Poor oral health, related quality of life, and use of dental care system among vulnerable migrants in Denmark – a cross-sectional study

Authors

  • Josefina Salazar Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark https://orcid.org/0000-0002-6448-5946
  • Hanne Winther Frederiksen Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Copenhagen, Hvidovre, Denmark https://orcid.org/0000-0003-0024-1560
  • Hanne Nødgaard Christensen Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Copenhagen, Hvidovre, Denmark
  • Esben Boeskov Øzhayat Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark https://orcid.org/0000-0001-8656-0292

DOI:

https://doi.org/10.2340/aos.v84.44658

Keywords:

Oral health, quality of life, immigrants, dental health service

Abstract

Objective: The study aims to describe the oral status, oral health-related quality of life (OHRQoL), and oral-health behaviours of vulnerable adult migrants with complex health problems.

Methods: We conducted a descriptive cross-sectional study at the Section of Immigrant Medicine, Hvidovre Hospital, Denmark. We conducted clinical examinations to assess participants’ number of teeth, caries, oral hygiene, and periodontal status. Participants also completed a questionnaire to evaluate OHRQoL, oral-health related behaviours (e.g. use of dental care system), and perceived barriers to access dental treatment and maintaining oral hygiene.

Results: We included 50 participants, with a mean age of 49.4 (SD 7.4) years, 82% of whom were women, and 40% were from the Middle East and North Africa. Regarding oral status, 28% of participants had a full dentition, 54% had decayed teeth, 12% had good oral hygiene, and 46% had periodontal disease. Regarding OHRQoL, 92% of participants reported that their oral health negatively impacted one or more daily activities. Around 40% of participants had visited the dentist in Denmark the previous year, and 95% reported the costs as a barrier to dental care.

Conclusions: There is a high prevalence of oral disease with a massive impact on the OHRQoL of this group of vulnerable migrants. Despite the need for essential dental treatments, participants rarely used the Danish dental care system. Our findings highlight the need for multi-sectoral interventions for this population.

Downloads

Download data is not yet available.

References

Davies A, Basten A, Frattini C. Migration: a social determinant of the health of migrants. International Organization for Migration: Geneva, Switzerland; 2009.

Lokdam N, Kristiansen M, Handlos LN, Norredam M. Use of healthcare services in the region of origin among patients with an immigrant background in Denmark: a qualitative study of the motives. BMC Health Serv Res. 2016;16:99. https://doi.org/10.1186/s12913-016-1346-1 DOI: https://doi.org/10.1186/s12913-016-1346-1

Scheppers E, van Dongen E, Dekker J, Geertzen J, Dekker J. Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract. 2006;23(3):325–48. https://doi.org/10.1093/fampra/cmi113 DOI: https://doi.org/10.1093/fampra/cmi113

Norredam M, Garcia-Lopez A, Keiding N, Krasnik A. Risk of mental disorders in refugees and native Danes: a register-based retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol. 2009;44(12):1023–9. https://doi.org/10.1007/s00127-009-0024-6 DOI: https://doi.org/10.1007/s00127-009-0024-6

Andersen GS, Kamper-Jørgensen Z, Carstensen B, Norredam M, Bygbjerg IC, Jørgensen ME. Diabetes among migrants in Denmark: inci-dence, mortality, and prevalence based on a longitudinal register study of the entire Danish population. Diabetes Res Clin Pract. 2016;122:9–16. https://doi.org/10.1016/j.diabres.2016.09.020 DOI: https://doi.org/10.1016/j.diabres.2016.09.020

Sengupta K, Christensen LB, Mortensen LH, Skovgaard LT, Andersen I. Trends in socioeconomic inequalities in oral health among 15-year-old Danish adolescents during 1995–2013: a nationwide, register- based, repeated cross-sectional study. Community Dent Oral Epidemiol. 2017;45(5):458–68. https://doi.org/10.1111/cdoe.12310 DOI: https://doi.org/10.1111/cdoe.12310

Christensen LB, Twetman S, Sundby A. Oral health in children and adolescents with different socio-cultural and socio-economic back-grounds. Acta Odontol Scand. 2010;68(1):34–42. https://doi.org/10.3109/00016350903301712 DOI: https://doi.org/10.3109/00016350903301712

Tandsundhed. Sundheds- og sygelighedsundersøgelsen 2021. Denmark: Statens Institut for Folkesundhed: Copenhagen, Denmark; 2023.

