What are the social determinants of health impacting quality of oral health among the UK children?
In England, the overall oral health of children population as significantly improved over the past decades. For example, PHE (2020) reported that the portion of 10-year-old children obvious decay in England reduced from 31% to 23% between 2008 and 2019. In spite of this significant improvement in the overall oral health among children in England, there are still incidences of unacceptable inequalities in the oral health (Glick et al., 2016; Peres et al., 2019; Steele et al., 2015). Specifically, the inequalities are observed in different contexts such as the manner in which dental services are commissioned to the children, organised and contracted, which may impact the quality of oral health. In England, dental services are either funded by private organisations or the National Health Service (NHS) England (2021). Even though private dental care forms large percentage of the dental service in some areas in England, availability of collated service data in the dental care context is still limited.
According to Delgado‐Angulo, Bernabé and Marcenes (2016) and NHS England (2019), good oral health plays an essential role in ensuring good health and wellbeing. Specifically, NHS England (2019) reported that good oral health has the ability of supporting individuals, especially adults, to stay autonomous for longer as well as to recover from the episodes of frailty or crisis. On the contrary, poor oral health may negatively impacts quality of life of an individual from childhood to adulthood, by increasing their vulnerability to infections and pain episodes, leading to problems in sleeping, eating, socialising as well as poor general wellbeing (Guarnizo-Herreño et al., 2014; Nuttall et al., 2016; Ravaghi et al., 2016). Children with poor oral health often experience high rates of school absenteeism, with their parents and carers likely to experience time off work in order to take care for children with poor oral health (Masood et al., 2017; Macfarlane, Beasley and Macfarlane, 2014; Pau, Croucher and Marcenes, 2017). An important oral health problem among children population is the tooth decay, as it is associated with high rates of hospital admissions among children in the 6-10 years old age group (PHE, 2018; PHE, 2017).
Between 2018 and 2019, there were at least 37000 hospital procedures for extracting carious teeth among children, which is an indication that at least 100 children within this age group were seeking teeth removal procedure per day (Bernabé and Sheiham, 2020). Consistently, comparative assessment of evidence presented in the studies by Levin and Currie (2019), Porter et al. (2016) and Sanders et al. (2019) shows that each school going child in England are missing at least 3 days per year in order to seek dental care services, such as removal of their teeth in the dental care clinics. Extraction of teeth by general anaesthetic is often the first step towards introducing the child to dental care and has been associated with the development of fear and anxiety with possible lifetime consequences.
Evidence from the existing literature, including previous reviews by Castilho et al. (2013), Fraihat et al. (2019) and Kumar, Kroon and Lalloo (2014), shows that oral health status of children is largely influenced by social dimensions such as parental education, ethnicity and income. Furthermore, factors such as socio-economic status of the family, parenting quality and family structure have been reported to play a central in influencing psychosocial and psychological attributes of the children (Barbosa and Gavião, 2018; Firmino et al., 2018; Vamos et al., 2015). However, these studies have generally focused on children population from underdeveloped and developing African and Asian countries. Therefore, the present study focused on assessing whether these social determinants of health are also involved in determining quality of oral health among children from developed countries, specifically the UK. Moreover, previous studies by Firmino et al. (2017), Moghaddam et al. (2020) and Nakre and Harikiran (2017) have established that parental socio-economic factors in addition to the home-related environmental factors have negative impacts on the children’s quality of life related to their oral health status, with children from orphanages reporting poorer quality of life in this context compared to their peers living with parents. However, these studies have generally emphasised on the parental factors’ influence on children oral health contrary to the present review which focused on assessing and reporting the potential impacts of social determinants of health on children’s quality of oral health, which would also include the parental factors such as their income and level of education.
Rationale and Significance of the Study
Results from the present review about the factors influencing relationships between the clinical variables and quality of oral health among children would be used to facilitate formulation of optically effective clinical interventions for addressing oral health among children poor families and minority groups in the UK. Even though systematic reviews have been previously conducted to explore the relationship between oral health status of children with their oral health related quality of life (OHRQoL) (Jankauskiene and Narbutaite, 2019; Omara, Stamm and Bekes, 2021; Skeie et al., 2019), extensive review has not been conducted to assess and report the impacts of social determinants of health, such as parental attributes, on the quality of oral health among children, especially those from the UK. Therefore, the present quantitative review focused on bridging this gap in knowledge by critically appraising evidence from the UK-based studies about the impacts on social determinants of health on quality of oral health among children to facilitate generation of new knowledge that can be used for addressing increasing incidences of oral health problems affecting children in the UK. The newly developed knowledge from the present review would be used for formulating new policies for addressing social determinants of health which are involved in negatively impacting the quality of oral health among children from poor families in the UK.
Research Aim
The principal aim of this review is to evaluate and account for the different social determinants of health which influence development of poor oral health among children in the UK.
Research Question
Research question for the present review was developed using population, exposure and outcome (PEO) approach. Specifically, the population of interest was poor children from the UK, exposure being the different forms of social determinants of health including neighbourhood and physical environment, socioeconomic status, education, social support networks and to health care, while outcome of interest being different forms of oral health problems such as tooth decay, oral cancer, gum diseases or periodontal disease, bad breath. Therefore, the specific research question for the present review was:
What are the social determinants of health impacting quality of oral health among the UK children?
Research Objectives
- To identify key social determinants of health impacting quality of oral health among children in the UK.
To establish strategies that can be used for addressing the negative consequences of social determinants of health on the oral health of children in the UK.
