When your teeth and gums are in good condition, you might not even notice their impact on your day-to-day life. Good oral health helps us chew, taste, swallow, speak and convey emotions.

This means the state of your mouth can affect nutrition, confidence, forming relationships and maintaining overall good health and wellbeing.

People who have missing or damaged teeth, or other oral health issues such as gum disease, know this all too well.

They may not only live with pain that affects their sleep, speech and ability to enjoy certain foods, but often also face discrimination and stigma.

So, why is it so shameful to have missing teeth or gum disease? And what can we do about it?

The social and psychological impact

Oral health is deeply tied to social status. People who don’t have good teeth often face stereotypes about their health, wealth and even their intelligence.

For example, in one 2010 study from the United Kingdom, researchers showed young people photographs of the same person, modified with different levels of tooth decay.

Whenever decayed teeth were visible, participants rated the person lower in intelligence, social skills, confidence, self-esteem and whether they appeared happy – based only on the photo.

These stereotypes can lead to bullying and stigma that scar people for life.

In a recent study with colleagues, we looked at nationally representative data on 4,476 children from the Longitudinal Study of Australian Children.

We found losing teeth to decay or injury was relatively common, affecting one in ten children. These children then had a 42% higher risk of being bullied at school.

These stigmatising experiences can lead to feelings of shame, embarrassment and low self-esteem. In some cases, they can mean people are less likely to seek dental care, fearing further humiliation or blame that they have neglected themselves.

Dental care is often out of reach

Tooth decay and gum disease are the most common oral diseases in Australia and can lead to missing teeth. These conditions can occur at any age, from childhood to adulthood, but they usually worsen with age.

Yet the government’s Child Dental Benefits Schedule only covers dental care for children aged 17 and under whose parents receive government benefits.

Some states and territories also provide oral care for eligible older adults. But long waiting lists show the public system is stretched.

This means oral health care remains inaccessible and unaffordable for many Australians.

Poor oral health affects everyday life

Arguments for improving oral health almost always focus on preventing other physical health conditions. For example, one large study of 172,630 adults in New South Wales found those with missing teeth or poor oral health were more likely to die from heart disease.

Yet when people can’t afford to fix their own oral health issues or their children’s, there can be other serious flow-on effects for their day-to-day life and wellbeing, beyond physical health.

Research shows when people are in pain from tooth decay they are more likely to take days off work and school. This can have long-term negative effects, disrupting education and employment.

Parents may also need to take time off work to take children to the dentist or dental hygienist. They often face financial pressures due to high out-of-pocket costs for dental treatments.

Research shows when people can’t afford dental treatments they may feel powerless to control their circumstances. As a result, they may choose cheaper treatments, such as having a tooth extracted even when it could have been saved.

There has also been a recent surge in people using superannuation to pay for dental treatments, for largely preventable conditions. This will further entrench financial disadvantage.

So, what’s the fix?

Research I conducted with colleagues this year found 96% of working-aged adults in Australia believe oral health care is essential.

But there continue to be significant financial barriers in getting required treatment, particularly for people who are unemployed, have low incomes or those with disability.

So, making dental care more affordable and accessible is an important step. This will encourage timely care and make sure check-ups aren’t a luxury for those who can afford them.

But while dental visits are important, they can’t provide sustainable and long-term protection from oral diseases when the social conditions and behaviours that lead to poor oral health stay the same.

Experiencing stigma because of poor oral health can be highly personal and feel shameful. But the burden to fix this should not be on individuals.

The main causes of oral diseases are behaviours – such as having a lot of sugar, alcohol and tobacco, or poor oral hygiene – and high levels of stress.

We know these behaviours and stress are more common among people who experience social disadvantage.

So we need broader policies that address the social conditions in which people live, work, age and grow – for example, by making access to nutritious food more accessible and affordable.

Reducing disadvantage is the key to addressing both tooth decay and gum disease and the stigma attached to these oral health issues.

Ankur Singh, Chair of Lifespan Oral Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Eating disorders can affect anybody, no matter their age, gender, ethnicity, socioeconomic status or body size. Yet the myth that eating disorders are “diseases of affluence” persists, and can mean those from wealthier backgrounds are more likely to receive a diagnosis and be able to access treatment.

