Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study

Oral health, stress and barriers accessing dental health care among war-affected Ukrainian refugees in Germany

BACKGROUND

After Russian invasion many Ukrainians fled to European countries including Germany. In this context, the German health care system faced challenges delivering dental care to a displaced population. Recently surfaced obstacles as well as different cultural and medical traits need to be considered in order to deliver appropriate medical care. The aim of this study was to evaluate oral health and hygiene of Ukrainian refugees, identify barriers accessing dental health care and explore the relation to their mental health state.

METHODS

This cross-sectional study was conducted using a self-assessment questionnaire, distributed via non-probability snowball sampling method among war-affected Ukrainians, who fled to Germany. The online form was distributed via web-based platforms, the printed version was hand-delivered across diverse local venues. Chi-Square Tests, T-Tests and Mann-Whitney-U Tests were performed. Analysis of variance and Spearman correlation coefficient analysis were also conducted.

RESULTS

From 819 completed questionnaires, 724 questionnaires were included in the analysis with 78 males (10.8%) and 640 females (88.6%) and a mean age of 37.5 years (SD = 10.5). The majority of participants rated their state of teeth (77%) and gums (81%) as average or better. The main problems, caused by state of their teeth, were: "Have avoided smiling because of teeth" (23.6%) or "Felt embarrassed due to appearance of teeth" (22.2%). The most frequent limiting factors to access dental care were finances (82.6%), language (82.2%) and complicated health care system (74.1%). 45.8% of the participants scored 10 or more in the Patient Health Questionnaire and 37.4% in the Generalized Anxiety Disorder 7-item scale, respectively. These participants were more likely to report pain, poor state of teeth and gums and to fail a dental consultation. Overall, 59.6% participants reported not consulting a dentist, when needed. Failed consultations were associated with a poorer reported state of teeth and gums.

CONCLUSIONS

Ukrainian refugees reported barriers accessing dental health care in Germany. It is important to improve oral health literacy and dental services for displaced people and provide help and guidance in seeking dental care.

[Determinants of asylum seekers' health and medical care in Germany]

Asylum seekers in Germany are exposed to a variety of health-related stressors, while their access to medical care is impaired. This review explains some of the determinants that structure this situation, for example by elaborating on how the Asylum Seekers' Benefits Act (ASBA), billing via treatment vouchers, and accommodation in refugee shelters affect asylum seekers' health and healthcare utilization. Hereby, it becomes clear that the exclusion of asylum seekers from the welfare system is detrimental to their health, is expensive, and raises ethical and legal questions. In particular, the huge discretionary scope of the social welfare offices in the assumption of costs as well as the different models for billing medical services for asylum seekers are potentially unjust and lead to a plurality of care, which lacks legal and ethical justification.The second part of the article shows that asylum seekers generally suffer from the same health problems as people with statutory health insurance-with the exception of mental illnesses, which are substantially more common among asylum seekers, but are often undiagnosed and frequently inadequately treated.This leads to three practical conclusions: (1) asylum seekers should be integrated into statutory health insurance, (2) from a public health point of view, accommodation in refugee shelters should be avoided in favor of decentralized accommodation, and (3) to ensure diversity-sensitive care for all patients, the healthcare system must make adjustments to its structures and practices.

Higher prevalence of dental caries and periodontal problems among refugees: A scoping review

Background

We assessed the prevalence data on oral health diseases, namely dental caries and periodontitis, among refugees and asylum seekers worldwide.

Methods

A systematic search of Scopus, Embase, and PubMed retrieved 1225 records; following title and abstract screening, 58 studies remained for full-text eligibility screening based on pre-defined inclusion criteria. Twenty-six studies were included in the review.

Results

Dental caries and tooth loss due to caries were high in refugee populations, regardless of their age, gender, or nationality. The adult population had a mean decayed, missing, and filled teeth (DMFT) index score of 9.2 (standard deviation (SD) = 2.3); children had a score of 3.1 (SD = 1.1) for deciduous teeth and 2.5 (SD = 1.1) for permanents. Caries prevalence among refugees ranged from 4.6% to 98.7%, and gingivitis from 5.7% to 100%, indicating a high heterogeneity in their oral health. Regarding oral health accessibility, 17% to 72% of refugees had never been to a dentist, showing a very low level of accessibility to dental health services.

Conclusions

Interventions and policies need to be designed to reduce oral health inequalities among refugee populations and asylum seekers, and host countries must implement strategies to increase their access to oral health care. Existing data should be used to set priorities for improving the oral health of refugees.

