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Oral Health Inequalities in the World

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Oral Health".

Deadline for manuscript submissions: closed (31 May 2020) | Viewed by 40678

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Dr. Jun Aida

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Guest Editor

Tohoku University, Sendai, Japan
Interests: health inequalities; health disparities; social determinants of health; income inequalities; social capital; universal health care; causal inference

Special Issue Information

Dear Colleagues,

Oral health inequalities are a fundamental problem in dentistry. “Health for all” has been one of the main messages since the Alma-Ata Declaration in 1978. In the Sustainable Development Goals (SDGs) by 2030 developed by the United Nations, “Ensure healthy lives and promote well-being for all at all ages” was set as the third goal. The key targets for achieving this goal are universal health coverage and prevention and treatment of noncommunicable diseases. With regard to oral health, reducing inequalities by ensuring prevention and treatment of oral diseases is necessary for achieving this health goal for all population.

In these two decades, plenty of research in health inequalities has been conducted. However, there is still room for carrying out research on oral health inequalities. Since monitoring trends in health inequalities is part of the strategy to reduce health inequalities, reports of recent oral health inequalities from children to older people remain valuable. Studies from non-Western countries are still scarce. Researches on various social determinants of inequalities and the mechanism of the determinants of oral health inequalities is still required.

This Special Issue welcomes the submission of all types of studies, reviews, and short communications. I would be delighted to attract as high a diversity and heterogeneity of submissions across the world as possible.

Dr. Jun Aida
Guest Editor

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Keywords

Oral health inequalities/disparities
Social determinants of health
Public health policy
Universal health coverage
Access to oral health care and prevention

Published Papers (12 papers)

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10 pages, 865 KiB

Open AccessArticle

Wider Dental Care Coverage Associated with Lower Oral Health Inequalities: A Comparison Study between Japan and England

by Kanade Ito, Noriko Cable, Tatsuo Yamamoto, Kayo Suzuki, Katsunori Kondo, Ken Osaka, Georgios Tsakos, Richard G. Watt and Jun Aida

Int. J. Environ. Res. Public Health 2020, 17(15), 5539; https://doi.org/10.3390/ijerph17155539 - 31 Jul 2020

Cited by 10 | Viewed by 3733

Abstract

Countries with different oral health care systems may have different levels of oral health related inequalities. We compared the socioeconomic inequalities in oral health among older adults in Japan and England. We used the data for adults aged 65 years or over from Japan (N = 79,707) and England (N = 5115) and estimated absolute inequality (the Slope Index of Inequality, SII) and relative inequality (the Relative Index of Inequality, RII) for edentulism (the condition of having no natural teeth) by educational attainment and income. All analyses were adjusted for sex and age. Overall, 14% of the Japanese subjects and 21% of the English were edentulous. In both Japan and England, lower income and educational attainment were significantly associated with a higher risk of being edentulous. Education-based SII in Japan and England were 9.9% and 26.7%, respectively, and RII were 2.5 and 4.8, respectively. Income-based SII in Japan and England were 9.2% and 14.4%, respectively, and RII were 2.1 and 1.9, respectively. Social inequalities in edentulous individuals exist in both these high-income countries, but Japan, with wider coverage for dental care, had lower levels of inequality than England. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

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14 pages, 343 KiB

Open AccessArticle

Differences in Utilization of Medical and Dental Services among Homeless People in South Korea

by Seung-Hyun Lee, Jae-In Ryu and Se-Hwan Jung

Int. J. Environ. Res. Public Health 2020, 17(15), 5304; https://doi.org/10.3390/ijerph17155304 - 23 Jul 2020

Cited by 4 | Viewed by 2489

Abstract

(1) Background: Homelessness contributes to both needs for care and barriers to access. This study aimed to explore the utilization of medical or dental services using Andersen’s model for a vulnerable population of homeless in South Korea. (2) Methods: The data were applied from the first national survey for homeless people in South Korea, 2016. Totally 2032 persons participated in the interview survey. This study team requested the raw data through the public portal and analyzed them. (3) Results: The participants who were homeless for more than ten years, staying in small rooming house or shelter, non-employed, earning less than 500,000 won per month, and having a medical condition showed a significantly higher chance of using Medicaid. The use of outreach programs had a significant relationship with gender, duration of homelessness, and monthly income. Among dental patients, the homeless who did not consume alcohol, stayed in a shelter, and were employed had higher chances of using dental service. (4) Conclusions: Medicaid service was strongly related to enabling factors but outreach programs with predisposing factors. Dental service showed strong relationships with the enabling domain, but the pattern was opposite: the jobless had less chance to avail it. The policymakers need to consider these domains of service utilization to provide equitable access to healthcare services. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

