Keywords
Deprivation
Oral Health
Correlation
Regression Analysis
Prevention
Categories
How to Cite
Abstract
Introduction: Reducing social inequality along with oral health inequality in Wales is a policy objective. In this ecological study the relationships between deprivation, dental workforce and oral health are explored.
Method: Twenty two Unitary Authorities (UAs) serving the population of Wales were studied. The number of dentists were obtained from NHS Business Services as well as the 2019 population figures from StatsWales. As data for whole time equivalent General Dental Practitioner (GDP) workforce were not available, GDP sites were used. The condition of teeth at the age 12 years was used as a measure of oral health from the most recent epidemiological survey available. The relationship between oral health and workforce was established using the Welsh Index of Multiple Deprivation (WIMD).
Results: Associations were observed between dental sites and population as well as between oral health and deprivation. A new composite variable called the University of South Wales Dental Index (USWDI) was introduced by combining the number of dentists with their corresponding WIMD of the most deprived 10% of the population. Using regression modelling the USWDI demonstrated its superiority in using either the number of dentists or the WIMD most deprived 10% alone to predict decayed, missing and filled teeth (DMFT).
Conclusion: Workforce levels have increased and there has been a corresponding improvement in oral health over two decades. At the same time deprived subgroups continue to experience relatively higher levels of disease. A proportion of the general dental services delivered in Wales has continued to be based on the principle of supply induced demand for care rather than oral health need. Improving oral health in a diverse population like Wales cannot be achieved by increasing dental workforce alone. It is necessary to account for levels of deprivation. USWDI as a predictor of DMFT could be a useful tool to monitor the macro delivery of oral health care for the future in Wales.
References
Kelly M, Steele J, Nuttall NM, Bradnock G, Morris J, Nunn J, et al. Adult Dental Health Survey: Oral Health in the United Kingdom.The Stationary Office: London; 2000.
Jones CM. Capitation registration and social deprivation inEngland. An inverse 'dental' care law? Br Dent J. 2001;190:203-206. https://doi.org/10.1038/sj.bdj.4800925
Public Health England. Health Matters: Child Dental Health. 2017 . [Published 14 June 2017]. Available from: https://www.gov.uk/government/publications/health-matters-child-dental-health
Appleby J, Reed R, Merry L. Root Causes Qualityand Inequality in Dental Health. The health Foundation Nuffield Trust. [Published 2 November 2017] Available from: https://www.nuffieldtrust.org.uk/
Watt R, Sheiham A. Inequalities In Oral Health: A Review of the Evidence and Recommendations for Action. Br Dent J. 1999;187: 6-12. https://doi.org/10.1038/sj.bdj.4800191
Casals E, Gomez A, Cuenca E. Trends in workforce and Utilisation of Dental Services in Catalonia Session C1Health Services Research 8th Annual Conference of The European Association of Dental Public Health Jyvaskyla Finland.
Birch S. The identification of supplier inducement in a fixedprice system of healthcare provision: the case of dentistry inthe United Kingdom. Journal of Health Economics.1988;7(2):129-150. https://doi.org/10.1016/0167-6296(88)90012-4
Oliver A. Reforming Public Sector Dentistry in the UK.British Journal of Health Care Management.2002; 8 (6):212-216. https://doi.org/10.12968/bjhc.2002.8.6.18965
Richards W. Needs and priorities in dental care. British Journal of Health Care Management. 2004;10(6): 178-181. https://doi.org/10.12968/bjhc.2004.10.6.18715
Bloomfield K.Fundamental review of dental remuneration:Report of Sir Kenneth Bloomfield KCB. London: HMSO;1992.
Audit Commission. Dentistry Primary Dental Care Servicesin England and Wales. Northampton: Belmont Press; 2002.
Benn DK. Extending the Dental Examination Interval: Possible Financial and Organizational Consequences. Evidence-Based Dentistry.2002; 3(3):62-63. https://doi.org/10.1038/sj.ebd.6400128
Dharamsi S, Mac Entee MI. Dentistry and distributive justice. Social Science & Medicine. 2002;55:323-239. https://doi.org/10.1016/s0277-9536(01)00174-5
Taylor G. Modernising NHS Dentistry –Implementing the NHS Plan. Community Dent Health.2000;17(4):207-209.
Department of Health. Government Response to The House of Commons Select Committee On Health's Report on Access to NHS Dentistry. London: Stationary Office; 2016. [Published October 2016]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/562506/Response_to_primary_care_A.pdf
Renson T. NHS Dentistry: Options for Change. PrimaryDental Care. 2002;9(4):131-131. https://doi.org/10.1308/135576102322481965
National Assembly Government (2002) Routes to Reform Cardiff: NAG[18]John B. Ensuring effective management of risks Department of Health. London: National Audit Office;2004-5. [Published 25 November 2004]. Available: https://www.nao.org.uk/wp-content/uploads/2004/11/040525.pdf
Watson M. The Health and Social Care Bill. Br Dent J. 195:637-638
UK Government. National Health Service Act 2006. London: 2006. Available: https://www.legislation.gov.uk/ukpga/2006/41/contents
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2021 Richards W et al.