In fact, people who experience socioeconomic disadvantage may be more at risk of developing eating disorder symptoms, such as excessive dieting, fasting or binge eating.

A new study from the United Kingdom followed 7,824 children, roughly half male and half female, from birth to 18 years. It found those born into financial hardship were more likely than others to later experience eating disorder symptoms as teens.

This means the stereotype that eating disorders only affect the rich is simply not true. And it shows we need to better understand the risk for children from lower-income families, so we can recognise and treat their symptoms earlier.

What the study looked at

Previous research has shown eating disorders can affect people from all socioeconomic backgrounds, not just those with higher economic status. But this new study is one of the first to show deprivation in childhood could be a risk factor for eating disorder symptoms in adolescence.

This new large, long-term study collected data from thousands of people over an 18-year period to investigate the impact of social and financial hardship.

Researchers looked at parents’ education, job type and where they lived. They also examined income, which was split into five groups from low to high. These were more aspects of social studies than previous research had considered.

To assess financial hardship, mothers rated how much they struggled to afford daily expenses such as food, heating, clothing, rent and baby items. They used a scale from 0-15, with higher scores indicating greater hardship.

When the children grew up to be teenagers, researchers assessed eating disorder symptoms in all the young people across the study.

Patterns of disordered eating included excessive dieting, binge eating, vomiting or using laxatives to get rid of food, and fasting. The teens were also asked how they felt about their bodies – for example, how satisfied they were with their appearance, weight and shape.

What the study found

Eating disorder symptoms were higher in young people aged 14–18 whose parents had suffered greater financial hardship when they were babies. For patterns of disordered eating, this meant a 6% higher likelihood for every one point increase between 0 and 15 on the financial-hardship scale.

The study also found teens whose parents completed less formal education (meaning only compulsory schooling) were 80% more likely to experience disordered eating patterns than those whose parents went to university. For teens with parents in the lowest fifth and fourth income band, the risk was 34–35% higher than those in the top band of income.

These results are different to other studies on eating disorders, because they show people from low socioeconomic backgrounds have a higher chance of developing eating disorder symptoms.

The researchers suggest this difference may be because other studies only included participants with a diagnosis or who have sought help. Research has shown those experiencing financial hardship are less likely to be formally diagnosed or access treatment.

While this study is impressive in its size and results, it has a few limitations. Only around half the participants (55.9%) completed the full study, which may have affected the results.

Among those who did complete the study, some of their data was missing. This may also have influenced the findings.

The study also did not measure whether young people had a diagnosed eating disorder – only whether they had symptoms.

So, it may have captured a wider range of eating disorder experiences, including from those who wouldn’t seek formal support. But it means more research is needed to understand the link between socioeconomic status and formal diagnosis.

What does this mean?

People who are born into financial hardship may be more likely to struggle with disordered eating and body image issues in their teenage years than those who are not.

This not only debunks the stereotype that eating disorders occur only in people from affluent backgrounds, it shows disadvantage can be a risk factor.

The study sheds light on the inequalities and barriers in recognising and treating eating disorders.

Rates of people seeking help for an eating disorder are already low – and even lower among people from disadvantaged backgrounds.

The researchers suggested this could be because people from lower socioeconomic backgrounds may also believe eating disorders mainly affect people from wealthier backgrounds.

Another reason may be that lower income is linked to higher rates of obesity and being overweight, and this might limit referrals for eating disorder symptoms.

Eating disorders not associated with thinness, such as bulimia and binge eating disorder, are often less visible and go undetected.

Better education about eating disorders – in schools and for families and health-care professionals – may help us recognise and treat them earlier.

But treatment also needs to be more affordable. In Australia, people can access eating disorder treatment sessions under Medicare, but this typically still involves a gap fee which can be up to A$100 or more, depending on the service. More no- or low-cost services are needed to reach everyone who needs them.

If you have a history of an eating disorder or suspect you may have one, you can contact the Butterfly Foundation’s national helpline on 1800 334 673 (or via their online chat).

Catherine Houlihan, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast and Kathina Ali, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast

This article is republished from The Conversation under a Creative Commons license. Read the original article.