OBJECTIVE: To examine the socio-economic background of patients who underwent inpatient and day-case oral operations from 1989-1994 in the West Midlands. DESIGN: Retrospective. SETTING: National Health Services Executive West Midlands; with a population of approximately 5.5 million. SUBJECTS: A total of 4,926,438 hospital inpatient finished consultant episodes, within 56 specialties recorded in the hospital episode statistics database, of which 60,904 (1.24 per cent) were dental; oral surgery. OUTCOME MEASURE: Standardised hospital inpatient activity ratios. RESULTS: The overall levels of activity rose moderately over the five year study period, although the type of activity remained consistent. Surgical removal of teeth was the third most common activity of all surgical procedures. Patients who availed themselves of elective inpatient oral surgery were generally from a higher socio-economic group, in marked contrast to those patients admitted for emergency oral surgery. This observation was highlighted even further by the procedure 'removal of impacted wisdom tooth', which accounted for 41 per cent of all oral surgery activity. The most deprived communities (15 per cent of the regional population) utilised this service 50 per cent less than all other groups. CONCLUSIONS: The application of a deprivation index to hospital episode data enables more accurate assessment of service utilisation by differing socio-economic groups. The inequality of the oral surgery provision to the 15 per cent of the population which were most deprived adds to the overall debate on the appropriateness of this service. Further examination of the pattern of behaviour and referrals amongst primary dental care services is clearly needed.