The philosophy underlying Australia's health system is that health is a right and that access to health care should not be related to ability to pay. This philosophy is in line with Priester1 who argues that fair access should be the pre-eminent value within any health care system. Fair access does not apply to oral health care in Australia as funding for dental services is predominantly an out-of-pocket expense for individuals.2
Access to regular dental care for check-ups and maintenance is associated with better oral health and quality of life. However, pain and other problems are strongly associated with use of dental services.3 Adults who make a dental visit when they are experiencing pain are likely to have more advanced disease and thus more limited treatment options.4 Brennan et al.5 found that extraction rates were higher at emergency visits than at visits for general care.
The decision to extract a tooth reflects a complex interaction between patient and provider. There are a number of possible explanations for extraction rates, some of which relate to characteristics of the patients (e.g. late presentation of the problem, ability to pay, value placed on retention of teeth, and ability to discuss treatment options). Other factors which could be important include factors relating to the dental provider (e.g. assumptions about the values and therefore the wishes of the patient, or ease of treatment).6 Whatever the explanation, the loss of teeth is regarded as a negative health outcome and it is of concern when extraction is significantly associated with socio-demographic factors as it indicates likely inequalities in oral health outcomes between different groups in the population.
Social inequality in health may be reflected in access to care issues related to irregular, symptomatic visiting and receipt of care resulting in tooth loss. The aims of this study were to assess social inequality in use of dental services in terms of whether the reason for visit was for relief of pain and if extraction services were received.