Mind the gap – how the pandemic revealed growing inequalities in dental decay

Ben Atkins discusses the issue of dental decay during COVID and the wide disparity of oral health between the rich and poor in the UKThe pandemic has only highlighted the wide disparity between rich and poor in the UK, says Ben Atkins.

Oral health shouldn’t be a postcode lottery.

Dental decay is entirely preventable and yet it remains the most common chronic disease worldwide, with high prevalence across multiple areas of the UK.

Regional variation, underpinned by socioeconomic factors, has created a stark oral health gap between more affluent and poorer parts of the country. This is at risk of being exacerbated by the current pandemic.

COVID-19 has had a wide-ranging impact across our health service. One impact that many may not have considered is the effect on oral health.

Dental practices are only just beginning to reopen after lockdown. Changes in our routines and eating habits while isolating at home could put our oral health at risk. Having a conversation about oral health is now more important than ever if we are to keep the nation’s mouths healthy and keep people out of hospitals.

Reflecting on this year’s National Smile Month, we have a timely reminder of the need to level up the country’s oral health, and ensure coronavirus doesn’t widen this gap.

The value of a healthy smile

Despite efforts to improve oral health, dental decay remains a significant challenge in the UK. For the NHS, we know the cost of dental diseases places significant pressure on already overstretched resources.

In 2017, the cost of tooth extractions for under 19-year-olds exceeded £50 million, with the vast majority of these the result of preventable dental caries (PHE, 2017).

Poor oral health can have a detrimental effect on patients’ overall wellbeing. Tooth loss can severely impact an individual’s quality of life, causing difficulty eating and drinking, interrupted sleeping, toothache and irritability.

Dental decay can even cause people to avoid smiling and laughing because of the appearance of their teeth.

This difficult period has emphasised the importance of a smile in communicating with those around us. A smile shows others, from the postman to our neighbours, friends and family, that we are here for each other. When we cannot hug or shake hands, a smile becomes our main tool to connect with others.

Postcode lottery

While everybody deserves a healthy smile, unfortunately for many it’s not that easy.

Recent data from Public Health England highlights significant regional variation in oral health outcomes.

Blackburn and Darwen, for example, currently have the largest proportion of children with visually obvious dental decay at 50.9%, compared to the national average of 23.4%. Contrast this to the other end of the scale in East Sussex where this figure drops dramatically to 8.7% (PHE, 2020).

Alongside this postcode lottery, we also know that socioeconomic background plays a key role in determining oral health outcomes.

The Health Foundation and the Nuffield Trust found that those from the most deprived backgrounds are twice as likely to be hospitalised for dental work than those that are better off (Appleby et al, 2017).

Levelling up oral health outcomes

Addressing this gap isn’t going to be simple. There is by no means one quick fix. However, an important first step is levelling up patient education.

There are many things we can do to maintain good oral health and one of the most important is, of course, brushing twice daily with fluoridated toothpaste.

On top of this, there are several other quick and easy things we can all do to protect our mouths. For example, using interdental brushes, mouthwash and sugar-free gum.

But, easy though they are, the use and understanding of such measures also correlates strongly with economic indicators like household income.

We know that people from a lower socioeconomic background are less likely to adopt additional oral health measures to prevent dental decay. A recent survey from the Oral Health Foundation found that those from lower income households were less likely to use dental floss, mouthwash or sugar-free gum.

Potentially driving this is a lack of understanding around what these interventions can do for your oral health.

For example, the same Oral Health Foundation survey found that those from higher income households were more likely to be aware that chewing sugar-free gum can neutralise plaque acid and clear food debris.

Chewing sugar-free gum represents a low cost and accessible way to support regular brushing and protect our teeth. A recent review by King’s College London found that people who regularly chewed sugar-free gum developed 28% less dental caries than those who did not (Newton et al, 2020).

Despite this evidence, it seems that understanding remains low on the benefits of sugar-free gum.

Reaching out

Ensuring everyone knows how to keep our mouths healthy is a good first step in closing the oral health gap.

This year’s National Smile Month made some great progress in reaching out to those groups where oral disease is far too common.

Activities like the Great British Brushathon and oral health home schooling helped to improve dental education amongst disadvantaged communities, but there is still much to do!

Maintaining a healthy smile can be really simple. It plays a key role in supporting individuals’ broader physical and mental wellbeing. But we know that for many it’s not that simple.

Where you were born, or how much your family earns, should not determine your risk of dental disease. It’s essential that we do more to support those from the most vulnerable and deprived communities.

Everyone’s lives have changed to some degree due to the current pandemic. We must ensure that oral health does not take a back seat. We need to level up the country’s oral health.


Appleby J et al (2017) Root causes: quality and inequality in dental health. The Health Foundation and Nuffield Trust

Newton JT, Awojobi O, Nasseripour M, Warburton F, Di Giorgio S, Gallagher JE, Banerjee A (2020) A systematic review and meta-analysis of the role of sugar-free chewing gum in dental caries. JDR Clin Trans Res 5(3): 214-223

Public Health England (2017) Health matters: child dental health

Public Health England (2020) Public Health Profiles: percentage of five-year olds with experience of visually obvious dental decay.

This article first appeared in Oral Health magazine. You can read the latest issue here. 

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