The Risks and Repercussions of Poor Oral Health Among Immigrants

Abstract

Last year, the number of refugees in the world reached over 103 million for the first time on record. 1 In the US, the proportion and number of immigrants and their children has been rapidly increasing, reaching nearly 27% of the total population in 2022. 2 Despite the growing number of immigrants, however, there is a lack of readiness among health care professionals to understand and address their health care needs. As refugees, asylum seekers, and immigrants ourselves, we have experienced firsthand the permeating consequences of migration on health and life outcomes. We have seen how past war, unstable living conditions, political persecution, and lack of health care resources can foster distrust of the US health care institution. We have experienced the need to prioritize finding a home, obtaining an income, learning a new language, and filing for legal status before considering "preventive health care."We have faced adversity before, during, and after migration that directly harmed and harms health.While the number of studies about general immigrant health is beginning to increase, the research conducted on oral health among immigrants remains limited. From the few crosssectional studies that have been done, we know that immigrants have worse oral health and hygiene than people who are native born, of White race, citizens of the US, English language proficient, and insured. [3][4][5] For example, when asked to rate the health of their teeth and gums, only 14.46% of Spanishspeaking Hispanic respondents rated "excellent or very good" compared with 39.25% of non-Hispanic White people. 3 However, differences in health outcomes associated with socially constructed variables such as race or citizenship are explained by differences in social, economic, and legal treatment, namely racism and discrimination, rather than differences in biology or genetics. In fact, being foreign born is associated with lower educational attainment, financial well-being, and insurance coverage in the US, all of which independently portend worse oral health. 3 Therefore, we, as health care practitioners and researchers, must consider and address the ubiquitous structures that marginalize certain peoples.Oral health and hygiene are particularly important given the recent research showing the associations between the oral microbiome and oral cavity cancer. 6 Early studies examined bacterial cultures and metabolite levels, showing, for example, that people with more dental disease had nearly twice as much carcinogenic metabolite production and more complex bacterial composition. 6,7 More recent studies use nextgeneration sequencing; comparing healthy controls with patients with precancerous and cancerous lesions, they show that as cancer progresses to advanced stages, the oral microbiome also has increasingly higher complexity and expression of genes involved in carbohydrate metabolism. [6][7][8] Opinion EDITORIAL jamaotolaryngology.com (Reprinted) JAMA Otolaryngology-Head & Neck Surgery