Social inequalities in dental health. Towards a theoretical explanation.

The analysis of social inequality is one of the predominant concerns of sociology. Inequalities in general health or utilization of health care services are nearly universal. The purpose of the paper is to describe inequalities in dental health in Denmark. Recent empirical findings are reviewed. Longitudinal data on the number of adults with few or no teeth left show remarkable differences between low and high social classes in 1976 and 1986. Among the younger individuals some reduction in the social differences has been observed over time. This was ascribed to the establishment of a public child dental health service. The level of dental caries and unmet treatment need is higher among workers than officials. Studies of industrial workers also indicate that dental illness or diseases are induced by environmental working factors. The association between health-related behavior and dental health status has been demonstrated as well as the effects of social network relations and lifestyle. Finally, theoretical explanations of the inequalities in dental health are outlined: artefact explanations, theories of natural or social selection, materialist or structuralist explanations, and cultural/behavioral explanations. Arguments for the relevance of the materialist/structuralist and the cultural/behavioral approaches are given and a combined model on dental health is presented. The practical implications of the various models are discussed.