Research shows that children living in deprived areas are three times more likely to undergo dental extractions in hospital

Researchers from Queen Mary University of London have found that children living in areas of high poverty are three times more likely to have severe tooth decay requiring a tooth extraction in hospital, compared to children living in more affluent areas. The findings highlight an urgent need for equal access to preventive dentistry.

In the study, published in BMJ Public Healthresearchers analyzed anonymized GP and hospital data from 600,000 children aged between five and sixteen living in North East London. During the five-year study period, one in 200 children had at least one tooth removed under general anesthesia, which had to be done in a hospital setting. Most of these children had multiple teeth extracted.

The study findings show wide socio-economic and ethnic inequalities in severe tooth decay in children, which is preventable through access to NHS dentists and policies such as teeth brushing in schools and controls on sugar in food and drinks.

• Children who lived in areas with the highest percentage of low-income households were three times as likely to have had a dental extraction, compared to children who lived in areas with the lowest percentage of low-income households.
• Children from some ethnic groups were more likely to need a tooth extraction, compared to children from white British ethnic groups:
  • White Irish: twice as likely;
  • Bangladeshi: 1.5 times more likely;
  • Pakistani: 1.4 times more likely.
• Obese children were less likely to require tooth extraction than healthy weight children. More research is needed to replicate and understand this finding.

The researchers also examined North East London council data, comparing rates of dental extractions in children with access to NHS GPs. After adjusting for deprivation and ethnic group, the highest risk of dental extraction was in children’s hospital in Tower Hamlets, which also has the lowest GP attendance in North East London.

Conversely, children living in Redbridge, Havering and Barking & Dagenham had the lowest risk of dental extraction in hospitals; these areas have the highest percentage of five-year-olds accessing general dental services. Furthermore, the 2022 National Dental Epidemiology Program (NDEP) oral health survey found that only 13% of decayed teeth in five-year-old children in London had been filled.

This study is the first to analyze the disparity in pediatric dental extractions under general anesthesia by ethnic group in such detail, revealing a difference in outcomes between white Irish and white British groups, and between Bangladeshi, Pakistani and Indian groups. By linking hospital data to GP records, which contain 16 categories for ethnic groups, researchers were able to reveal ethnic inequalities that are less apparent when using the broader ethnicity categories used in previous research.

Vanessa Muirhead, co-author and reader and honorary consultant in dental public health at Queen Mary, said: “Unfortunately, our findings reveal major socio-economic and ethnic inequalities in access to dental care and its outcomes.

“Tooth extraction is a last resort, but when families have difficulty obtaining timely prevention and treatment services, dental problems can worsen until children require more serious and expensive interventions, such as multiple tooth extractions under general anesthesia.”

Nicola Firman, lead author and Health Data Scientist at Queen Mary, said: “Linking health data from different settings has allowed us to see the inequalities in the dental care system more clearly.

“Our findings indicate an urgent need for equitable access to preventive general dental services, and interventions that target the broader determinants of dental health.”

Christopher Tredwin, Dean and Director of the Institute of Dentistry at Queen Mar, said: “This research reveals clear inequalities in oral health, which we are also acutely aware of through our long-standing service to the local community.

“In partnership with Barts Health NHS Trust, the Queen Mary Institute of Dentistry opened a new dental outreach clinic in Kenworthy Road, Homerton earlier this year.

“It now provides faster and easier access to dental care in the local area, while our dental and therapy students learn to treat children in these primary care settings. Through the excellent work of our students in these clinics, we hope to alleviate the effects of unequal access to general dentistry in North East London and help deliver care to those who need it most.”

Victoria King, Director of Funding and Impact at Barts Charity, said: “This important work, supported by Barts Charity, has shown that there are major preventable inequalities associated with serious tooth decay for children in East London. Understanding these health inequalities is key to enabling better healthcare for our diverse population in East London.”