Oral Health Status among Migrants from Middle- and Low-Income Countries to Europe: A Systematic Review

The economic and societal impact of periodontal and peri-implant diseases

Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.

Cardiovascular risk and access to primary care: Comparisons among Chinese documented and undocumented immigrants

AIMS

The aim of this study was to examine main risk factors of undocumented Chinese migrants living in Italy when compared with Chinese migrants registered with National Health Service (NHS).

METHODS

A cohort of 3435 Chinese first-generation immigrants living in Prato underwent blood pressure (BP) measurement and blood tests. Hypertension was diagnosed for BP ≥ 140/90 mmHg at 2 visits, and/or antihypertensive drug use; type 2 diabetes (T2DM) for fasting glucose ≥ 126 mg/dL at 2 visits, and/or use of hypoglycemic drugs; hypercholesterolemia (HC) for cholesterol ≥ 240 mg/dL and/or statins use. Subjects diagnosed with hypertension, T2DM, or HC unaware of their condition were considered newly diagnosed. Comparisons were performed using multivariable adjusted logistic regression analysis.

RESULTS

A large proportion of Chinese migrants were undocumented (1766, 51 %); newly diagnoses of risk factors were performed especially among undocumented migrants; registration with NHS was associated with higher level of awareness for hypertension and T2DM and with 6 times higher rate of treatment for T2DM. Only a small minority of subjects with high cholesterol were treated with statins.

CONCLUSIONS

Undocumented immigrants had high prevalence of risk factors with lower levels of awareness than migrants registered with the NHS. Health policies targeting this hard-to-reach population needs to be improved.

Oral Health Status, Behaviours and Oral Healthcare Utilization among Indian Migrants Compared to the Host Population in the Netherlands: A Descriptive Cross-sectional Study

The aim of this study was to assess the oral health status, oral health behaviours and oral healthcare utilization among Indian migrants living in the Netherlands and how they compare with the host population. Based on a random sample from Dutch municipalities, cross-sectional data were obtained for the Indian migrants living in the Netherlands (n = 148) and the host population (n = 244). A questionnaire was used to collect information on socio-demographic, self-reported oral health status, oral health behaviours and oral healthcare utilization. The distribution of self-reported oral health variables for both groups were tabulated and compared using logistic, ordinal and multinomial regression analysis. When adjusted for covariates such as age, gender, marital status, education, income, occupation and dental insurance, regression analysis for oral health status showed that the odds of reporting oral impact on daily performances (OIDP) was 5.87 times higher for Indians compared to the host population (95%CI:3.45;9.65). In contrast, the odds of Indians reporting bleeding gums [OR = 0.44 (95%CI:0.27;0.73)] and diagnosed with gum diseases [OR = 0.23(95%CI:0.13;0.39)] were lower than the host population. Also, the odds of consuming alcohol and cakes or chocolates was significantly lower among Indian migrants compared to the host population [(OR = 0.15(95%CI:0.09;0.25)] and [OR = 0.33(95%CI:0.21;0.52)], respectively. But the odds of consuming sugar in hot beverages were significantly higher among Indians [OR = 10.44(95%CI:5.99;18.19)]. The odds of Indians visiting a dental professional were 9.22 times (95%CI:4.62;18.40) lower compared to the host population. We found that oral health status and behaviours among Indian migrants were different in certain aspects compared to the host population. However, their oral healthcare utilization remained overall lower. The underlying determinants for such observations merit further research. Migrant friendly approach from both the dental professionals and policy makers can encourage dental visits and improve the utilization patterns among Indians migrants in the future.

Canadian immigrants' oral health and oral health care providers' cultural competence capacity

Background

Immigrants to Canada count among the socially disadvantaged groups experiencing higher rates of oral disease. Culturally competent oral health care providers (OHCPs) stand to be allies for immigrant oral health. The literature reveals limited knowledge of practising OHCPs' cultural competency, and little synthesis of the topic has been completed. A scoping review is warranted to identify and map current knowledge of OHCPs' understanding of culturally competent care along with barriers and facilitators to developing capacity.

Methods

This study was conducted between December 2022 and April 2023 using Arksey and O'Malley's 5-step framework and PRISMA-ScR checklist. Four databases were searched using keywords related to 4 themes: population, provider, oral health, and cultural competence. Peer-reviewed articles published in English in the last 10 years were included.

Results

Search results yielded 74 articles. Title and abstract review was completed and an author-developed critical appraisal tool was applied. Forty-six (46) articles were subject to full-text review and 14 met eligibility criteria: 7 qualitative and 7 quantitative. Six barriers and six facilitators at individual and systemic levels were identified, affecting oral care for immigrants and providers' ability to work cross-culturally.