12 pages, 1652 KiB

Open AccessArticle

Violence as the Most Frequent Cause of Oral and Maxillofacial Injuries among the Patients from Low- and Middle-Income Countries—A Retrospective Study at a Level I Trauma University Emergency Department in Switzerland

by Triantafillos Loutroukis, Ekaterini Loutrouki, Jolanta Klukowska-Rötzler, Sabine Koba, Fabian Schlittler, Benoit Schaller, Aristomenis K. Exadaktylos, Michael Doulberis, David S. Srivastava, Silvana Papoutsi and John Patrik M. Burkhard

Int. J. Environ. Res. Public Health 2020, 17(13), 4906; https://doi.org/10.3390/ijerph17134906 - 7 Jul 2020

Cited by 6 | Viewed by 3185

Abstract

Preventive strategies can be developed by gathering more information about oral and maxillofacial injuries and oral pathologies in immigrants from low- to middle-income countries (LMIC). Additional information on the quality of care can also improve the allocation of clinical resources for the management of these patients. We studied immigrants from LMIC who presented in the emergency department (ED) at Berne University Hospital with dental problems or oral or maxillofacial injuries. The patient data included age, gender, nationality, the etiology and type of trauma and infection in the oral-maxillofacial area, and overall costs. The greatest incidence of maxillofacial injuries was observed in the age group of 16–35 years (n = 128, 63.6%, p = 0.009), with males outnumbering females in all age groups. Trauma cases were most frequent in the late evening and were mostly associated with violence (n = 82, 55.4%, p = 0.001). The most common fracture was fracture of the nose (n = 31). The mean costs were approximately the same for men (mean = 2466.02 Swiss francs) and women (mean = 2117.95 Swiss francs) with maxillofacial injuries but were greater than for isolated dental problems. In conclusion, the etiology of dental and maxillofacial injuries in immigrants in Switzerland requires better support in the prevention of violence and continued promotion of oral health education. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

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11 pages, 493 KiB

Open AccessArticle

Individual- and City-Level Socioeconomic Factors and Tooth Loss among Elderly People: A Cross-Level Multilevel Analysis

by Mario Vianna Vettore, Janete M. Rebelo Vieira, José F. F. Gomes, Nara M. O. Martins, Yan N. L. Freitas, Gabriela de A. Lamarca and Maria A. B. Rebelo

Int. J. Environ. Res. Public Health 2020, 17(7), 2345; https://doi.org/10.3390/ijerph17072345 - 30 Mar 2020

Cited by 8 | Viewed by 2535

Abstract

This study aimed to test the association of contextual and individual socioeconomic status with tooth loss among Brazilian elderly people aged 65–74 years. Data from 5435 elderly participants from the Brazilian National Oral Health Survey (2010) were linked to city-level data for 27 state capitals and the Federal District. Tooth loss was clinically assessed according to the number of missing natural teeth. Contextual social variables included Human Development Index income (HDI-income) and HDI-education. Individual socioeconomic measures were monthly family income and years of schooling. Covariates included sex, skin colour, number of residents per room and number of goods. Multilevel Negative Binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals between contextual and individual variables and tooth loss. Contextual and individual income and education measures were consistently associated with tooth loss. Elderly people living in cities with low HDI-income and low HDI-education were respectively 21% and 33% more likely to present tooth loss. Cross-level interaction suggested that the relationship of lower income and lower schooling with tooth loss is different across levels of city-level income and city-level education inequality, respectively. Public policies aiming to reduce the income and education gaps and preventive dental interventions are imperative to tackle tooth loss among elderly people. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

