Institute of Dentistry

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Associated Centre/s: Dental Public Health

Associated Research:  Patient and Population Orientated Research

This mixed methods study has been carried out in East London in the boroughs of Waltham Forest, Redbridge, and Barking and Dagenham since 2009 in order to further understand oral health inequalities, in particular the barriers, facilitators and pathways between neighbourhood deprivation, oral health behaviours and oral health status. It included quantitative and qualitative phases.

The phase 1 quantitative study assessed differences in socio-dental concepts, concepts of oral health based on aesthetics, biomedical concepts, and oral health behaviours of adults living in these relatively deprived areas in London. It also tested the interactions between socio-economic and socio-psychological measures to explain oral health behaviours and status. The phase II qualitative study assessed the effect of the interaction between concepts of oral health and levels of deprivation on oral health behaviours (oral hygiene; smoking; sugar consumption; alcohol consumption, and dental attendance) in participants living in deprived and less deprived areas in ONEL.

Research Programme Status: Active


Phase I of the ELOHI Study adopted a stratified random sampling approach to select a representative sample of the general non-institutionalised population. The sampling frames were lists of all addresses in each of the wards (n=58) in Waltham Forest, Redbridge, and Barking and Dagenham.  A minimum of 55 addresses were randomly selected from each ward to yield 3,193 addresses. Residents in these addresses were then contacted by post, and invited to participate in the study. Vacant addresses, commercial premises, and households with ineligible residents (e.g.: outside the age range of interest) were excluded. The maximum number of adults and children invited to participate per household was three and two respectively.

Participants underwent an oral examination and completed a structured questionnaire in their own homes.  Trained and calibrated dentists performed the oral examinations using a standardized protocol adapted from the UK Adult Dental Health Survey 1998 protocol (Office for National Statistics, 2000)  and standardized equipment (e.g.: daray light, mirror, and periodontal probes. Duplicate examinations were carried out among participants to assess intra examiner agreement within a two-week interval. Trained interviewers administered the questionnaires to adult participants and one parent/ carer of each child participant. The self-complete questionnaire included measures of  socio-demographic factors (age, gender, ethnicity, education, and socio-economic position); satisfaction with dental appearance, the impact of dental conditions on people's quality of life, oral pain and oral health behaviours including oral cleanliness, dental attendance, sugar consumption and tobacco use.

Phase II involved semi-structured interviews and focus groups with patients, general dental practitioners and stakeholders in the most and least deprived areas in North East London. We purposively selected participants from the four groups identified from the quantitative study to provide maximum variance with a range of views. This captured barriers and facilitators perceived by patients living in the least and most deprived neighbourhoods in East London who had "good" and "poor" oral health defined using validated clinical indices and measures of oral health. Data gathering continued until thematic saturation was achieved. We successfully interviewed 32 patients, 7 dentists and 3 stakeholders.

Key Publications

Rasha Al-Kaabi (2012).  Oral cancer awareness level in adult population in outer north east London: a cross-sectional study [PDF 2,302KB]. MSc thesis.


Professor Marcenes
Professor in Oral Epidemiology
+44 (0)20 7882 8650

Centre for Clinical & Diagnostic Oral Sciences
5th Floor, Institute of Dentistry
Barts and the London School of Medicine & Dentistry
Turner Street
E1 2AD

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