Global Oral Health Inequalities

Abstract

The birth prevalence of orofacial clefts, one of the most common congenital anomalies, is approximately one in 700 live births, but varies with geography, ethnicity, and socio-economic status. There is a variation in infant mortality and access to care both between and within countries, so some clefts remain unrepaired into adulthood. Quality of care also varies, and even among repaired clefts there is residual deformity and morbidity that significantly affects some children. The two major issues in attempts to address these inequalities are (a) etiology/possibilities for prevention and (b) management and quality of care. For prevention, collaborative research efforts are required in developing countries, in line with the WHO approach to implement the recommendations of the 2008 Millennium Development Goals (www.un.org/millenniumgoals). This includes the "common risk factor" approach, which analyzes biological and social determinants of health alongside other chronic health problems such as diabetes and obesity, as outlined in the Marmot Health inequalities review (2008) (www.ucl.ac.uk/gheg/marmotreview). Simultaneously, orofacial cleft research should involve clinical researchers to identify inequalities in access to treatment and identify the best interventions for minimizing mortality and residual deformity. The future research agenda also requires engagement with implementation science to get research findings into practice.

Population-Based Study of Birth Prevalence and Factors Associated with Cleft Lip and/or Palate in Taiwan 2002–2009

“…Previous studies showed a worldwide prevalence of 0.1% for CL/P [15]. While Asian populations generally have the highest rates, rates vary widely, reflecting genetic, environmental and health equality factors [1]. A study in Jordan of 25,440 infants reported incidence of facial cleft deformities to be 0.2% [15].…”

“…While the worldwide prevalence of such deformities is about 1.5 per 1,000 live births, the rate varies six-fold for CL/P and three-fold for CP [1]. Reports in Asian populations put overall rates around 1.76 to 1.81, reflecting the higher prevalence in this region [2], [3].…”

“…However, the Center for Disease Control, Department of Health, has not reported the birth prevalence of CL/P or CP in Taiwan since 2000, when it ceased issuing annual reports [4]. Worldwide, the World Health Organization and the International Perinatal Database of Typical Oral Clefts Working Group have called for efforts to characterize rates of facial cleft deformities and related factors [1], [12], [13]. Therefore, we sought to characterize the birth prevalence of CL/P and CP in Taiwan from 2002 to 2009, and to identify factors that may be associated with their prevalence over time.…”

Implementing the Brazilian Database on Orofacial Clefts

“…As knowledge of genetics and of gene-environment interaction in the aetiology of OC improves, clinical genetics is becoming increasingly important specialty to ensure accurate diagnosis and allow appropriate genetic counselling [3]. Therefore, clinical genetic approach improves accuracy, consistency, and reliability of clinical descriptions and aetiological assessment which are critical to genotype-phenotype correlations.…”

Is MTHFD1 polymorphism rs 2236225 (c.1958G>A) associated with the susceptibility of NSCL/P? A systematic review and meta-analysis

“…Cleft of the lip and/or palate (CL/P) is one of the most common facial malformations 1– 3 and a societal burden, affecting the patient ability to eat and speak and influencing social integration 4 . Non-syndromic CL/P, accounting for about 70% of CL/P, is considered closely related to genetic and environmental factors 5 .…”