Oral health-related quality of life among Syrian refugees in Jordan: a cross-sectional study

Factors associated with access to dental care among refugees: A systematic review of quantitative studies

OBJECTIVES

To identify, appraise and synthesize the published evidence from quantitative studies on the individual and contextual-level factors determining access to dental care among refugees worldwide.

METHODS

A systematic literature search was conducted until the last week of February 2022 in four electronic databases - MEDLINE, Embase, Web of Science (all databases) and APA PsycINFO - without any restrictions. Quantitative studies published in English language and meeting the a priori eligibility criteria were reviewed and data extracted. Quality assessment was conducted using the National Institutes of Health tool. The identified factors were stratified according to the framework of the Behavioural Model of Health Services Use, and the evidence related to each of these factors was summarized in tables. Narrative synthesis of the findings was conducted.

RESULTS

The search retrieved 6776 unique records, of which 69 were deemed eligible for full-text screening and nine studies were included in the final data analysis and synthesis. The studies were rated to be of 'fair' quality at best. Self-reported previous dental visits was the most commonly used measure of access. Associations between individual-level factors and dental care access were most frequently examined (predisposing [n = 6], need [n = 2] and enabling [n = 1]), while the contextual-level factors were rarely examined (predisposing and enabling [n = 1, each]).

CONCLUSIONS

Individual-level predisposing factors, such as English language proficiency, education, health and dental literacy and acculturation and integration, were shown to be significantly associated with refugees' access. There is limited evidence to determine the effect of individual enabling and need and contextual factors.

Evaluation of a tailored oral health promotion intervention for Syrian former refugees in New Zealand

To investigate a health promotion strategy to improve oral health among former refugees in New Zealand. Former refugees were recruited (n = 63) and answered a questionnaire about their oral home care, smoking, sugar consumption and use of dental services. Participants then joined either focus group sessions to co-design oral health educational material (n = 39) or to be dentally examined for oral hygiene, periodontal health, gingivitis and dental caries and receive motivational instructions to improve their oral health habits (n = 20). Health messages using dual-language leaflets (covering oral home care, smoking, diet and access to services) were subsequently individually delivered monthly to all participants via a mobile phone application. After 6 months, follow-up questionnaires were sent to all participants and those who had been dentally examined were re-examined. Half of those who did not brush twice daily at baseline (54.1%) had increased brushing to at least twice daily by follow-up; 76.9% of those who consumed sugary drinks at least twice daily, reduced their sugar intake. No smokers quit smoking, however, 52.4% reported reducing the number of cigarettes or engaging in smoking cessation activities. Among those who had been dentally examined, plaque scores, gingivitis and periodontal pocketing all decreased significantly. Culturally and linguistically tailored oral health promotion interventions led to improved oral health behaviours for this group of former refugees over a 6 months follow-up period. We expect this to not only improve the oral health quality of life for this population, but also reduce the burden on the health system.

Oral Health–Related Quality of Life of Refugees in Settlements in Greece

Introduction

The objective of this cross-sectional study was to investigate the oral health–related quality of life (OHQoL) amongst refugees at emergency dental clinics in settlements in Northern Greece.

Methods

A self-reported survey was undertaken in 7 settlements. The American Dental Association questionnaire on oral health (OH) was adapted and distributed to adults attending a mobile dental clinic between July and August 2017. Data were collected on sociodemographics, length of stay in settlement, utilisation of dental service, and OHQoL. Statistical analysis included descriptive analysis and Chi-square tests of associations.

Results

Of 156 participants, the majority were male (73%), were aged 18 to 34 (59%), and had education up to high school (48%). Most of the participants rated OH as fair or poor (76%) and had spent more than 6 months in the settlements (45%). A majority of the participants (85%) had no access to dental care without the mobile clinic.

Negative impact on OHQoL was significantly (P < .05) related to settlement location and time spent, smoking status, frequency of cleaning teeth and use of fluoridated toothpaste, perceived OH, and time since last dental visit. Those who spent less than 1 month in the settlement reported a higher negative OHQoL impact related to chewing, anxiety, smiling, daily activity, and sleeping (range, 48%-73%) compared to those who had spent more than 6 months (range, 17%-41%) (P < .05).

Conclusions

To the best of our knowledge, this is the first cross-sectional study assessing the OHQoL of refugees seeking emergency dental care in settlements in Greece. There is evidence that the refugees who were new arrivals to the settlements when provided with access to dental care reported a negative impact on their OHQoL. There is an urgent need for further research to understand the OH needs of refugees in Europe in order to design and deliver targeted and effective interventions.

Pattern, frequency and causes of dental extraction among children/adolescents Syrian refugees: an observational study

Background

The Syrian conflict has had a massive impact on the dental health of refugees. Dental extraction is a good indicator of socioeconomic position and degree of oral hygiene, however there is a scarcity of evidence in the scientific literature that characterizes the reasons for extraction in refugees.

Aims and methods

The current study looked at the extraction causes and related sociodemographic variables of 322 Syrian refugees (46.3% females, 53.7% males) who were treated in a dental clinic in Zaatari camp (Jordan), from September to December 2019. All child Syrian refugees (aged 4–16) visiting the facility were eligible to participate. A validated semi-structured survey was used to collect clinical and sociodemographic data from the research sample. Chi-square test, Independent sample t-test, and ANOVA test were used to examine associations between the different variables. The significance level was set at P < 0.05.

