Indicators of integrating oral health care within universal health coverage and general health care in low-, middle-, and high-income countries: a scoping review

BACKGROUND

The World Health Organization (WHO) has recently devoted special attention to oral health and oral health care recommending the latter becoming part of universal health coverage (UHC) so as to reduce oral health inequalities across the globe. In this context, as countries consider acting on this recommendation, it is essential to develop a monitoring framework to measure the progress of integrating oral health/health care into UHC. This study aimed to identify existing measures in the literature that could be used to indicate oral health/health care integration within UHC across a range of low-, middle- and high-income countries.

METHODS

A scoping review was conducted by searching MEDLINE via Ovid, CINAHL, and Ovid Global Health databases. There were no quality or publication date restrictions in the search strategy. An initial search by an academic librarian was followed by the independent reviewing of all identified articles by two authors for inclusion or exclusion based on the relevance of the work in the articles to the review topic. The included articles were all published in English. Articles concerning which the reviewers disagreed on inclusion or exclusion were reviewed by a third author, and subsequent discussion resulted in agreement on which articles were to be included and excluded. The included articles were reviewed to identify relevant indicators and the results were descriptively mapped using a simple frequency count of the indicators.

RESULTS

The 83 included articles included work from a wide range of 32 countries and were published between 1995 and 2021. The review identified 54 indicators divided into 15 categories. The most frequently reported indicators were in the following categories: dental service utilization, oral health status, cost/service/population coverage, finances, health facility access, and workforce and human resources. This study was limited by the databases searched and the use of English-language publications only.

CONCLUSIONS

This scoping review identified 54 indicators in a wide range of 15 categories of indicators that have the potential to be used to evaluate the integration of oral health/health care into UHC across a wide range of countries.

An Assessment of Oral Health Training Among Geriatric Fellowship Programs: A National Survey

Oral health (OH) has profound effects on the overall health of elderly people. While oral disease is prevalent in the geriatric population and access to care is a major issue, it is unclear the extent of OH training among US geriatric fellowship programs. A 19-item electronic survey was sent to all 148 accredited geriatric fellowship training programs via the Association of Directors of Geriatric Medicine. Directors were asked about hours of trainings, barriers, and evaluation of trainees among other topics. Univariate and bivariate analyses were performed. Seventy-five directors completed the survey (51% response rate). Sixty-three percent (46/73) report their fellows receive 1 to 2 hours of OH instruction (ie, lectures, workshops) during their training. Almost a quarter (23%; 17/73) reported 0 hours of OH content. Only 17% (13/75) have clinical experiences in a dental setting. Barriers to more OH education include competing priorities or lack of time (57%; 43/75), lack of faculty expertise (55%; 41/75), and no clear geriatric national educational competencies (44%; 33/75). Programs with an OH champion or dental school/residency affiliation had more hours of OH instruction. Geriatric fellowships appear to need more OH training, which could be achieved by creating OH champions and connecting fellowships with dental schools/residencies. Barriers could be overcome by exposing fellowships to existing resources and creating national competencies. J Am Geriatr Soc 67:1079-1084, 2019.

A scoping review and research synthesis on financing and regulating oral care in long-term care facilities

BACKGROUND

Oral health care for frail elders is grossly inadequate almost everywhere, and our knowledge of regulating and financing oral care in this context is unclear.

OBJECTIVE

This scoping study examined and summarised the published literature available and the gaps in knowledge about regulating and financing oral care in long-term care (LTC) facilities.

METHODS

We limited the electronic search to reports on regulating and financing oral care, including reports, commentaries, reviews and policy statements on financing and regulating oral health-related services.

RESULTS

The broad electronic search identified 1168 citations, which produced 42 references, including 26 pieces of grey literature for a total of 68 papers. Specific information was found on public and private funding of care and on difficulties regulating care because of professional segregation, difficulties assessing need for care, uncertainty on appropriateness of treatments and issues around scope of professional practice. A wide range of information along with 19 implications and 18 specific gaps in knowledge emerged relevant to financing and regulating oral healthcare services in LTC facilities.

CONCLUSIONS

Effort has been given to enhancing oral care for frail elders, but there is little agreement on how the care should be regulated or financed within the LTC sector.

Oral disease experience of older adults seeking oral health services

OBJECTIVE

The objective of this investigation was to describe the dental disease (dental caries and alveolar bone loss) experience in a sample of community-dwelling older adults who regularly utilize dental services in New York City.

BACKGROUND

Public financing for dental care directed at older adults in the United States is minimal. Improved preventive methods, primarily the use of fluorides, have resulted in declines in tooth loss, and concomitant increase in risk for dental diseases among older adults. While the oral disease burden in institutionalized elderly and those unable to access services is well-documented, the dental care needs of older adults who access dental services are not well documented.

MATERIALS AND METHODS

Radiographic and record review were used to determine prevalence of dental caries, alveolar bone loss, frequency of service utilization, and medical status in this cross-sectional investigation of a sample of older adults (N = 200) using dental services at Columbia University College of Dental Medicine.

RESULTS

Only 9% of the sample was completely edentulous, the mean DMFT was 19.9 and mean alveolar bone loss was 3.6 mm. Missing and Decayed Teeth accounted for 57.8% and 6.5% of the total caries burden respectively. Missing Teeth and alveolar bone loss increased with increasing age, but there was no increase in Decayed Teeth.

CONCLUSIONS

While access to and utilization of dental services may result in improved tooth retention, older adults who use dental services continue to have dental care needs, especially periodontal care needs.

Effects of the new fixed-subsidy system for prosthetic dental care in Germany: results of descriptive research

OBJECTIVE

To detail how provision of prosthetic treatments altered in Germany following changes in legislation on 1 January 2005, enacted as part of the health system modernisation law (GMG). This legislation directs health insurance companies to fix subsidies on dental prostheses based on diagnostic findings. The goal of the reform is to ensure that insured persons can select any medically recognised form of prosthetic treatment without losing their right to a health insurance subsidy.

AIM

To show subsequent effects on provision of prosthetic treatments.

METHOD

The four largest substitute health insurance funds each collected the billing data from 300 medical and costs projections and/or from the submitted bills in June 2005, allowing access and analysis of a randomised sample (n = 1,200), which in turn made usable assertions possible.

RESULTS

Under the fixed-subsidy system the co-payment from the insured person has risen as soon as the area of Standard Prosthetic Care is left and dental prostheses treatment is provided from the categories care of a similar or different kind. The costs of dental prostheses in the new fixed-subsidy system are composed of approx. 39% dentists' fee and 61% dental materials. Only a small proportion of insured persons capitalise on these changes; in fact only 1.2% of the subsidy is for surgically implanted prostheses in the new fixed-subsidy system.

CONCLUSIONS

The current fixed-subsidy system results in substantially higher co-payments for the insured, as soon as Standard Prosthetic Care is left and care of a similar or different kind is provided. This raises the question as to whether the marginalisation of contractual care to fund the additional costs resulting from surgically implanted prostheses was necessary.