Key Points
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The study has confirmed that persons in areas of low socio-economic status are more likely to report orofacial pain.
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Socio-economic status per se does not influence the onset of symptoms but is only a marker for a set of environmental and individual factors which may influence onset.
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This study in examining some specific mechanical, psychological and behavioural factors has demonstrated that they cannot account for the excess symptoms amongst those living in areas of low socio-economic status.
Abstract
Study objective To confirm a relationship between self-reported oro-facial pain and deprivation using an area-based measure of deprivation, and to investigate possible mechanisms of the association.
Design A cross sectional population based survey.
Setting General medical practice in South-East Cheshire (Borough of Congleton, North West England).
Participants Two thousand, five hundred and four people aged 18-65 years living in the community.
Methods A postal questionnaire was sent which asked about pain in the oro-facial region. Information on factors which may 'explain' any relationship between pain and social class was collected: psychological distress, maladaptive responses to illness, sleep problems and local mechanical factors such as teeth grinding and facial trauma. Participants were allocated a Townsend index deprivation score on the basis of their postcode.
Main results The study achieved an adjusted participation rate of 74% (N = 2,504) and the overall prevalence of oro-facial pain was 26%. Statistical analysis revealed that people in the most deprived areas were more likely to report oro-facial pain compared with the most affluent ones [OR 1.50 (95% confidence interval 1.09, 2.07)]. This relationship remained after adjusting for all potential confounding factors.
Conclusion While the relationship between oro-facial pain and deprivation exists, the mechanisms of such relationships are not clear. Local mechanical factors, trauma or psychological distress did not explain it. The factors linking pain with social deprivation remain to be elucidated.
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Acknowledgements
The authors are grateful to staff and patients of Lawton House Surgery for their help with the study. V. R. Aggarwal was supported by a Wellcome Trust entry-level fellowship and currently holds a Wellcome Trust clinical epidemiology research fellowship
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Aggarwal, V., Macfarlane, T. & Macfarlane, G. Why is pain more common amongst people living in areas of low socio-economic status? A population-based cross-sectional study. Br Dent J 194, 383–387 (2003). https://doi.org/10.1038/sj.bdj.4810004
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DOI: https://doi.org/10.1038/sj.bdj.4810004
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