Interventions to reduce socio-economic inequalities in dental service utilisation - a systematic review

Objective: A gradient exists where people with lower socio-economic status (SES) use dental services less regularly than others. Evidence suggests these SES differences may contribute to inequalities in oral health. A variety of approaches have been tried to increase regular dental service use, although it is possible that some are ineffective or may even widen SES inequalities. We aimed to undertake a systematic review of interventions to reduce SES differences in dental visiting. Basic research design: Interventions limited to those influencing dental service use by adults. Any type of experimental design, investigating interventions aiming to reduce SES inequalities in dental service use, was included. Primary outcome was a measure of dental utilisation. Results: Electronic search of 8 databases, with citation snowballing, identified 14,396 titles and abstracts. Paper eligibility screening identified 63 full papers, of which 6 met the inclusion criteria. All included studies were conducted in the United States. Of these, three were targeted to parents, and two towards pregnant women. Two studies incorporated mailing postcards as (at least) one component of the intervention, although results were mixed. Another three studies included scheduling dental appointments as part of a multi-component approach, again with mixed results. The remaining study, involving community health advisors undertaking activities aimed at raising community awareness, found no significant intervention effect. Conclusions: Evidence in this area is limited and results are mixed. More work is needed to investigate the effectiveness of interventions to reduce SES inequalities, especially in different healthcare systems and involving a wider participant range.