Even though particular groups are at greater risk of poor oral health than the general population, risk factors and poor oral health are present in all groups across the population. This shows that a complex interaction of factors can lead to poor oral health. Income distribution helps illustrate this point: lower income groups are more likely to have unfavourable visiting patterns than higher incomes groups, yet there are a significant proportion of people with higher incomes that have unfavourable visiting patterns. Unlike lower income earners’ visiting patterns, this cannot be singularly explained by income alone and so other reasons must be present. This is not to exclude income and cost as an issue, but more to explain that the causes of poor oral health are more complex than an initial assessment might reveal. This indicates that there are structural and social as well as individual factors affecting access. Diet and behaviour shaped and maintained by social circumstances across the whole population also play a role in determining poor oral health.
Survey data shows that caries occur across the whole population and that their occurrence is not closely linked to income. However, whether and how caries are treated is closely linked to income. This is evident in patterns of untreated decay which are far greater in low income groups. What generally appears to happen is that those with favourable patterns access a preventive regime and restorative treatment earlier, while those with unfavourable patterns access care later – once the caries have progressed and more comprehensive and costly treatment to save a tooth is required. The increased cost of saving a tooth shapes the decision to negotiate the alternative treatment of a tooth being extracted. Level of income and other barriers to access have a significant influence on outcomes.
There are differences in access between adults and children, with some of the key access problems experienced by adults not as extensive for children. Children have far better visiting patterns, which provide some indication of why children’s oral health has improved over the last several decades. However, with the burden of disease borne by a small number of children, and recent increases in caries following years of improvement, resources need to be focused on those children suffering from oral disease. As well as this, investments need to ensure that high visiting patterns are maintained to support the good foundation of oral health for the 80 per cent of children with regular access. Any decline in these areas risks problems and increased costs in the future.