Social Inequalities and Oral Health

Aim - The aim of the study was to explore: (i) the geographical reach and reaction of the online participants engaging in an oral health campaign ‘National Smile Month’ (NSM) and (ii) whether Twitter was being used by dental practices during NSM as a tool to help address regional oral health inequalities.
Methods - Cross-sectional investigation using a mixed method approach. Twitter posts (i.e. ‘tweets’) were collected using Mozdeh an API search engine from 15/05/16 to 16/06/16. A content analysis of the tweets was performed and tweets were classified into high, medium and low impact. To explore socio economic and geographical inequalities the participants’ postcode data was obtained via a web search. The geolocation of tweets were then linked by postcode to the 2015 Index of Multiple Deprivation and the data from the DPHEP 2014/15 oral health survey of 5 year olds and mapped using Google Fusion Tables.
Results – A total of 23,100 tweets were captured with a final total of 2968 usable tweets from 763 separate accounts. 212 of tweets were from dental practices. 107 classified as low, 99 medium, 6 high. Interactive choropleth maps were created to give a visual representation of the relationship between the participants ‘high’ tweets and the level of deprivation and dental decay in 5 year olds in that region. 
Conclusion – The majority of tweets did not promote any specific preventative behaviour. Dental practices in England were not contributing to National Smile Month via Twitter in a way that would improve regional oral health inequalities. In areas of high need there is evidence of pro-active engagement with NSM via Twitter by Local Authorities and their health care partners. Improvements could be made by targeting dental practices in areas of high need and encouraged to be more pro-active in their local communities and get more involved campaigns like NSM.

Much research on children’s oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such
upstream factors—the so-called structural determinants of health—play a crucial role. Children’s lives, and in turn their health, are
shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between
children’s clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health–related quality of life) and
4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health
Organization’s Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational
epidemiological samples of 8- to 15-y-olds in 11 countries (N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429),
Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico
(335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability),
gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government
expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children’s oral health. The
structural determinants accounted for between 5% and 21% of the variance in children’s oral health quality-of-life scores. These findings
bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public
health dentistry research and the oral health inequalities policy agenda.