosse, 2009). A healthy public policy should be created and minister of public health should create national and local food policies. They should ensure that there is reduction in the total consumption of non milk extrinsic sugars and proper nutritional guidelines should be included in the guidelines of nursery school meals, school meals and guidelines for food in residential homes (Watt & Sheiham, 1999). Common risk factor approach is another effective strategy to reduce oral health inequalities. This approach stresses on tackling the common risk factors and conditions that are shared by chronic non-communicable diseases. Some of the common risk factors are use of tobacco, poor diet, consumption of alcohol, stress, injuries, poor hygiene and inactive lifestyle. Thus solving these factors would not only reduce oral diseases but other serious illness that are associated with oral health such as cancers, heart strokes, mental illness etc. (Crosse, 2009). Smoking policy should be made stricter and actions should be made by the government to prevent the selling and consumption of smoking. Further marketing and advertising of cigarette industry should be discouraged. Thus reducing smoking rates would minimize the social, political and economic factors associated with the oral health inequalities. Just like cigarettes, paan have the similar effect on oral health, the usage of Paan is more prevalent in the South Asian Countries so thus government should make restriction on the sale and promotion of tobacco. Further reorienting health services include the role of the service commissioner, where he plays a key role in promoting and developing such policies that reduce the oral health inequalities. Then finally strengthening the community action could be achieved through community development programmes and this approach would help in lowering the society inequalities because according to this programme, workers among the socially deprived groups are facilitated and their oral health is improved. 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