Discussion

Lack of cultural or linguistically appropriate resources, guidance, and structural supports were identified as contributing to low utilization of services and to lack of familiarity between providers and immigrants.

Conclusion

OHCPs' cultural competency development is required to improve oral health care access and outcomes for diverse populations. Further research is warranted to identify factors impeding OHCPs' capacity to provide culturally sensitive care. Intentional policy development and knowledge mobilization are needed.

A scoping review linking early childhood caries to violence, neglect, internally displaced, migrant and refugee status

BACKGROUND

The aim of the scoping review was to identify and synthesize the available literature concerning the relationship between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC) as it relates to the United Nation's Sustainable Development Goal 16 (SDG 16).

METHODS

Data regarding the links between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC), and the associations between ECC and maternal and child exposure to physical and sexual abuse, insecurity, crime, exploitation, torture, and displacement were extracted. The search was carried out in January 2023 across three databases (PubMed, Web of Science, and Scopus). Only publications in English with accessible full texts were included. Descriptive statistics were utilized to summarize the categories of the retrieved papers, and graphical representation was employed for visualization purposes. The relationships between the publications and each of the 10 targets of Sustainable Development Goal 16 (SDG 16) were also assessed.

RESULTS

Forty-five studies were reviewed. Most studies (42.2%) originated from the Americas Regions, while no studies were identified from the Africa Region. A significant portion (46.7%) of the papers focused on abuse, violence, and neglect as risk factors for ECC. Migrants, refugees, and IDPs were the most investigated populations (44.4%). Only one study specifically focused on IDPs and migrants respectively. The prevalence of untreated caries was higher among migrants, refugees, and IDPs compared to the host community, ECC was more prevalent among children who experienced abuse, neglect, or were in protective care. The was no clear direction on the associations between ECC and intimate partner violence, adverse childhood experiences, and wars. In terms of the SDGs, the reviewed publications addressed four targets (SDG16.1, SDG16.2, SDG16.3, and SDG16.5) out of the ten targets outlined in SDG 16.

CONCLUSION

There is available evidence regarding the connections between ECC and war, refugees, migration, violence, and neglect, as outlined in SDG 16. Future studies are needed to investigate how forced movements directly affects ECC status, how disruptions of peace and stability is a risk factor for ECC, and the associations between ECC and other indicators related to SDG 16 targets.

An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach

BACKGROUND

Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app.

OBJECTIVE

This study aims to describe the development process of the MuMi app.

METHODS

For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation.

RESULTS

On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group.

CONCLUSIONS

The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background.

Sexual and reproductive health and gender-based violence among female migrants in Morocco: a cross sectional survey

BACKGROUND

Over the past decade, Morocco has increasingly become the chosen destination for a growing number of migrants from neighbouring countries and especially from Sub-Saharan Africa. The aim of this study is to describe the sexual and reproductive health (SRH), as well as sexual and gender-based violence (SGBV) among female migrants in Morocco.

METHODS

This is a descriptive cross-sectional study conducted between July and December 2021. Female migrants were recruited from one university maternity hospital and two primary healthcare centres in Rabat. Data were collected using a structured face-to-face questionnaire, which included information about sociodemographic characteristics, SRH, history of SGBV and its impact, as well as the utilization of preventive and supportive SGBV services.

RESULTS

A total of 151 participants were included in this study. The majority of participants (60.9%) were aged 18 to 34 years old and 83.3% were single. Many participants (62.1%) did not use contraceptives. More than half (56%) of the participants who were pregnant at the time of the study were receiving pre-natal care. About 29.9% of interviewed participants reported experiencing female genital mutilation, and a significant majority (87.4%) experienced SGBV at least once during their lifetimes, while 76.2% experienced SGBV during migration. The most commonly reported form of violence was verbal abuse (75.8%). Among the victims of SGBV, a minority have visited a health facility (7%) or filed a complaint (9%) in the aftermath of violence.

CONCLUSION

Overall, our findings showed low contraception coverage, moderate access to prenatal care, high prevalence of SGBV, and low utilization of preventive and supportive SGBV services among migrant women in Morocco. Further studies are needed to understand the contextual barriers to access, and utilization of SRH care and additional efforts should be undertaken to strengthen SGBV prevention and support systems.