Results

The total number of teeth extracted was 397: 25 (6.3%) permanent teeth, 371 (93.5%) primary teeth, and one mesiodens (0.2%). Overall, lower teeth were most commonly extracted (56.9%). The most common teeth that required extraction were the lower primary molars, with lower left primary second molars being the most commonly extracted (15.9%). As the level of parental education increased, the mean number of extracted teeth decreased (P = 0.035), additionally, as the frequency of toothbrushing increased extractions due to caries decreased significantly (P = 0.027).

Conclusions

Dental caries and pulpal diseases were discovered to be the most prevalent causes for primary and permanent tooth extraction, with no difference between males and females. The lower left primary molar was the most commonly afflicted tooth.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.

Eritrean Refugees' and Asylum-Seekers' Attitude towards and Access to Oral Healthcare in Heidelberg, Germany: A Qualitative Study

Oral health concerns in Eritrean refugees have been an overlooked subject. This qualitative study explored the access of Eritrean refugees and asylum-seekers (ERNRAS) to oral health care services in Heidelberg, Germany, as well as their perceptions and attitudes towards oral health care. It involved 25 participants. We employed online semi-structured interviews (n = 15) and focus group discussions (n = 2). The data was recorded, transcribed, and analysed, using thematic analysis. The study found out that most of the participants have a relatively realistic perception and understanding of oral health. However, they have poor dental care practices, whilst a few have certain misconceptions of the conventional oral hygiene tools. Along with the majority's concerns regarding psychosocial attributes of poor oral health, some participants are routinely consuming Berbere (a traditional spice-blended pepper) to prevent bad breath. Structural or supply-side barriers to oral healthcare services included: communication hurdles; difficulty in identifying and navigating the German health system; gaps in transculturally, professionally, and communicationally competent oral health professionals; cost of dental treatment; entitlement issues (asylum-seekers); and appointment mechanisms. Individual or demand-side barriers comprised: lack of self-sufficiency; issue related to dental care beliefs, trust, and expectation from dentists; negligence and lack of adherence to dental treatment follow-up; and fear or apprehension of dental treatment. To address the oral health burdens of ERNRAS, it is advised to consider oral health education, language-specific, inclusive, and culturally and professionally appropriate healthcare services.

Knowledge and awareness of dental implants among Syrian refugees: a cross sectional study in Zaatari camp

Background

The popularity of implant dentistry is increasing dramatically, but the success of implant treatment depends on a patient’s knowledge and expectations.

Methods

This study aimed to assess dental implant knowledge among refugees as a treatment option (n = 565), using face-to-face interviews. The frequency distribution of the responses in general and according to age, gender and education was calculated.

Results

81.8% of the interviewees had missing teeth, however, only 26.2% replaced them. 16.6% of participants had never/hardly heard about implants. Females who never heard of implants were more than males (P < 0.001). 51.3% of participants described dental implants as a screw, and only 35.4% knew implants were placed in jawbones. 6.2% of respondents reported that implants required more care than a natural teeth, with 47.6% believing that diseases affect implant success. Friends were the main source of information (61.4%). Highly educated participants showed higher knowledge about implants.

Conclusions

The surveyed sample revealed limited knowledge about dental implants with high cost being a major obstacle, warranting more strategies to increase awareness and to make implants more affordable for this population.

Assessing Oral Health Status, Practices, and Access to Care among War-Affected Refugees Living in San Antonio, Texas

OBJECTIVES

 Refugees encounter several health disparities including oral health problems. This study evaluated the self-reported oral health status, practices, and access to care of adult refugees living in San Antonio, Texas, United States.

MATERIALS AND METHODS

 Adult refugees (n = 207) who accessed services from two centers in San Antonio, completed this survey. Multivariate logistic regression was used to examine the relationship of the refugees' demographics with oral health status, practices, and access to care.

RESULTS

 Oral pain in the previous 12 months was common among refugees having been reported by almost 58.9% of the survey participants; 43% reported pain as the reason for their last dental visit. Approximately half of the participants reported both the condition to their teeth and gums as being good: 42.5 and 54.6%, respectively. Most participants (84%) reported brushing their teeth one or two times a day, and around 78% reported they never smoked. Fifty-two percent reported needing dental care in the past 12 months, but not being able to receive it; while 45.9% reported not having dental insurance, 41.5% reported not having money to pay a dentist. Fifteen percent reported never visiting a dentist. Arabic speakers, moving to the United States more recently, and lower level of education were associated with a poor oral health status and practices (p < 0.05).

CONCLUSION

 Refugees in this study encountered limited access to dental care. Their inability to seek dental care could affect their oral and general health, weaken efforts of preventing oral health diseases, and restrict their full inclusion into the community.

Dental services provided to Syrian refugee children in Jordan: A retrospective study

BACKGROUND

Little is known about oral health care in Syrian refugee children in host countries. We describe the pattern and nature of oral healthcare service provided to Syrian refugee children in Jordan METHOD: The clinical records of 3 to 7-year-old children who attended dental clinics at Zaatari refugee camp over a period of 8 months were retrieved and analyzed.

RESULTS

Records of 259 children were analyzed. The mean age of the study sample was 5.6 years, and all included children were born in Zaatari refugee camp. Most children (66%; n = 171) presented because of dental pain and/or dental infection. Dental extraction was the most common procedure (55%), followed by dental fillings (25%), pulpotomy (10.6%), and stainless steel crown (9.2%). Most patients (75.3%; n = 195) received only one dental procedure during their stay in the camp, and no significant correlation between age and number of dental procedures was found.

CONCLUSIONS

Oral health care is not a priority in this population, and the available capacity for dental services is insufficient. Dental health programs should be implemented to improve refugee dental care.