Dental Attendance in Undocumented Immigrants before and after the Implementation of a Personal Assistance Program: A Cross-Sectional Observational Study

Strategies to integrate oral health into primary care: a systematic review

OBJECTIVES

Integration of oral health into primary care has been proposed as a primary healthcare approach for efficient and sustainable delivery of oral health services, and the effective management of oral diseases. This paper aimed to synthesise evidence on the effectiveness of strategies to integrate oral health into primary care.

DESIGN

Systematic review.

DATA SOURCES

MEDLINE, CINAHL, Embase, Scopus, ProQuest, Cochrane and Google Scholar were searched without date limits until the third week of June 2022. Reference lists of eligible studies were also searched. Experts in the field and existing professional networks were consulted.

ELIGIBILITY CRITERIA

Only studies that evaluated integration strategies were included in the review. Eligibility was restricted to English language studies published in academic peer-reviewed journals.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data and performed the risk of bias assessments. A narrative synthesis approach was used to report review findings. Heterogeneity among included studies precluded a meta-analysis.

RESULTS

The search identified 8731 unique articles, of which 49 were included in the review. Majority of the studies explored provision of oral healthcare by primary care professionals in primary care settings, where integration was primarily via training/education and/or policy changes. Most studies reported results favouring the integration strategy, such as improvements in referral pathways, documentation processes, operating efficiencies, number of available health staff, number of visits to non-dental primary care professionals for oral health issues, proportion of children receiving fluoride varnish applications/other preventive treatment, proportion of visits to an oral health professional and dental caries estimates.

CONCLUSION

The findings from this review demonstrate that the majority of identified strategies were associated with improved outcomes and can be used to inform decision-making on strategy selection. However, more research and evaluation are required to identify best practice models of service integration.

PROSPERO REGISTRATION NUMBER

CRD42020203111.

Oral Care Needs Amongst Disadvantaged Migrants in France

Background

Disadvantaged migrant populations face risk factors that can affect their oral health amongst other health issues. The purpose of this study was to explore the oral care needs of these populations and to identify the obstacles they might encounter in accessing dental care.

Methods

A cross-sectional study using secondary data was carried out in the Centre Médical Louis Guilloux in Rennes, France, a health centre offering dental consults to migrants. The data were obtained by clinical oral examination and analysed according to various criteria: reason for consultation, diagnosis, treatment plan, drug prescriptions, and referrals to other practitioners.

Results

A high prevalence of decay was observed amongst the patients (72.3%). Fifty-nine patients were identified as needing major oral health care amongst the 130 files that were analysed. The lack of proficiency in the host country's language was associated with a major need for oral care (P < .02).

Conclusions

This study highlights that disadvantaged migrants face important oral care needs in France. It suggests alternative actions that should be carried out to improve their access to dental care, including access to interpreting.

Promoting Inclusion Oral Health: Social Interventions to Reduce Oral Health Inequities

To advance our understanding of inclusion oral health and to address the impact of social exclusion upon oral health, this group of papers sets out to provide an argument for the need for social and community-based interventions, theoretically underpinned by pluralistic definitions of evidence-based practice and the radical discourse of health promotion for those experiencing exclusion. Using the definition and framework of inclusion oral health, these papers illustrate the requirement for mixed-methods research, the incorporation of experts by experience in the research process, and the need for co-design and co-produced interventions. The papers in this Special Issue present various sources of evidence used to transform top-down into bottom-up community-based interventions for people experiencing homelessness, people in custody, and families residing in areas of high social deprivation. The first two papers provide the evidence for extreme oral health in those experiencing exclusion, and the final four papers report on the implementation and evaluation of social or community-based interventions. This collection of research papers will be of interest to all those wishing to reduce health inequities. This will be achieved by focusing on prevention, adopting a common risk factor agenda, and incorporating co-design and co-production elements into interventions, to tackle the oral health inequities felt by those most excluded in our societies.