Unequal smiles: consequences of untreated dental caries in citizens living in vulnerable circumstances in the Netherlands: an exploratory pilot study
DOI:
https://doi.org/10.2340/aos.v83.42028Keywords:
Untreated dental caries, dental caries, odontogenic infection, oral health-related quality of life, social class, poverty, oral healthcare servicesAbstract
The often poor oral health status of socioeconomically vulnerable adults is widely recognised. Nevertheless, research on it is scarce. To address this gap, this exploratory pilot study aimed to report on the prevalence of untreated caries and its clinical odontogenic consequences, as well as the associated Oral Health Related Quality of Life (OHRQoL) in a marginalised adult Dutch population.
The Dutch department of Médecins du Monde (Doctors of the World) included socioeconomically vulnerable (low socioeconomic position [SEP]) adults in the Netherlands through community organisations. The validated Deprivation in Primary Care Questionnaire (DiPCare-Q) was translated in Dutch and used to characterise the SEP of the population. To document untreated caries and severe odontogenic consequences, the DMFT (Decayed, Missing, Filled Permanent Teeth) and PUFA (Pulpal, Fistula, Ulceration, Abscess) index were used. The validated Dutch Oral Health Impact Profile questionnaire (OHIP-14) was used to document the impact of these issues on OHRQoL. Data analysis was conducted in SPSS® (Statistical Package for the Social Sciences) statistics (Kruskal-Wallis, Mann-Whitney-U-test) and STATA software.
Data from 59 adult participants were analysed. The prevalence of untreated caries (DT ≥ 1) was 65.5%, 57.9% of which experienced severe odontogenic consequences (DT+PUFA). The prevalence of severe odontogenic consequences (PUFA ≥ 1) was 45.5%. The mean OHIP-14 score of 17.7 ± 13.4 (25th–75th percentile: 6–26) illustrated that untreated caries may have impact on OHRQoL. Individuals who experienced any severe odontogenic consequences from untreated caries reported significantly higher OHIP-14 scores (mean ± s.d.: 21.8 ± 14.8 vs.11.1 ± 7.2).
The untreated caries and severe odontogenic consequences seen in a large number of the socioeconomically vulnerable adult participants seemed to have an impact on OHRQoL. These findings emphasise the urgency of including these adults in the professional oral health system for treatment and prevention, and may emphasise the necessity of improving the socioeconomic circumstances of this population. Further exploration of the exact barriers and facilitators to oral healthcare access for socioeconomically vulnerable adults is necessary.
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References
World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. Geneva: World Health Organization; 2022. Available at: http://apps.who.int/bookorders
Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet. 2019;394(10194):249–260. https://doi.org/10.1016/s0140-6736(19)31146-8 DOI: https://doi.org/10.1016/S0140-6736(19)31146-8
Sischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. J Dent Res. 2011;90(11):1264–1270. https://doi.org/10.1177/0022034511399918. DOI: https://doi.org/10.1177/0022034511399918
Duijster D, Groeniger JO, Van Der Heijden GJMG, van Lenthe FJ. Material, behavioural, cultural and psychosocial factors in the explanation of socioeconomic inequalities in oral health. Eur J Public Health. 2018;28(4):590–597. https://doi.org/10.1093/eurpub/ckx209. DOI: https://doi.org/10.1093/eurpub/ckx209
Mackenbach JP, Stronks K. A strategy for tackling health inequalities in the Netherlands. Br Med J. 2002;325(2371):1029–1032. https://doi.org/10.1136/bmj.325.7371.1029. DOI: https://doi.org/10.1136/bmj.325.7371.1029
Sacker A, Bartley M. Social inequalities in oral health: from evidence to action. Watt RG, Listl S, Peres M, Heilmann A, editors. London: UCL; 2015. 27 p.
