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LONDON, UK: Researchers at University College London have highlighted the COVID-19 pandemic’s effect of having widened inequalities in oral health in the UK. Reduced access to dental services and preventive initiatives as well as increases in behaviours that are harmful to oral health have had a greater impact on certain groups within the population—namely children, older adults and those who are less affluent. The researchers say that long-term investment is now needed in order to avoid worsening oral health in these groups.
In a January commentary in the British Dental Journal, Dr Michelle Stennett and Prof. Georgios Tsakos, researchers from the Department of Epidemiology and Public Health at University College London, sought to document the impact of the pandemic on oral health inequalities. They conducted a literature review and analysed public health and sales data, and the focus of their analysis was the period from March 2020 to February 2021.
National Health Service (NHS) general dental services suffered historic disruptions in 2020, beginning in March with the declaration of the SARS-CoV-2 pandemic and the subsequent temporary closure of most dental clinics. Oral health programmes in schools and care homes were largely suspended between March and October of that year and referrals for oral cancer—the incidence of which is higher among more deprived and vulnerable groups—and tooth extractions in children dramatically declined.
According to the researchers, by October, the use of NHS general dental services had somewhat recovered but this was not the situation among older adults and children, and the resumption of the use of the services among these two groups was more gradual in the more deprived areas of the country. They wrote: “[There] were clear inequalities in the uptake of dental services in this initial resumption period, particularly among children and older adults, with 10% more children and older adults in the least deprived areas of England utilising services in October 2020, compared to those in the most deprived areas.”
Sales data from March to July 2020 showed increases in the sale of confectionary and other foods rich in free sugars and variations in the purchase of oral care products between higher and lower socio-economic groups. Among the latter, a decrease in the purchase of oral care products was recorded from June. Combined sales data and survey results showed the researchers that the consumption of alcohol by the population increased between March and June 2020 and that the increase in sales was driven by heavy consumers of the drug. “Consequently, this high-risk group of heavy drinkers is now, following the lockdown, even more likely to experience alcohol-related harm with implications for oral health, particularly for oral cancer,” the researchers wrote.
Owing to these factors and to the severity and economic impact of the pandemic in the UK, the authors postulated that the pandemic was likely to have a major impact on oral health and widen health inequalities in the country. They noted that inequalities in health in the UK had already been increasing since 2010.
“[It] should be acknowledged that oral health programmes and dental services are part of an ever-changing picture as we move through the different phases of the COVID-19 pandemic”
The researchers commented: “It seems that less deprived groups are more able to navigate the changing architecture of NHS dental service provision than the more deprived. This is a serious concern, as the vulnerable, more deprived population groups have a greater reliance on the NHS for their dental care.” They further observed that the disruptions to health services related to oral cancer and secondary dental care had primarily affected more vulnerable groups and lower socio-economic groups. They stressed: “While this commentary reflects on the situation up to February 2021, it should be acknowledged that oral health programmes and dental services are part of an ever-changing picture as we move through the different phases of the COVID-19 pandemic.”
It was crucial to consider a plan of action to address health inequalities as the UK moved towards the resumption of NHS dental services to pre-pandemic levels. This plan should include oral health improvement programmes having an emphasis on the more vulnerable groups and should address broader social and commercial factors that worsen oral health inequalities, the researchers wrote.
This would require less disinvestment in public health and greater prioritisation of programmes that support equitable access to health services, they concluded.
“After all, good oral health contributes considerably to the health and quality of life of the population,” they stated.
The article, titled “The impact of the COVID-19 pandemic on oral health inequalities and access to oral healthcare in England”, was published online on 28 January 2021 in the British Dental Journal.
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