The Dental Health Needs of Individuals Living in Areas of Multiple Deprivation in Glasgow

The relationship between general health and socio-economic environment is well documented. Dental disease has also been reported to be influenced by socio-economic factors. The study reported in this thesis examined the effect of social environment on dental health attitudes, beliefs and behaviours, by using an area deprivation classification. The relationship of all parameters to the level of oral health of adult populations was investigated by employing multi-layer modelling techniques. By examining personal and environmental factors alongside the availability of the dental services, the study aimed to determine the major influences on oral health. Both qualitative and quantitative research methodologies were used. The questionnaire which was used in the main survey was developed from group discussions, thus ensuring that researcher bias was minimised. In total, 852 subjects randomly selected from the areas under study, aged 16 to 65 years, took part in the survey. Of them 512 (60.1%) were examined clinically. All dental services in the areas of interest were visited for collection of the relevant information. Bivariate and multivariate analyses examined the separate and the combined effect of behavioural / attitudinal and service availability variables on dental health and dental behaviours. The study showed that dental health is related to social deprivation. The effect of deprivation on dental health was strong, even after controlling for differences in dental attitudes and behaviours, and availability and accessibility of dental services. Deprived populations were found to exhibit substantially higher levels of caries and periodontal disease, as well as overall treatment needs. Differing dental health behaviours were found to account for a considerable proportion of the differences in the oral health needs of affluent and deprived groups. However, complex interactions between personal attributes, social environment, behaviours and oral health were detected. Dental anxiety was a major barrier to attendance, particularly among deprived populations. Fear of the cost for dental treatment also appeared to be a barrier, and to a certain extent this seemed to stem from a poor dentist - patient communication. Efforts to reinforce healthy dental behaviours should tackle this problem, and furthermore, should be based on the dental health value system of the targeted populations. The dental health services were perceived by the populations to be available, and seemed to be sufficient for the current levels of demand for care, in both deprived and affluent population groups. However, if unmet needs were to be translated into demand for dental care amongst the deprived populations, additional dental services in these areas would be required. Areas of deprivation are areas of greater dental needs and should be targeted by health promotion interventions. However, such efforts alone, according to the results presented in this thesis, are unlikely to solve the problem of social inequalities in oral health. Parallel efforts by the state are also required in order to improve the prevailing social and economic situation in such areas, before oral health can become an attainable goal