Tsakos G, Demakakos P, Breeze E, Watt, RG. Social gradients in oral health in older adults: findings from the English longitudinal survey of aging. Am J Public Health. 2011;101(10):1892–1899. https://doi.org/10.2105/AJPH.2011.300215. DOI: https://doi.org/10.2105/AJPH.2011.300215
Shahid M, Shum JH, Tadakamadla SK, Kroon J, Peres MA. Theoretical evidence explaining the relationship between socio-demographic and psy chosocial barriers on access to oral health care among adults: a scoping review. J Dent. 2021;107:103606. https://doi.org/10.1016/j.jdent.2021.103606. DOI: https://doi.org/10.1016/j.jdent.2021.103606
Hach M, Christensen LB, Lange T, Hvidtfeldt UA, Danielsen B, Diderichsen F, et al. Social inequality in tooth loss: separate and joint effects of household income and dental visits. Community Dent Health. 2021;38(4):241–245.
Hach M, Christensen LB, Lange T, Hvidtfeldt UA, Danielsen B, Diderichsen F, et al. Social inequality in tooth loss, the mediating role of smoking and alcohol consumption. Community Dent Oral Epidemiol. 2019;47(5):416–423. https://doi.org/10.1111/cdoe.12468. DOI: https://doi.org/10.1111/cdoe.12468
van Midde M, Hesse I, van der Heijden GJMG, Duijster D, van Elteren M, Kroesen M, et al. Access to oral health care for undocumented migrants: perspectives of actors involved in a voluntary dental network in the Netherlands. Community Dent Oral Epidemiol. 2021;49(4):330–336. https://doi.org/10.1111/cdoe.12605. DOI: https://doi.org/10.1111/cdoe.12605
Vermaire JH, Schuller AA. Socioeconomic differences in oral health outcomes among adults in the Netherlands. Ned Tijdschr Tandheelkd. 2019;126(6):297–303. https://doi.org/10.5177/ntvt.2019.06.19008. DOI: https://doi.org/10.5177/ntvt.2019.06.19008
van Nes KA, Veerkamp JSJ, Reis R. Barriers and opportunities to oral health in Dutch-Moroccan children in the Netherlands: a narrative report. Eur Arch Paediatr Dent. 2018;19(5):353–364. https://doi.org/10.1007/s40368-018-0367-3. DOI: https://doi.org/10.1007/s40368-018-0367-3
Benzeval M, Judge K. Income and health: the time dimension. Soc Sci Med. 2001;52:1371–1390. https://doi.org/10.1016/S0277-9536(00)00244-6. DOI: https://doi.org/10.1016/S0277-9536(00)00244-6
Costa SM, Martins CC, Bonfim MDLC, Zina LG, Paiva SM, Pordeus IA, et al. A systematic review of socioeconomic indicators and dental caries in adults. Int J Environ Res Public Health. 2012;9(10):3540–3574. https://doi.org/10.3390/ijerph9103540. DOI: https://doi.org/10.3390/ijerph9103540
Sabbah W, Tsakos G, Sheiham A, Watt RG. The role of health-related behaviors in the socioeconomic disparities in oral health. Soc Sci Med. 2009;68(2):298–303. https://doi.org/10.1016/j.socscimed.2008.10.030. DOI: https://doi.org/10.1016/j.socscimed.2008.10.030
Riley WJ. Nashville M. Health disparities: gaps in access, quality and affordability of medical care. Trans Am Clin Climatol Assoc. 2012;123:167–174.
Benoit C, Jansson M, Millar A, Phillips R. Community-academic research on hard-to-reach populations: benefits and challenges. Qual Health Res. 2005;15(2):263–282. https://doi.org/10.1177/1049732304267752. DOI: https://doi.org/10.1177/1049732304267752
Jiao S, Slemon A, Guta A, Bungay V. Exploring the conceptualization, operationalization, implementation, and measurement of outreach in community settings with hard-to-reach and hidden populations: a scoping review. Soc Sci Med. 2022;309:115232. https://doi.org/10.1016/j.socscimed.2022.115232. DOI: https://doi.org/10.1016/j.socscimed.2022.115232
Kauffman KS, Dosreis S, Ross M, Barnet B, Onukwugha E, Mullins CD. Engaging hard-to-reach patients in patient-centered outcomes research. J Comp Eff Res. 2013;2(3):313–324. https://doi.org/10.2217/cer.13.11. DOI: https://doi.org/10.2217/cer.13.11
Bonevski B, Randell M, Paul C, Chapman K, Twyman L, Bryant J, et al. Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Med Res Methodol. 2014;14(1):42. https://doi.org/10.1186/1471-2288-14-42. DOI: https://doi.org/10.1186/1471-2288-14-42
Bukmir RP, Paljevi. E, Pezelj-Ribari. S, Prso IB. Association of the self-reported socioeconomic and health status with untreated dental caries and the oral hygiene level in adult patients. Dent Med Probl. 2022;59(4):539–545. https://doi.org/10.17219/dmp/138908. DOI: https://doi.org/10.17219/dmp/138908
Schuller AA, van Kempen I, Vermaire E, Poorterman J, Verlinden A, Hofstetter H, et al. Gebit fit? Een onderzoek naar de mondgezondheid en het tandheelkundig preventief gedraag van volwassenen in Nederland in 2013. Leiden; 2014. Available at: http://resolver.tudelft.nl/uuid:c776997e-93f8-4fd8-a317-15fade31925b (Accessed: 16 August 2021).
