Dental Health Inequalities among Indigenous Populations: A Systematic Review and Meta-Analysis

Abstract

The aim of this systematic review and meta-analysis was to document the disparity in dental caries experiences among indigenous and nonindigenous populations globally by measuring dental caries prevalence and severity. An electronic database (MEDLINE) was initially searched using relevant keywords. This was followed by use of the search string in the following electronic databases: Scopus, EBSCOhost, Cochrane, and Open Grey. Two independent reviewers conducted the study search and screening, quality assessment, and data extraction, which was facilitated using JBI SUMARI software. The primary outcome was the decayed missing filled teeth (DMFT) score and dental caries prevalence. Subgroup analysis was done by country of publication to identify causes of heterogeneity. Forest plots were used with the standardized mean difference (SMD) and publication bias was assessed using the Egger test with funnel plot construction. For the final review, 43 articles were selected and 34 were meta-analyzed. The pooled mean DMFT for both the permanent dentition (SMD = 0.26; 95% CI 0.13–0.39) and deciduous dentition (SMD = 0.67; 95% CI 0.47–0.87) was higher for the Indigenous population than for the general population. Indigenous populations experienced more decayed teeth (SMD = 0.44; 95% CI 0.25–0.62), a slightly higher number of missing teeth (SMD = 0.11< 95% CI –0.05 to 0.26), and lesser filled teeth (SMD = –0.04; 95% CI –0.20 to 0.13) than their nonindigenous counterparts. The prevalence of dental caries (SMD = 0.27; 95% CI 0.13–0.41) was higher among indigenous people. Globally, indigenous populations have a higher caries prevalence and severity than nonindigenous populations. The factors which have led to such inequities need to be examined.

A Global Perspective of Racial–Ethnic Inequities in Dental Caries: Protocol of Systematic Review

“…Racialethnic health inequities have been documented for a range of health outcomes, including higher mortality, the recent COVID-19 pandemic [14], psychiatric disorders, cardiovascular disease, cancer, HIV/AIDS, diabetes, and other chronic and infectious diseases [15,16]. A higher prevalence of untreated tooth decay (caries), severe periodontal disease, and complete or partial edentulism have been observed among racially marginalized groups [17][18][19][20]. The prevalence of dental caries has been disproportionately high among minoritized racial and ethnic groups, despite pronounced changes in related risk factors, treatment, and access to treatment of oral diseases [18,20].…”

“…A higher prevalence of untreated tooth decay (caries), severe periodontal disease, and complete or partial edentulism have been observed among racially marginalized groups [17][18][19][20]. The prevalence of dental caries has been disproportionately high among minoritized racial and ethnic groups, despite pronounced changes in related risk factors, treatment, and access to treatment of oral diseases [18,20]. Untreated dental caries can affect the overall quality of life by interfering with speech, eating, sleep, and work by causing pain.…”

“…To the best of our knowledge, no systematic review has estimated the disproportionally higher burden of dental caries among racially marginalized groups globally. Current reviews have restricted their search strategy to Indigenous populations [20,[22][23][24], or other groups, [25,26], often without any comparator. Systematic reviews and meta-analyses provide the highest quality evidence from a clinical, research, or policy perspective.…”

Prevalence of periodontal disease among Indigenous and non-Indigenous populations: protocol for systematic review and meta-analysis

“…Oral diseases have serious health and economic ramifications and are among the most widespread diseases globally [ 9 ]. Poor oral health among the Indigenous group not only impacts the oral cavity but can result in debilitating pain, limited social interactions, difficulties eating and speaking, embarrassment, and reduced quality of life [ 10 , 14 ].…”

Periodontal disease inequities among Indigenous populations: A systematic review and meta‐analysis

“…There are approximately 400 million Indigenous peoples globally who, across geographic, cultural and spiritual differences, share a common experience of disproportionally higher disease burden than their non‐Indigenous counterparts 11,12 . Indigenous populations around the globe have much in common in terms of histories of colonisation, loss of lands, institutionalised racism and state‐mandated removal of children 13 .…”