Socioeconomic inequalities and dental attendance among adults in England. Findings from the Adult Dental Health Survey 2009

Abstract

Background: Socioeconomic inequalities in oral health are well established, with disadvantaged groups disproportionately affected by poor outcomes and lower engagement with preventive care. Regular dental attendance supports early detection of disease, reinforces preventive behaviors, and reduces inequalities in oral health outcomes. However, the extent to which different indicators of socioeconomic position (SEP) independently shape dental attendance patterns in England remains underexplored. Aim: The aim of this study was to examine the association between socioeconomic position (SEP), namely education, occupation and Index of Multiple Deprivation (IMD), and dental attendance (pattern and time since last visit) among adults in England and explore whether these associations are influenced by demographics, service barriers and clinical oral health indicators. Methods: This study conducted secondary analyses of data from the nationally representative Adult Dental Health Survey 2009. The analyses sample comprises adults aged 25 years and over and living in England. Two outcomes were examined: pattern of dental attendance (regular check-ups versus visiting occasionally or when having trouble) and time since last visit to the dentist (up to 2 years versus more than 2 years). Explanatory variables included education, occupation, and IMD. Logistic regression models were constructed, adjusting sequentially for demographics (age and sex), service barriers (access, dental insurance and cost) and clinical oral health indicators (number of natural teeth, periodontal pocketing ≥4 mm and number of decayed or unsound teeth). Results: Significant socioeconomic inequalities in dental attendance were observed across all SEP indicators, even in the fully adjusted models that accounted for demographics, barriers-related, and clinical variables. Compared with adults with no qualifications, those with other qualifications had 1.51 (1.23-1.85) and degree-level or above had 1.55 (1.23-1.95) higher odds of regular attendance, while the respective odds ratios of visiting the dentist within 2 years were 1.35 (1.05-1.73) and 1.61 (1.20- 2.15), respectively. Compared to those in routine/manual occupations, participants in intermediate occupation had 1.61 (1.32-1.95) and managerial/professional occupations had 1.45 (1.23-1.70) higher odds of regular attendance, while the respective odds ratios for visiting the dentist within 2 years were 1.54 (1.21-1.96) and 1.56 (1.27-1.91), respectively. The strongest inequalities were observed by IMD: adults living in the least deprived quintile were more than twice as likely to attend regularly with OR=2.62 (2.08-3.29) and to have visited the dentist within 2 years with OR=2.49 (1.88-3.30) compared with those in the most deprived quintile. Physical access barriers had minimal role, while dental insurance and cost had a relatively small influence on the associations between SEP and dental attendance in the associations of interest. Clinical oral health, mainly number of natural and dental caries but less so periodontal disease, seemed to have a relatively stronger role in attenuating the associations of interest, which remained significant throughout the adjustment process. Conclusion: This study highlights persistent socioeconomic inequalities in dental attendance in England. Individuals with lower levels of education, in manual occupations, and living in deprived areas remain significantly less likely to engage in regular dental visits or to have visited a dentist within 2 years. These findings underscore the influence of both individual and structural determinants in shaping healthcare utilization. Policies that reduce cost barriers, support flexible access through workplace provisions, and address structural inequalities in service availability are essential to achieving more equitable access to dental care.