Oral health inequalities

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  Posted by: Dental Design      21st June 2022

Oral health inequalities were already quite stark in the UK, but what has been labelled the cost of living crisis has placed additional burdens on all but the very affluent. Dramatically rising inflation, taxes, and supply chain disruption combined with wage stagnation are placing people’s finances under unprecedented pressure.

Those on lower incomes are typically also time poor. There are a multitude of reasons for this from having to spend longer grocery shopping in order to economise, to working multiple jobs to get by. As a general rule, the lower your income the longer your commute, due to the rapidly escalating price of accommodation the closer you get to urban centres where most jobs are concentrated. This is then compounded by accessing public transport, which becomes less and less accessible away from heavily travelled corridors due to infrequent buses and trains (where these lines have not been axed altogether). Being time poor contributes to harmful stress, and diminishes time and energy that could otherwise be spent productively on looking after yourself, such as exercising and cooking.

The rising cost of food is forcing many to make choices that will ultimately be costly to their health. Cheaper food is generally poorer quality and worse for your health, often being nutrient poor but calorie dense and cariogenic. Cooking rather than relying on ready meals or fast food, is often advocated as a way to reduce costs. However, in addition to time poverty, the cost of staple foods and produce has drastically increased due to a combination of geopolitical factors. Moreover, the cost of energy has skyrocketed, which can make the prospect of running the electricity or gas long enough to cook a meal from scratch an anxiety-inducing choice. Many people are feeling so pressured that they go without food entirely multiple days a week. Some have glibly commented that this might have a positive impact on obesity rates, but this is a fundamentally ignorant position that fails to understand the mechanisms behind obesity. Skipping breakfast is associated with weight gain and impairs glucose response throughout the day, resulting in higher blood sugar spikes when food is later consumed. This may contribute to the development of metabolic syndrome, and for diabetic patients may worsen their blood sugar control.[1] Food uncertainty increases stress and signals to the body that the food supply is not reliable. The body responds by lowering the patient’s metabolic rate, and storing more fat as soon as the opportunity arises (this adaptive response also at least partially explains why people find their weight inexorably rising in the long term, despite repeated weight loss diets).[2] Even prior to the pandemic, 2.5% of all UK households were reliant on food banks.[3]

Beyond the difficulties facing the working poor, many minority groups contend with additional deprivations that contribute to unequal oral health outcomes. A report by Public Health England last year acknowledged that most existing research has focused on socio-economic position and area deprivation (with clear evidence that these impact oral health and accessing services) with little to no research into the impact on vulnerable groups such as prisoners, children in care, homeless people, the LGBT population, people with disabilities, refugees, minority ethnic groups, etc. The fact that there is such a paucity of basic data on these inequalities is itself a damning indictment of how left behind by the system many groups are.[4]

While NHS dental care provides a safety net, accessing that care can be difficult and many areas have inadequate service provision relative to their population.4 Poor literacy, language, inability to access the internet, geographic location, infirmity, mental impairment, ability and means to travel to receive care, and more can all present significant barriers to individuals and families accessing care.

It is ultimately more cost effective to prevent a problem than to fix one. PHE has recommended a host of measures and policy changes that may help vulnerable groups. This includes pushing for water fluoridation and targeted community-based schemes (with a focus on education).4 Even among those with a little more security, many lack the savings to handle emergency expenses. Oral hygiene is essential for all patients, and ignoring it is false economy that can come back to haunt them.

The Waterpik® Water Flosser is a strong recommendation for patients that supplements toothbrushing and is easy-to-use. The Plaque SeekerTM Tip, with specially designed bristles to deal with stubborn plaque accumulation in more difficult to access areas, can be especially useful for patients that struggle to use string floss, as it makes it simple to clean difficult crevices and corners. It is clinically proven to be more effective at reducing plaque and improving gingival health than both string floss and interdental brushes, and it has the prestigious accreditation of the Oral Health Foundation.[5], [6]

Dental care providers need to do more to address oral health inequalities. Reaching patients is the critical first step, with education and resources being the second. By empowering patients to be able to adequately look after their own oral health much greater costs can be avoided down the line.

For more information on Waterpik® products please visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Asda, Costco UK, Argos, Boots, Superdrug online and in stores across the UK and Ireland.

Book a free Waterpik® Professional Lunch and Learn for 1 hour of verifiable CPD and a free Waterpik® Water Flosser – available either as a face to face meeting or a webinar. Please visit www.waterpik.co.uk/professional/lunch-learn/



Dental hygienist and therapist Michayla Morris, graduated from the University of Sheffield in 2010. Alongside working full time as a dental hygiene/therapist in central London, she also works for waterpik as a professional educator. She has recently completed a BSc in Dental studies at the University of Central Lancashire and is due to start a MSc in Global health and development later in the year. 


[1] Jakubowicz D., Wainstein D., Landau Z., Bar-Dayan Y., Froy O. Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: a randomized clinical trial. Diabetes Care. 2015; 38(10): 1820-1826. https://doi.org/10.2337/dc15-0761 March 9, 2022.

[2] Higginson A., McNamara J. An adaptive response to uncertainty can lead to weight gain during dieting attempts. Evolution, Medicine, and Public Health. 2016; 2016(1): 369-380. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139007/ March 9, 2022.

[3] Bramley G., Treanor M., Sosenko F., Littlewood M., I-SPHERE, Heriot-Watt University. State of hunger: building the evidence on poverty, desititution, and food insecurity in the UK. The Trussell Trust. 2021. https://www.trusselltrust.org/wp-content/uploads/sites/2/2021/05/State-of-Hunger-2021-Report-Final.pdf March 9, 2022.

[4] PHE. Inequalities in oral health in England. Public Health England. 2021. https://www.gov.uk/government/publications/inequalities-in-oral-health-in-england March 9, 2022.

[5] Barnes C. M., Russell C. M., Reinhardt R. A., Payne J. B. and Lyle D. M. Comparison of irritation to floss as an adjunct to toothbrushing: effective on bleeding, gingivitis and supragingival plaque. J Clin Dent. 2005; 16(3): 71-77. https://pubmed.ncbi.nlm.nih.gov/16305005/ March 9, 2022.

[6] Goyal C. R., Lyle D. M., Qaqish J. G. and Schuller R. Comparison of water flosser and interdental brush on reduction of gingival bleeding and plaque: a randomized controlled pilot study. J Clin Dent. 2016; 27: 23-26. https://pubmed.ncbi.nlm.nih.gov/28390208/ March 9, 2022.

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