Community Dental Health (2016) 33, 156–160 © BASCD 2016 Received 7 March 2016; Accepted 1 April 2016 doi:10.1922/CDH_3716Gibson05 Inequalities in oral health: the role of sociology B. Gibson 1 , . M. Blake 2 and S. Baker 1 1 Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire, UK; 2 Depart- ment of Geography, University of Sheffield, Sheffield, South Yorkshire, UK Abstract: This paper seeks to identify an important point of contact between the literature on inequalities in oral health and the sociology of power. The paper begins by exploring the problem of social inequalities in oral health from the point of view of human freedom. It then goes on to briefly consider why inequalities in oral health matter before providing a brief overview of current approaches to reduc- ing inequalities in oral health. After this the paper briefly introduces the problem of power in sociology before going on to outline why the problem of power matters in the problem of inequalities in oral health. Here the paper discusses how two key principles associated with the social bond have become central to how we think about health related inequalities. These principles are the principle of treating everyone the same (the principle of autonomy) and the related principle of allowing everyone to pursue their own goals (the principle of intimacy). These principles are outlined and subsequently discussed in detail with application to debates about interventions to reduce oral health related inequalities including that of water fluoridation. The paper highlights how the ‘Childsmile’ programme in Scotland ap- pears to successfully negotiate the tensions inherent in attempting to do something about inequalities in oral health. It then concludes by highlighting some of the tensions that remain in attempting to alleviate oral health related inequalities. Key words: inequality, oral health, sociology, freedom, Scotland Introduction: Human freedom and the problem of oral disease Oral diseases are problematic because they impact on the quality and extent of human life (Locker, 1988; 1995; Locker and Allen, 2007; Slade, 1997; 1998; Slade et al., 2005). Put another way, they interfere with the ability of individuals to realise their ambitions; to live a life that is free from pain and disease. Furthermore, those who experi- ence oral disease and any associated pain also experience serious implications with regard to their life chances. Evidence from the US shows that children who suffer from tooth pain have trouble concentrating in school and are less likely to be academic achievers (Kozol, 2014). Several important reviews on the extent of inequalities in oral health have demonstrated that the extent of inequali- ties in oral health can be quite stark (Newton and Bower, 2005; Sheiham et al., 2011; Watt, 2005; 2007; 2012; Watt and Sheiham, 1999, 2012). Take the example of Aborigi- nal children in Australia; there is evidence that they have up to twice the rate of dental caries compared to their non-Aboriginal counterparts (Jamieson et al., 2007). The differences become more dramatic when aged-matched pairs were taken from the third wave of the Aboriginal Birth Cohort study and the 2004–2006 National Survey of Adult Oral Health Young Australian Aboriginal adults were eight times more likely to experience dental decay than their age-matched Australian counterparts (Jamieson et al., 2010). It is well established that significant proportions of poor children suffer from a greater proportion of disease than those from more affluent backgrounds (Locker, 2000; Sheiham et al., 2011; Watt and Sheiham, 1999). Correspondence to: Professor Barry Gibson, Unit of Dental Public Health, School of Clinical Dentistry, The University of Sheffield, 31 Claremont Crescent, Sheffield, S10 2TA, UK. Email: b.j.gibson@sheffield.ac.uk Several authors have indicated that inequalities in oral health are important because they insult our sense of fair- ness (Shaw et al ., 2009; Watt, 2007, 2012). Our reasons for objecting to inequalities in oral health are also significant because they relate to a number of important social principals, these principals are rarely discussed in the literature but they nonetheless reveal hidden dimensions in debates related to inequalities in oral health. The first principle is to do with our desire to promote human agency. Promoting human agency has become a central goal of social institutions in OECD countries for several centuries. The valorisation of human agency involves allowing everyone to equally exercise their right to self-control. The second principal involves the freedom to live differently; to live one’s life in a way that provides a sense of personal identity (Sulkunen and Warsell, 2012). The Finnish sociologist Pekka Sulkunen referred to this as the principal of intimacy. The principal of intimacy followed when people took the right of autonomy for granted he stated: “When people take their autonomy for granted they start to claim the right to intimacy, too. Inti- macy means separation from others, a sensitivity to authentic selfhood, distinction, and identity, in other words difference.” (Sulkunen, 2014: p190) He argued that both of these principles could clash. On the one hand we want to promote universal agency through the protection of autonomy for everyone, on the other hand, we wish to preserve the right of individuals to choose their own destiny (Sulkunen, 2010; 2014; Sulkunen and Warsell, 2012). This paradox has important implica- tions for how we see inequalities in oral health and how we might legitimately intervene to reduce such disparities.