Teething trouble: The oral health of men

Monday, May 13th, 2013 |

A great deal has been said about men’s poor use of GP services. But men’s use of dental services has been virtually ignored, even though they are at greater risk of gum disease and mouth cancers than women (women, however, are more at risk of tooth decay). Men also take poorer care of their own oral health – they are much less likely than women to brush their teeth regularly or to floss. With the oral health campaign National Smile Month kicking off next week (on 20 May), it’s worth asking what can be done about this.

But, first, a closer look at the problem. The Adult Dental Health Survey for England, Wales and Northern Ireland 2009 found that women were far more likely than men to clean their teeth at least twice a day (82% compared to 67%) and to use dental floss (26% v 16%). Women were also more likely to have made an appointment with a NHS dentist in the past three years (62% v 54%). The Scottish Health Survey 2009 found that women with dentures were more likely than men with dentures to clean them daily (65% v 56%) or leave them out at night (34% v 26%).

It’s not just UK men who neglect their oral health. A study of middle-aged Lithuanians found that 73% of women and 49% of men brushed their teeth more than once a day and 54% of women and 41% of men attended dental check-ups. The Swiss Health Survey of 2002 showed that women had a higher prevalence of visits to the dentist in the last 12 months (64% v 60% men), of visits to dental hygienists (39% v 34%), and of frequent tooth brushing (82% v 66%). Even male dental students don’t practice good oral self-care: just three-quarters of male Iraqi dental students (74%, compared to 84% of females) brushed their teeth regularly and the men were 2.5 times more likely to have bleeding gums. Men’s generally higher levels of alcohol consumption, smoking and sugar consumption – apparent throughout the world – also contribute significantly to their oral health problems.

Poorer use of dental services by men is not just a potential problem for the health of their teeth and gums. It could also delay the diagnosis of oral cancers. According to Cancer Research UK data, men are more than twice as likely as women to develop an oral cancer; these can be caused by tobacco, alcohol and HPV infection. (The Throat Cancer Foundation believes that 25% of mouth cancers are HPV-related.) Gum disease is linked to erectile dysfunction – one recent study found that severe gum disease may more than double a man’s risk of ED – and cardiovascular disease. It has also been suggested that men are more than four times as likely as the general population to suffer from age-related blindness if they have lost the bone supporting the teeth.

Across Europe, survey data suggests that the main reason given by men for not visiting the dentist is cost. But this is less the case in the UK where a high number of men cite waiting lists as a significant deterrent. Among 18-44 year olds in particular, lack of time is also a major factor throughout Europe.

So how can men’s oral health and use of dental services be improved? Here’s my 10-point plan:

  • Commission more research into men’s attitudes to oral health and their use of dental services to identify more accurately the barriers and how they could be overcome.
  • Produce male-targeted self-care resources on oral health (using paper and digital formats).
  • Give oral health a higher profile in public health campaigns on smoking, alcohol, heart disease and cancer.
  • Companies with a commercial interest in oral health (e.g. toothbrush, mouthwash, toothpaste manufacturers) should target more marketing specifically at men to improve both men’s oral health and product sales.
  • Establish outreach dental health checks (e.g. in workplaces, sports stadia, faith settings) to reach men less likely to use traditional services.
  • Create ‘male-friendly’ dental surgeries, e.g. male-targeted posters, leaflets and magazines, and offer appointments outside standard working hours.
  • Enable patients to make online appointments with their dentist.
  • Make every contact count with other healthcare professionals (e.g. pharmacists) more actively promoting oral health to men.
  • Introduce HPV vaccination for boys to reduce the risk of men developing HPV-related oral cancers. Australia is now vaccinating boys as well as girls and the UK should follow its lead.
  • Government policy on dental and oral health should take account of gender differences and dental practices should monitor and report on their performance in tackling health inequalities, including gender.

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