Evaluation and Comparison of Oral Health Status between Spanish and Immigrant Children Residing in Barcelona, Spain

The present study aimed to evaluate and compare the level of oral health among Spanish and immigrant children residing in Barcelona, Spain. Oral health status was evaluated in 1400 children aged 3 to 14 years between September 2018 and June 2019. Multiple variables (dental caries lesions, exodontia, trauma, malocclusions, gingivitis, fillings, stainless steel crowns in primary dentition, and pit and fissure sealings in permanent dentition) were compared in both populations. Statistically significant differences (p < 0.001) were found in the prevalence of caries in the primary dentition, which was higher in the immigrant group (62.3%) than in the Spanish group (42.6%). For the permanent dentition, the prevalence of dental caries lesions was 12.2% in Spanish children and 16.4% in immigrant children, showing statistically significant differences (p = 0.026) between the two groups. The prevalence of fillings in the primary dentition was 14.6% in Spanish and 12.5% in immigrant children (p = 0.253). Regarding the permanent dentition, the number of fillings was also higher in the Spanish population (6.8%) compared to the immigrant population (3.5%), again evidencing statistically significant differences (p = 0.006). Our findings suggest a better oral health status in Spanish children than in immigrant children.

Burden of infectious diseases among undocumented migrants in France: Results of the Premiers Pas survey

Introduction

An increase in migration rates to the European Union has been observed over the last few years. Part of these migrants is undocumented. This work aimed to describe the reported frequency of infectious diseases and their associated factors among unselected samples of undocumented migrants in France.

Methodology

The Premier Pas survey is a cross-sectional epidemiological survey of a random sample (two-stage sample design) conducted among undocumented migrants recruited in Paris and the Bordeaux region, in places and facilities likely to be frequented by undocumented migrants. The percentages were weighted. The analysis was performed using Stata 15.1 software.

Results

A total of 1,223 undocumented migrants were recruited from 63 places and facilities, with a participation rate of 50%. Most of them were between 30 and 40 years of age (36%), 69% were men, aged mainly 30–40 (36%) years old, from sub-Saharan Africa (60%) or North Africa (25%), and 60% had arrived <3 years earlier. Among the participants, 24.8% declared a poor perceived health status and 33.5% a chronic health condition. Dental infections concerned 43.2% of the participants. Apart from dental issues, 12.9% reported suffering from at least one infectious disease: HIV infection (3.5%), chronic hepatitis B virus infection (3.1%), upper respiratory tract infection (1.7%), skin mycosis (1.2%), skin and soft tissue infection (0.8%), chronic hepatitis C infection (0.8%), urinary tract infection (0.7%), lower respiratory tract infection (0.7%), scabies (0.3%), tuberculosis disease (0.2%), vaginal mycosis (0.6%), and herpes (0.1%). Regarding HIV, HBV, and HCV infections, 56, 71, and 89%, respectively, were diagnosed after their arrival. Chronic viral infections were more often reported by undocumented migrants from sub-Saharan Africa and Latin America. In multivariate analysis, a higher risk of reporting chronic viral infection was observed among people food insecure.

Conclusion

This original study on a large random sample confirms the frequency of infectious diseases among undocumented migrants in France and the importance of integrating their screening during a health Rendezvous and their management into early access to care and inclusive medico-psycho-social management.

Oral Health in Migrants: An Observational Study on the Oral Health Status of a Migrant Cohort Coming from Middle- and Low-Income Countries

Introduction. The oral health conditions of migrants coming from middle- and low-income countries to developed countries have been shown to be poorer than those of the host population. Since the phenomenon of migration has continued to grow over the past five decades, the oral health status of migrant populations should be an issue of great concern. Objectives. The objective of our observational study was to analyse the periodontal health status and the prevalence of dental caries and lesions of the oral mucosa in a migrant cohort resident in Italy, assessing the association between the oral health status and the educational level of the included patients. Materials and Methods. Our research was conducted at the dental department of Policlinico Tor Vergata (Rome, Italy). A sample of 200 migrants coming from middle- and low-income countries, aged between 3 and 37, was included in our study. Each patient underwent a physical examination of the oral cavity, recording the DMFT/dmft index, Community Periodontal Index of Treatment Needs (CPI), and lesions of the oral mucosa. The one-way ANOVA test was used to establish the correlation between the oral health status and the educational level of the participants. Results. Many participants (62.5%) showed a DMFT/dmft Index ≥ 4; only 27% of the migrants had a DMFT/dmft Index lower than 4, and only 21 of them (10.5%) were recorded at 0. A CPI equal to 0 or 1 was observed in 131 patients (65.5%), while only 30 participants presented a CPI equal to or higher than 4 (15%), and 19.5% (39 patients) were assigned to code 2 and 3. Significant statistical differences were found in the CPI after adjusting data for the educational level of the included participants (p-value < 0.01). Conclusions. The data obtained in our research highlighted poor oral conditions among the analysed migrant population, recording a high prevalence of dental caries and inadequate oral hygiene habits.