Oral Health Inequalities in 0-17-year-old Children Referred for Dental Extractions Under General Anaesthesia in Wolverhampton, 2013-2017

Abstract

Objective: Describe the inequalities in oral health in children treated in a hospital located in a deprived urban area in the UK.

Research design: Case-note review of 1911 0-17-year-olds who underwent dental extractions under a general anaesthetic (DGA).

Main outcome measures: Associations between Age, Ethnicity, Year-of-Treatment and Index of Multiple Deprivation (IMD) with the number of teeth extracted. Analysis used multilevel modelling assuming a Poisson distribution.

Results: Mean number of teeth extracted was higher in the youngest children treated aged 0-5 years (relative risk coefficient, (RR=exp(β)=1.39; 95% CI 1.24 to 1.56) compared to those aged 6-17 years and in 'Other Whites' (predominantly immigrants from Eastern Europe) (RR=exp(β)=1.34; 95% CI 1.25 to 1.43), 'South Asians' (RR=exp(β)=1.15; 95% CI 1.08 to 1.23) but fewer in the 'Black' ethnic group (RR=exp(β)=0.85; 95% CI 0.76 to 0.95). DGA increased during the study with more teeth extracted in 2015, 2016 and 2017 (RR=exp(β)=1.12, 95% CI 1.22, 1.25) and with a negative gradient in the rate of DGA's (per decile) in children from the most deprived to most affluent locations (RR=exp(β)=0.98; 95% CI 0.97 to 0.99).

Conclusions: Significant oral health inequalities exist in children from a deprived urban area in the UK. A preventive approach to children's oral health is needed to reduce such inequalities, including public health and healthcare agencies to informing parents of children whose first language is not English about dental caries.

Keywords: General anaesthesia; caries; deprivation; ethnicity; inequalities.