The epidemiology of dental caries has changed over the last decades. Historically, repairing the ravages of dental caries has been the backbone of general dental practice. This opinion article highlights the challenges of moving from a repair service to a preventive service from the viewpoint of: what is the future health market? It also touches on the negative aspects of how organisations manage the challenges of the change process.

Background/Objectives: This study aimed to assess whether income was associated with dental caries experience and dental care levels among 12-year-old children in two contrasting economic contexts, Sri Lanka (lower-middle-income) and Wales (high-income), regardless of national income status. Methods: An ecological study design was used with published data. For Sri Lanka, the income parameters used included household income, mean per capita income, and the Gini coefficient. For Wales, the Welsh Index of Multiple Deprivation was used. Dental caries was assessed using the DMFT index and its components (DT, MT, FT), while dental care was assessed using the care index, restorative index, and treatment index. Pearson correlations were used to explore associations between income measures and both caries experience and dental care indices across districts in Sri Lanka and unitary authorities in Wales. Results: The mean DMFT for 12-year-old children was 0.6 in both Sri Lanka and Wales, with caries prevalence of 30.4% and 29.6%, respectively. In Sri Lanka, both mean household income and per capita income showed moderate, statistically significant positive correlations with DMFT (r = 0.47, p = 0.01). Income inequality, measured by the Gini coefficient, was positively associated with caries experience (r = 0.42, p = 0.03). In Wales, higher deprivation (lower income) was moderately associated with increased DMFT, in areas within the 20% (r = 0.54, p < 0.01), 30% (r = 0.53, p < 0.01), and 50% (r = 0.61, p < 0.01) deprived quintiles. The dental care indices showed no clear association with income in either of the countries. Conclusions: Income-related disparities in dental caries were evident in both countries. Prevention strategies should focus on higher-income groups in Sri Lanka and on deprived populations in Wales. However, as this was an ecological study, the results are subject to ecological fallacy and should therefore be interpreted with caution.

IntroductionReducing social inequality along with oral health inequality in Wales is a policy objective. In this ecological study the relationships between deprivation, dental workforce and oral health are explored. MethodTwenty-two Unitary Authorities (UAs) serving the population of Wales were studied. The number of dentists were obtained from NHS Business Services as well as the 2019 population figures from StatsWales. As data for whole time equivalent General Dental Practitioner (GDP) workforce were not available, GDP sites were used. The condition of teeth at the age 12 years was used as a measure of oral health from the most recent epidemiological survey available. The relationship between oral health and workforce was established using the Welsh Index of Multiple Deprivation (WIMD).ResultsAssociations were observed between dental sites and population as well as between oral health and deprivation. A new composite variable called the University of South Wales Dental Index (USWDI) was introduced by combining the number of dentists with their corresponding WIMD of the most deprived 10% of the population. Using regression modelling the USWDI demonstrated its superiority in using either the number of dentists or the WIMD most deprived 10% alone to predict decayed, missing and filled teeth (DMFT).ConclusionWorkforce levels have increased and there has been a corresponding improvement in oral health over two decades. At the same time deprived subgroups continue to experience relatively higher levels of disease. A proportion of the general dental services delivered in Wales has continued to be based on the principle of supply induced demand for care rather than oral health need. Improving oral health in a diverse population like Wales cannot be achieved by increasing dental workforce alone. It is necessary to account for levels of deprivation. USWDI as a predictor of DMFT could be a useful tool to monitor the macro delivery of oral health care for the future in Wales.