America loves a healthy-looking smile. According to the American Dental Association, the U.S. spent 111 billion dollars on its teeth in 2012. And, as proud as Americans are of their pearly whites, they tend to be somewhat disparaging of foreign fangs — especially those of the British. Yet, contrary to popular belief, the oral health of U.S. citizens is not better than that of their European cousins, according to a study in the Christmas issue of medical journal The BMJ.
Resurrecting a decades-old cliché, U.S. culture likes to portray the average British mouth as the epitome of poor dental health. From the The Simpsons to Austin Powers, stereotypes of U.K. teeth abound. Yet, despite this belief, there has never been much evidence for it — no study has ever directly compared levels either of oral health and oral health inequalities in Britain and the U.S. Now, a transatlantic research team based in the U.K. and the U.S. has weighed up oral health measures and socioeconomic indicators on both sides of the pond using data from the English Adult Dental Health Survey (ADHS), and the US National Health and Nutrition Examination Survey (NHANES).
Data from adults aged 25 years and older was analyzed in the research with groups of 8,719 in England and 9,786 in America used for analyses by education, while 7,184 participants in England and 9,094 in the U.S. were used for analyses by income. The main issues examined by the team were the number of missing teeth, the participants' perceptions of their own oral health as well as oral impacts on daily life such as pain, difficulty eating, avoiding smiling and social effects. Education level and household income were used as socioeconomic indicators.
The results showed that the average number of missing teeth was actually higher in the U.S. (with a mean of 7.31) than in Britain (who had lost 6.97), while the reporting of oral impacts on daily life was higher in Britain. One possible reason the researchers suggest for the difference in the two sets of data is America's greater addiction to sugar and tobacco, although they are also keen to point out that "wider societal differences in welfare policies exist, with England having a more comprehensive range of 'safety net' policies which may help to reduce oral health inequalities."
The teams showed that differences in the ethnic makeup of the two countries had no effect on the figures but differences in social equity did. Though there is strong evidence, they say, of significant socioeconomic inequalities in oral health in both countries these inequalities are consistently higher in the U.S. than in the U.K. According to the researchers: "Adults in the highest education or income groups tended to have better oral health in the U.S., except for [the] number of missing teeth in the top income group. Conversely, those in the lowest socioeconomic position levels tended to be better off in England."
"In conclusion," the researchers say, "we have shown that the oral health of Americans is not better than the English, and there are consistently wider educational and income related oral health inequalities in the U.S. compared with England."