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10 pages, 743 KiB

Open AccessArticle

Is the Association between Green Tea Consumption and the Number of Remaining Teeth Affected by Social Networks?: A Cross-Sectional Study from the Japan Gerontological Evaluation Study Project

by Manami Hoshi, Jun Aida, Taro Kusama, Takafumi Yamamoto, Sakura Kiuchi, Tatsuo Yamamoto, Toshiyuki Ojima, Katsunori Kondo and Ken Osaka

Int. J. Environ. Res. Public Health 2020, 17(6), 2052; https://doi.org/10.3390/ijerph17062052 - 20 Mar 2020

Cited by 6 | Viewed by 3999

Abstract

Consumption of green tea without sugar, as well as social networks, are associated with a lower risk of tooth loss. There is a possibility of confounding both factors because tea is often drunk with friends. Therefore, the present study aimed to examine whether green tea consumption is beneficially associated with the number of remaining teeth, while considering social networks. This cross-sectional study was based on the Japan Gerontological Evaluation Study (JAGES) in 2016. Self-administered questionnaires containing questions about green tea consumption were mailed to 34,567 community-dwelling residents aged ≥ 65 years. We used the number of remaining teeth as a dependent variable, and green tea consumption and the number of friends met over the past month (social network size) as independent variables. Linear regression models with multiple imputation were used. A total of 24,147 people responded (response rate = 69.9%), and 22,278 valid data were included into our analysis. Participants’ mean age was 74.2 years (standard deviation = 6.3), and 45.9% were men. Among the participants, 52.2% had ≥ 20 teeth, 34.2% drank 2–3 cups of green tea per day, and 32.6% met ≥ 10 people over the past month. After adjusting for all potential confounders, both higher green tea consumption and a larger social network size were associated with more remaining teeth (both p for trend < 0.001). The association of green tea was greater among those with smaller social networks (p for interaction < 0.05). The protective association of green tea was remarkable among people with smaller social networks. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

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11 pages, 720 KiB

Open AccessArticle

Effects of Community Water Fluoridation on Dental Caries Disparities in Adolescents

by Go Matsuo, Jun Aida, Ken Osaka and Richard Gary Rozier

Int. J. Environ. Res. Public Health 2020, 17(6), 2020; https://doi.org/10.3390/ijerph17062020 - 19 Mar 2020

Cited by 9 | Viewed by 5333

Abstract

Despite improvements in the prevalence of dental caries, disparities are still observed globally and in the U.S. This study examined whether community water fluoridation (CWF) reduced dental caries disparities in permanent teeth of 10- to 19-year-old schoolchildren in North Carolina. We used cross-sectional data representing K-12 schoolchildren in North Carolina (NC) public schools. A poisson regression model was used to determine whether the association between children’s parental educational attainment and the prevalence of dental caries of children differed by children’s lifetime CWF exposure. We analyzed data on 2075 students. Among the children without any CWF exposure in their life, statistically significant caries disparities by parental educational attainment were observed. Compared to the children of parents with more than high school education, the relative risk for those with a parent with a high school education was 1.16 (95% CI = 1.01, 1.33) and those with less than a high school education was 1.27 (95% CI = 1.02, 1.60). In contrast, these disparities were not observed among children exposed to CWF throughout their lives. Socioeconomic disparities in dental caries were not observed among 10–19-year-old schoolchildren with lifetime CWF exposure. CWF seemed to reduce dental caries disparities. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

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11 pages, 322 KiB

Open AccessFeature PaperArticle

Does the Association between Guardians’ Sense of Coherence and their Children’s Untreated Caries Differ According to Socioeconomic Status?

by Akiko Mizuta, Jun Aida, Mieko Nakamura and Toshiyuki Ojima

Int. J. Environ. Res. Public Health 2020, 17(5), 1619; https://doi.org/10.3390/ijerph17051619 - 3 Mar 2020

