What makes inequality in the area of dental and oral health in developing countries? A scoping review

Abstract

Background Equity in health is an important consideration for policy makers particularly in low and middle income developing country. The area of oral and dental health is not an exception. This study is conducted to explore the main determinants that make inequality in oral and dental health area in developing countries. Methods This was a scoping review applying the framework enhanced by Levac et al. Four databases of Scopus, PubMed, WOS and ProQuest were systematically searched applying to related keywords up to 27.11.2020. There restriction was placed in the English language but not on the study design. All the related studies conducted in the low or middle income developing countries were included. A qualitative thematic analysis was applied for data analysis and a thematic map was presented. Results Among 436 articles after excluding duplications, 73 articles were included that the number of publications from Brazil was greater than other developing countries (33.33%). Thematic analysis of the evidence has led to 11 determinants that may result in inequality in oral and dental health services in developing countries including personal characteristics, health status, health needs and health behaviours, social, economic, cultural and environmental factors, as well as insurance, policies and practices and provided related factors. Conclusion The policymakers in the low and middle income developing countries should be both aware of the role of inequality determinants and also try to shift the resources to the policies and practises that can improve the condition of population access to oral and dental services the same as comprehensive insurance packages, national surveillance system and fair distribution of dentistry facilities. It is also important to improve the population’s health literacy and health behaviour through social media and other suitable mechanisms according to the countries’ local contexts.

Cross-Sectional Analysis of Oral Healthcare vs. General Healthcare Utilization in Five Low- and Middle-Income Countries

“…Low oral healthcare access is driven in part by the routine omission of oral healthcare from Universal Health Coverage [ 15 ], as well as the biomedical model of dentistry that incentivizes treatment-oriented oral healthcare, including fillings, crowns, and extractions, over prevention-oriented oral healthcare such as routine checkups, cleanings, application of fluoride varnish, and oral hygiene instruction [ 16 , 17 ]. This traditional model perpetuates the demand for highly-skilled dentists; however, in many LMICs, insufficient resources have been allotted to cultivate a prevention-oriented oral healthcare workforce and approach [ 10 , 18 ]. Finally, the rise in the overconsumption of sugary food products, specifically sugar-sweetened beverages, has exacerbated oral disease and has contributed greatly to the lack of improvement in global oral health [ 19 , 20 ].…”

Individual, Family, and Socioeconomic Contributors to Dental Caries in Children from Low- and Middle-Income Countries

“…The SES in our data was focused on household income, which served as an economic indicator. Many socioeconomic determinants, including health inequality, income, ability to pay for services, and physical and geographical access to dental care services, have directly or indirectly correlated with dental health disparities [ 64 ]. We found that a significant number of children (~44%) with dental caries had access to dental services, which suggests the role of numerous socioeconomic constraints beyond geographical limitations in LMICs.…”

Periodontitis and Preeclampsia in Pregnancy: A Systematic Review and Meta-Analysis

“…In other words, using national income as a proxy may result in this variation and therefore, suggested the individual level approach for future studies to tackle this issue. Moreover, lower middle-income countries have poorer oral health condition compared to upper-middle and high-income country groups, which may indicate the inequalities in oral health care (Bastani et al, 2021 ; Watt & Sheiham, 1999 ). Inequalities can stem from unjust provision of services or inappropriate access and become more pronounced by the fact that most dental treatment is funded by out-of-pocket payments (Listl et al, 2015 ).…”