Centraal Bureau voor Statistiek. Armoede en sociale uitsluiting 2023: Den Haag. https://longreads.cbs.nl/armoede-en-sociale-uitsluiting-2023/
Broers DLM, Dubois L, de Lange J, Welie JVM, Brands WG, Bruers JJM, et al. Financial, psychological, or cultural reasons for extracting healthy or restorable teeth. J Am Dent Assoc. 2022;153(8):761–768.e3. https://doi.org/10.1016/j.adaj.2022.01.008. DOI: https://doi.org/10.1016/j.adaj.2022.01.008
Monse B, Heinrich-Weltzien R, Benzian H, Holmgren C, van Palenstein Helderman W. PUFA – an index of clinical consequences of untreated dental caries. Community Dent Oral Epidemiol. 2010;38(1):77–82. https://doi.org/10.1111/j.1600-0528.2009.00514.x. DOI: https://doi.org/10.1111/j.1600-0528.2009.00514.x
Vaucher P, Bischoff T, Diserens EA, Herzig L, Meystre-Agustoni G, Panese F, et al. Detecting and measuring deprivation in primary care: development, reliability and validity of a self-reported questionnaire: the DiPCare-Q. Br Med J. 2012;2(1):1–10. https://doi.org/10.1136/bmjopen-2011-000692. DOI: https://doi.org/10.1136/bmjopen-2011-000692
Eurostat. Eurostat urban-rural typology, by NUTS 3 regions. Available at: https://ec.europa.eu/eurostat/cache/RCI/#?vis=urbanrural.urb_typology&lang=en
von Elm E, Altman D, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology. 2007;18(6):800–804. https://doi.org/10.1097/EDE.0b013e3181577654. DOI: https://doi.org/10.1097/EDE.0b013e3181577654
van der Meulen MJ, Lobbezoo F, John MT, Naeije M. Oral health impact profile. Meetinstrument voor de invloed van de mondgezondheid op de levenskwaliteit. Ned Tijdschr Tandheelkd. 2011;118(3):134–139. https://doi.org/10.5177/ntvt.2011.03.10178. DOI: https://doi.org/10.5177/ntvt.2011.03.10178
Townsendj P. Deprivation. Health Visit. 1972;45(8):223–224.