Cited by 3 | Viewed by 2451

Abstract

Untreated caries is the most prevalent disease in the world. A sense of coherence (SOC) is believed to contribute to oral health. We aimed to clarify the association between guardians’ SOC and their children’s caries based on socioeconomic status (SES) in Japan. This study’s subjects were Japanese public junior high schoolers (N = 1730), aged 12–15, and their guardians in Kosai City. We administered a questionnaire survey among guardians in 2016 to assess their SOC and family environment. With their students’ consent, public junior high schools shared the results of the dental examinations that were part of their school physicals. Multivariate logistic regression was conducted to clarify the association between guardians’ SOC and their children’s untreated decayed permanent teeth. We also conducted a stratified analysis according to a relative poverty line. We observed in the multivariate regression a significant inverse association between children’s untreated decay and their guardians’ SOC (OR 0.93, 95%CI 0.87–1.00). The association of SOC was stronger in the low economic group (OR 0.64, 95%CI 0.43–0.95). Guardians with higher SOC were associated with children having fewer caries. Guardians’ SOC is a factor for the prevalence of caries and access to dental care, especially among children with low economic status. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

9 pages, 313 KiB

Open AccessArticle

Social Inequalities in Use of Preventive Dental and Medical Services among Adults in European Countries

by Shiho Kino, Eduardo Bernabé and Wael Sabbah

Int. J. Environ. Res. Public Health 2019, 16(23), 4642; https://doi.org/10.3390/ijerph16234642 - 22 Nov 2019

Cited by 10 | Viewed by 2454

Abstract

This study examined inequalities in dental check-ups and medical screenings using subjective and objective socioeconomic indicators. Data from 23,464 adults, aged 20 years old and over, who participated in a multi-national survey across Europe (Eurobarometer 72.3) were analysed. Participants’ socioeconomic position (SEP) was measured by education, difficulty in paying bills and subjective social status. Use of preventive services was measured by attendance for dental check-ups, cancer and cardiovascular screenings in the past 12 months. Socioeconomic inequalities were assessed in two-level logistic regression (adults nested within countries), adjusting for demographic factors and type of healthcare system. There were apparent social inequalities in using all three preventive services. However, only dental check-ups showed consistent and significant inequalities across all socioeconomic indicators with those in the bottom groups in education (odds ratio: 0.51; 95% confidence interval: 0.46–0.55), difficulty in paying bills (OR: 0.64; 95% CI: 0.59–0.72) and subjective social status (OR: 0.63; 95% CI: 0.57–0.69) having lower odds of reporting dental check-ups in the past 12 months than those in the top groups. Cancer screening was not associated with difficulty in paying bills whereas cardiovascular disease screening was not associated with education and subjective social status. Despite the availability of universal health coverage, there were clear social gradients in using preventive services particularly across education and subjective social status groups. The stronger and more consistent gradients observed in dental check-ups compared to cancer and cardiovascular screening could be attributed to difference in the level of coverage of dental and medical services in Europe. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

11 pages, 334 KiB

Open AccessArticle

by Jung-Ha Lee, Seung-Kyoo Yi, Se-Yeon Kim, Ji-Soo Kim, Han-Na Kim, Seung-Hwa Jeong and Jin-Bom Kim

Int. J. Environ. Res. Public Health 2019, 16(20), 3927; https://doi.org/10.3390/ijerph16203927 - 16 Oct 2019

Cited by 17 | Viewed by 2569

Abstract

This study aimed to determine the association between the number of existing teeth (NET) and socioeconomic status (SES), oral health-related behaviours, and metabolic syndrome in Korean adults aged 55–79 years. The study included 3255 adults who underwent oral health examinations and answered questionnaires regarding SES, oral health-related behaviours, and metabolic diseases in the Sixth Korea National Health and Nutrition Examination Survey (2013–2015). The dependent variable was the binary status based on the median NET in each age group. The independent variables were based on SES, oral health-related behaviours, and the presence of metabolic syndrome. The study findings showed that the factors associated with the NET were sex, household income, education level, region of residence, daily toothbrushing frequency, dental visit within 1 year, smoking, and metabolic syndrome. NET was lower in males (adjusted OR: 0.74), in low household income group (adjusted OR: 0.77), in primary school graduates (adjusted OR: 0.53) and in rural residents (adjusted OR: 0.78). The interventions aimed at preserving existing teeth in elderly population should consider their SES, oral health-related behaviours, and metabolic syndrome and overhauling current oral healthcare system and redefining the roles of oral health professionals. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

9 pages, 349 KiB

Open AccessArticle

Inequalities in Caries Experience Among Mongolian Children

by Tselmuun Chinzorig, Jun Aida, Upul Cooray, Tsengelsaikhan Nyamdorj, Soyolmaa Mashbaljir, Ken Osaka and Ariuntuul Garidkhuu

