Study Disproves British Reputation for Bad Smiles



If you think the British have bad teeth, think again. A cross-sectional analysis of national surveys in the United States and in England has shown that American oral health is not better than British oral health. In fact, the mean number of missing teeth among American adults is 7.31, compared to 6.97 for British adults. Poor oral health in both countries, though, is impacted by socioeconomic inequalities.

“Whilst welcoming this new study that destroys the reputation we have for poor dental health and confirms that it has come on in leaps and bounds recently, there does remain major inequalities across the country,” said Fiona Sandom, president of the British Association of Dental Therapists (BADT).

The researchers pulled their data from the English Adult Dental Health Survey (ADHS) and the US National Health ad Nutrition Examination Survey (NHANES), including dentate subjects age 25 and older. They looked at the number of missing teeth, self-rated oral health, and oral impacts on daily life. Educational attainment and household income were used for socioeconomic position indicators.

While the mean number of missing teeth was significantly higher in the United States, oral impacts were more prevalent in England. The difference in subjects who rated their own oral health as less than good was not significantly different. In both countries, women reported more oral impacts and had more missing teeth than men, though the opposite was true for self-rated oral health.

Furthermore, missing teeth and edentulousness were higher in the United States among those aged 25 to 64, while the number of missing teeth was higher among older adults in England. Adults in the highest education or income groups in the United States had better oral health, except for the number of teeth in the top income group, while those in the lowest socioeconomic position levels were better off in England.

The researchers additionally noted significant associations between oral health and socioeconomic position and a general pattern of social gradients in both countries, which were steeper in the United States except for the income gradient in the number of missing teeth. In other words, negative outcomes were higher among those with less education and income, with relative inequalities higher in the United States.

“The Marmot Review into health inequalities in England highlighted the social gradient of such health inequalities, which are obviously largely preventable,” said Sandom. “We now need a joined-up approach to securing improvements in the nation’s dental health, and the BADT will continue to add support to the numerous campaigns aimed at improving children’s tooth decay figures, especially in those areas of deprivation.”

The researchers note that different levels of access and provision of treatment services between the countries’ respective health systems may have contributed to their findings, as England provides dental care through its National Health Service and has a comprehensive “safety net” of welfare policies, while dental insurance dominates care in the United States.

The study, “Austin Powers Bites Back: A Cross Sectional Comparison of US and English National Oral Health Surveys,” was written by Carol C. Guarnizo-Herreño, Georgios Tsakos, Aubrey Sheilham, Michael G. Marmot, Ichiro Kawachi, and Richard G. Watt and published by The British Medical Journal.

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