Which population groups are at risk and why?
This section will focus on core epidemiological issues that take account of fixed risk factors (such as age, gender, ethnicity, family history) and modifiable risk factors (such as behaviour). The wider determinants of health (such as housing, transport and environment) are also considered.
Age
Children (age 5 in particular) – 2022 survey found 23.7% of 5-year-olds in England had experience of dental decay. Children in most deprived areas are twice as likely to experience tooth decay in comparison to those in less deprived areas. One of the most common reasons for hospital admissions among children aged 6-10 is tooth extraction for tooth decay1. In Yorkshire and the North East, up to 23% of Year 6 children have experienced dental decay compared to 12% in the South West2. Adults over 65 are at increased risk of: tooth loss; root caries; dry mouth; and oral cancer3.
Gender
Gender risk is dependent on age and condition. Among 12–15-year-olds, females had significantly higher rates of dental caries that had progressed into dentine Decayed, Missing and Filled Teeth (DMFT scores) in a 2013 Dental Health Survey. Therefore, adolescent girls are at greater risk of dental caries4. Among adults, men are less likely to access health care services which may increase risk of periodontal disease. There are higher rates of smoking and alcohol use among men which are risk factors. Oral cancer is more common in men due to smoking and alcohol use5.
Socioeconomic status
Children in the most deprived areas of England are more than twice as likely to experience dental decay compared to those in the least deprived areas. Adults from lower socio-economic backgrounds are more likely to have untreated dental decay, experience tooth loss and/or suffer from gum disease. These adults are less likely to access dental services due to cost, availability or lack of awareness5.
Qualifications
Lower educational attainment is linked to higher rates of smoking and alcohol use, both major risk factors for oral cancer. People with lower educational levels often have lower health literacy, affecting their ability to understand advice and access services. Children of parents with lower education are significantly more likely to experience dental decay, tooth extractions and/or poor oral hygiene habits. Adults with lower educational attainment are more likely to have untreated decay, suffer from tooth loss and are less likely to engage in preventive dental behaviours or access services5.
Mental health
Those with a mental health condition and/or poor mental health are at increased risk of poor oral health6, 7.
Ethnicity
There is a lack of data on oral health outcomes by ethnicity5. Ethnic minority groups report lower levels of dental attendance and poorer experiences with services. Gypsy, Roma and Irish Traveller communities face extreme barriers to accessing dental care. South Asian and Black communities experience conditions linked to poor oral health such as diabetes8.
Prisoners
Prisoners face significantly worse oral health outcomes and greater barriers to care5. Prisoners have a high prevalence of oral disease9. Low access to treatment, low motivation and health literacy, substance use and diet and vulnerability attribute to poor oral health among prisoners10.
Sexual orientation
There is no available or consistent evidence directly linking sexual orientation to oral health outcomes. Indirect risks such as discrimination or stigma and higher rates of smoking, alcohol and substance use in some groups may contribute to increased risk5.
Vulnerable children
Vulnerable and looked-after-children face significantly worse oral health outcomes and greater barriers to care5. Children in the most deprived areas are more than twice as likely to experience tooth decay than those in the least deprived areas2.