Int. J. Environ. Res. Public Health 2019, 16(20), 3892; https://doi.org/10.3390/ijerph16203892 - 14 Oct 2019

Cited by 11 | Viewed by 4089

Abstract

Although inequalities in dental caries have been well-reported, there is only one Mongolian study on the association between socioeconomic status (SES) and caries experience, which was published ten years ago. This study aimed to determine the dental health status of Mongolian children living in urban and suburban areas of Ulaanbaatar city and examine its association with income and parental educational attainment. An oral examination was conducted by dentists and caries were measured as deft/DMFT indices. A questionnaire including demographic characteristics and socioeconomic status was completed by their parents or caregiver. Parental educational attainment and household income were used as the measures of SES. The relative index of inequality (RII) and slope index of inequality (SII) were employed to examine the association between SES on deft and DMFT after adjusting for covariates. Dental caries prevalence (those with deft/DMFT > 0) was 89.3% among the total number of participants. The mean deft/DMFT values for age groups 1–6, 7–12, and 13–18 were 5.83 (SD = 4.37, deft), 5.77 (SD = 3.31, deft/DMFT), and 3.59 (SD = 2.69, DMFT), respectively. Rather than residence area and parental educational attainment, significant caries experience inequality was observed in relation to income (RII 0.65 95%, CI 0.52 to 0.82, SII −2.30, 95% CI −4.16 to −0.45). A prevention strategy for lower socioeconomic groups and building integrated oral health surveillance to monitor epidemiological trends for further evaluation of its progress is necessary. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

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6 pages, 1077 KiB

Open AccessCommentary

Oral Health Inequalities and the Corporate Determinants of Health: A Commentary

by Lisa Jamieson, Barry Gibson and W. Murray Thomson

Int. J. Environ. Res. Public Health 2020, 17(18), 6529; https://doi.org/10.3390/ijerph17186529 - 8 Sep 2020

Cited by 11 | Viewed by 3307

Abstract

Empirical research critically examining the role of the corporate determinants of health has gained traction in the past few years. Many of these reports have received strong, sometimes litigious, backlash from the corporations exposed. The aim of this paper is to provide a critical commentary on existing literature, policies, procedures and observations of issues, especially regarding the use of the corporate determinants of health as a research construct, in the persistence and flourishing of oral health inequalities at a global level. We discuss theoretical frameworks that underpin the power constructs of the corporate determinants of health, including Lukes “three faces of power” theory. This theory posits that power is exercised in three ways: through decision-making, through non-decision-making and ideologically. We will demonstrate, using examples of corporate determinants of health and oral health inequalities from several countries, how intervening at key leverage points is a crucial strategy for improving oral health inequalities at a global level. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

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6 pages, 288 KiB

Open AccessCommentary

Indigenous Oral Health Inequalities at an International Level: A Commentary

by Lisa Jamieson, Dandara Haag, Helena Schuch, Kostas Kapellas, Rui Arantes and W. Murray Thomson

Int. J. Environ. Res. Public Health 2020, 17(11), 3958; https://doi.org/10.3390/ijerph17113958 - 3 Jun 2020

Cited by 12 | Viewed by 3863

Abstract

Oral health inequalities reflect social injustice. This is because oral health simultaneously reflects material circumstances, access to health services and inequities across the life course. Oral health inequalities between Indigenous and non-Indigenous populations are among the largest in the world. This paper provides a critical commentary on Indigenous oral health inequalities at an international level based on existing literature and policies. We include the role of systematic and institutionalized racism and how this enables the persistence and flourishing of Indigenous oral health inequalities. We discuss theoretical frameworks—including Shiffman and Smith’s Political Power Framework—that underpin the power constructs that contribute to those. This theory posits that power is exercised in four ways: (i) the power of ideas; (ii) the power of the issue; (iii) the power of the actors; and (iv) the power of the political context. We will demonstrate, using examples of Indigenous oral health inequalities from several countries, how intervening at key leverage points, acting simultaneously on multiple subsystems and counteracting the social determinants of health are crucial strategies for ameliorating Indigenous oral health inequalities at a global level. Full article

(This article belongs to the Special Issue Oral Health Inequalities in the World)

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