Pitts NB, Ekstrand K. International caries detection and assessment system (ICDAS) and its international caries classification and management system (ICCMS) – methods for staging of the caries process and enabling dentists to manage caries. Community Dent Oral Epidemiol. 2013;41(1):e41–e52. https://doi.org/10.1111/cdoe.12025. DOI: https://doi.org/10.1111/cdoe.12025
Svensson L, Hakeberg M, Wide U. Dental pain and oral health-related quality of life in individuals with severe dental anxiety. Acta Odontol Scand. 2018;76(6):401–406. https://doi.org/10.1080/00016357.2018.1473892. DOI: https://doi.org/10.1080/00016357.2018.1473892
Koyama T, McHaffie JG, Laurienti PJ, Coghill RC. The subjective experience of pain: where expectations become reality. Proc Natl Acad Sci U S A. 2005;102(36):12950–12955. https://doi.org/10.1073/pnas.0408576102. DOI: https://doi.org/10.1073/pnas.0408576102
Paredes SDO, da Nóbrega RF, Soares TDS, Bezerra MED, de Abreu MHNG, Forte FDS. Dental pain associated with untreated dental caries and sociodemographic factors in 5-year-old children. J Clin Exp Dent. 2021;13(6):552–557. https://doi.org/10.4317/jced.57827. DOI: https://doi.org/10.4317/jced.57827
Lawal FB, Bankole OO. Impact of untreated dental caries on daily performances of children from low social class in an urban African population: the importance of pain. Pesqui Bras Odontopediatria Clin Integr. 2019;19(1):231–300. https://doi.org/10.4034/PBOCI.2019.191.82. DOI: https://doi.org/10.4034/PBOCI.2019.191.82
Verrips GH, Schuller AA. De invloed van mondgezondheid op de levenskwaliteit van volwassen Nederlanders. Ned Tijdschr Tandheelkd. 2011;118(3):162–164. https://doi.org/10.5177/ntvt.2011.03.10221. DOI: https://doi.org/10.5177/ntvt.2011.03.10221
Cohen-Carneiro F, Souza-Santos R, Bessa Rebelo MA. Quality of life related to oral health: contribution from social factors. Cien Saude Colet. 2011;16(1):1007–1015. https://doi.org/10.1590/S1413-81232011000700033. DOI: https://doi.org/10.1590/S1413-81232011000700033
Øzhayat EB, Østergaard P, Gotfredsen K. Oral health-related quality of life in socially endangered persons in Copenhagen, Denmark. Acta Odontol Scand. 2016;74(8):620–625. https://doi.org/10.1080/00016357.2016.1229022. DOI: https://doi.org/10.1080/00016357.2016.1229022
Lamenha-Lins RM, Cavalcanti-Campêlo MC, Cavalcante-Silva CR, Rodrigues-Mota K, Leao-Oliveira CV, Lopes-Nascimento PB, et al. Odontogenic infection and dental pain negatively impact schoolchildren’s quality of life. Acta Odontol Latinoam. 2020;33(1):38–44. https://doi.org/10.54589/aol.33/1/038. DOI: https://doi.org/10.54589/aol.33/1/038
Vasavan S, Retnakumari N. Assessing consequences of untreated dental caries using pufa/PUFA index among 6–12 years old schoolchildren in a rural population of Kerala. J Indian Soc Pedod Prev Dent. 2022;40(2):132–139. https://doi.org/10.4103/jisppd.jisppd_342_21. DOI: https://doi.org/10.4103/jisppd.jisppd_342_21
Quadros LN, Rebelo MAB, de Queiroz AC, pereira JV, Vettore MV, Vieira JMR. Clinical consequences of untreated dental caries and school performance in low-income adolescents. Int J Paediatr Dent. 2021;31(5):619–626. https://doi.org/10.1111/ipd.12747. DOI: https://doi.org/10.1111/ipd.12747
Needleman I, Ashley P, Meehan L, petrie A, Weiler R, McNally S, et al. Poor oral health including active caries in 187 UK professional male football players: clinical dental examination performed by dentists. Br J Sports Med. 2016;50(1):41–44. https://doi.org/10.1136/bjsports-2015-094953. DOI: https://doi.org/10.1136/bjsports-2015-094953
Dental health among adults using unscheduled care. Public Health England 2017: London. https://assets.publishing.service.gov.uk/media/5c4b1d3ded915d38abfc7c66/Out_of_hours_adult_users_unscheduled_care_dental_summary.pdf
OECD. Health for everyone?: social inequalities in health and health systems. OECD Health Policy Studies. OECD; 2019. Available at: https://www.oecd-ilibrary.org/social-issues-migration-health/health-for-everyone_3c8385d0-en
Donders ART, van der Heijden GJMG, Stijnen T, Moons KGM. Review: a gentle introduction to imputation of missing values. J Clin Epidemiol. 2006;59(10):1087–1091. https://doi.org/10.1016/j.jclinepi.2006.01.014. DOI: https://doi.org/10.1016/j.jclinepi.2006.01.014
Centraal Bureau voor de Statistiek. CBS StatLine. Bevolking; kerncijfers. 2021. Available at: https://opendata.cbs.nl/statline/#/CBS/nl/dataset/37296ned/table?ts=1655746710306 (Accessed: 13 January 2021).
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