Registration

Open Science Framework: https://doi.org/10.17605/OSF.IO/SU59K.

Finnish dentists' experiences with foreign-background patients-a qualitative study

OBJECTIVE

The population in many countries is becoming more diverse. The number of people from foreign backgrounds is growing in Finland as well. The aim of this study was to better understand how the foreign background of a patient affects the dentist's work.

METHODS

The research was carried out as a semi-structured interview. Six dentists from Helsinki municipality public dental care were interviewed between December 2019 and January 2020. After the interviews were transcribed verbatim, two members of the research group read individually the interviews to find emerging themes.

RESULTS

The most common problems that arose in the interviews were problems within communication and interpretation. Periodontal diseases and the importance of self-care in treating them were observed to be unfamiliar to many foreign-background patients. The dentists also noticed different expressions of pain among foreign-background patients compared with native Finnish patients. The interviewed dentists thought that the length of time a patient had lived in Finland affected the experienced difficulties and the prejudice that the patients and dentists faced.

CONCLUSION

In this qualitative research, we were able to identify some of the common difficulties that the dentists experience while treating patients from foreign backgrounds, despite the small number of participants.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.

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

Introduction. Economic inequality, political instability and globalization have contributed to the constant growth of the migration phenomenon in recent years. In particular, a total of 4.2 million people migrated to Europe during 2019 and most of them settled in Germany, France and Italy. Objectives. The objective of this study was to conduct a systematic review of studies analyzing the oral health condition among migrants from middle- and low-income countries to Europe and assessing the eventual association between their sociodemographic and socioeconomic characteristics and oral health status. Materials and Methods. A systematic review was conducted in PubMed, Cochrane Library, Scopus and Science Direct databases. After titles, abstracts and full-text examination, only 27 articles were selected on the basis of inclusion criteria and consequently included for quality assessments and data extraction. Results. Most of the studies reported a higher prevalence of caries experience, a poorer periodontal health and more difficulties in accessing dentalcare services among migrant groups compared with the non-migrant population. Inequalities were mostly associated with ethnic background, economic condition and social grade. Conclusion. Our review demonstrates the lack of dental health among migrants, underlining that their cultural beliefs and their social and economic living conditions could influence their oral health.

Oral health problems facing refugees in Europe: a scoping review

Introduction

Europe has been experiencing a flow of refugees and asylum seekers driven by conflicts or poverty. Their oral health is often neglected despite its clear impact on quality of life.

Objective

To explore the status of oral health among refugees and asylum seekers groups by examining the available literature and to determine which evidence exists regarding the problems they face in terms of oral health.

Methods

The current paper followed PRISMA guidelines. A scoping review methodology was followed to retrieve 2911 records from five databases and grey literature. Twelve articles met the following inclusion criteria: experimental research concentrated on the oral and dental health of refugees and/or asylum seekers between 1995 and 2020 in English. Analysis was both descriptive and thematic, whilst a critical appraisal was applied using the Critical Appraisal Skills Program (CASP).

Results

Seven studies (58,3%) were quantitative, while five studies (41,6%) were qualitative. In general, the quality of most of the studies (83.3%) was good. Limited access to oral health care services was shown with a higher prevalence of oral diseases compared to the native populations of the host countries. Approaches to improve oral health have been implemented in some studies and have shown positive outcomes.

Conclusions

Oral health care strategies should consider the oral health problems facing refugees in Europe, and oral health promotion campaigns are essential to give adequate guidance on how to access oral health care in the host countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11272-z.

Dental Caries among Refugees in Europe: A Systematic Literature Review

Oral health is one of the most neglected aspects of refugee health. The study aimed to systematically review evidence on prevalence of dental caries and dental care services provided to refugees in Europe. Following PRISMA guidelines, we searched PubMed, Cochrane, WHOLIS, Web of Science, Medline Ovid, and Google Scholar identifying studies on dental caries among refugees in Europe after the 2015 refugee crisis. From 3160 records, fourteen studies were included in the analysis. Eight studies on oral health showed caries prevalence of between 50% and 100%, while it ranged from 3% to 65% in six general health studies. Caries prevalence was proportional to age and inversely associated with education, whereas gender and country of origin showed no significant association. Nowhere is oral health part of general health assessment on arrival and is complaint based. Primary focus on resettlement, language, cultural, and economic barriers emerged as explanatory models for limited access. Our study identified a high prevalence of caries and limited access to dental health services as main challenges. Integrating oral health check-ups may contribute in shifting towards preventive oral care. Further research is urgently needed to better understand the dental needs of refugees in Europe.