Petersen PE, Davidsen M, Rosendahl Jensen H, Ekholm O, Illemann Christensen A. Trends in dentate status and preventive dental visits of the adult population in Denmark over 30 years (1987–2017). Eur J Oral Sci. 2021;129(5):e12809. https://doi.org/10.1111/eos.12809 DOI: https://doi.org/10.1111/eos.12809

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):249–60. DOI: https://doi.org/10.1016/S0140-6736(19)31146-8

D’Aiuto F, Gable D, Syed Z, Allen Y, Wanyonyi KL, White S, et al. Evidence summary: the relationship between oral diseases and diabetes. Br Dent J. 2017;222(12):944–8. https://doi.org/10.1038/sj.bdj.2017.544 DOI: https://doi.org/10.1038/sj.bdj.2017.544

Dietrich T, Webb I, Stenhouse L, Pattni A, Ready D, Wanyonyi KL, et al. Evidence summary: the relationship between oral and cardiovascu-lar disease. Br Dent J. 2017;222(5):381–5. https://doi.org/10.1038/sj.bdj.2017.224 DOI: https://doi.org/10.1038/sj.bdj.2017.224

Seitz MW, Listl S, Bartols A, Schubert I, Blaschke K, Haux C, et al. Current knowledge on correlations between highly prevalent dental conditions and chronic siseases: an umbrella review. Prev Chronic Dis. 2019;16:E132. https://doi.org/10.5888/pcd16.180641 DOI: https://doi.org/10.5888/pcd16.180641

Rigert JM, Napenas JJ, Wally M, Odum S, Yu Z, Runyon M, et al. Dental pain management with prescription opioids by nondental healthcare professionals in a healthcare system network. J Public Health Dent. 2022;82(1):22–30. https://doi.org/10.1111/jphd.12459 DOI: https://doi.org/10.1111/jphd.12459

Ferreira MC, Dias-Pereira AC, Branco-de-Almeida LS, Martins CC, Paiva SM. Impact of periodontal disease on quality of life: a systematic review. J Periodontal Res. 2017;52(4):651–65. https://doi.org/10.1111/jre.12436 DOI: https://doi.org/10.1111/jre.12436

Øzhayat EB, Åkerman S, Lundegren N, Öwall B. Patients’ experience of partial tooth loss and expectations to treatment: a qualitative study in Danish and Swedish patients. J Oral Rehabil. 2016;43(3):180–9. https://doi.org/10.1111/joor.12355 DOI: https://doi.org/10.1111/joor.12355

Oral Health [Internet]. World Health Organization; 2023. Available from:https://www.who.int/news-room/fact-sheets/detail/oral-health [cited August 3 2023]

Short SE, Mollborn S. Social determinants and health behaviours: conceptual frames and empirical advances. Curr Opin Psychol. 2015;5:78–84. https://doi.org/10.1016/j.copsyc.2015.05.002 DOI: https://doi.org/10.1016/j.copsyc.2015.05.002

Skeie MS, Riordan PJ, Klock KS, Espelid I. Parental risk attitudes and caries-related behaviours among immigrant and western native children in Oslo. Community Dent Oral Epidemiol. 2006;34(2):103–13. https://doi.org/10.1111/j.1600-0528.2006.00256.x DOI: https://doi.org/10.1111/j.1600-0528.2006.00256.x

Batra M, Gupta S, Erbas B. Oral health beliefs, attitudes, and practices of South Asian migrants: a systematic review. Int J Environ Res Public Health. 2019;16(11):1952. https://doi.org/10.3390/ijerph16111952 DOI: https://doi.org/10.3390/ijerph16111952

Lamb CE, Whelan AK, Michaels C. Refugees and oral health: lessons learned from stories of Hazara refugees. Aust Health Rev. 2009;33(4):618–27. https://doi.org/10.1071/AH090618 DOI: https://doi.org/10.1071/AH090618

Raifman S, DeVost MA, Digitale JC, Chen Y-H, Morris MD. Respondent-driven sampling: a sampling method for hard-to-reach populations and beyond. Curr Epidemiol Rep. 2022;9(1):38–47. https://doi.org/10.1007/s40471-022-00287-8 DOI: https://doi.org/10.1007/s40471-022-00287-8

Tyldum G. Surveying migrant populations with respondent-driven sampling. Experiences from surveys of east-west migration in Europe. Int J Soc Res Methodol. 2021;24(3):341–53. https://doi.org/10.1080/13645579.2020.1786239 DOI: https://doi.org/10.1080/13645579.2020.1786239

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–8. https://doi.org/10.1136/bmj.39335.541782.AD DOI: https://doi.org/10.1136/bmj.39335.541782.AD

Rosenkrands HS, Kristiansen M, Hansen AL, Norredam M. Providing targeted healthcare services for immigrants with complex health needs. Dan Med J. 2020;67(10):A03190160.

Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc. 1964;68:7–13. https://doi.org/10.14219/jada.archive.1964.0034 DOI: https://doi.org/10.14219/jada.archive.1964.0034

Baishya B, Satpathy A, Nayak R, Mohanty R. Oral hygiene status, oral hygiene practices and periodontal health of brick kiln workers of Odisha. J Indian Soc Periodontol. 2019;23(2):163–7. https://doi.org/10.4103/jisp.jisp_383_18 DOI: https://doi.org/10.4103/jisp.jisp_383_18

Cutress TW, Ainamo J, Sardo-Infirri J. The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals. Int Dent J. 1987;37(4):222–33.

Adulyanon S, Sheiham A. Oral impacts on daily performances. In: G. Slade, editor. Measuring oral health and quality of life. Chapel Hill: University of North Carolina: Dental Ecology; 1997.

Gülcan F, Ekbäck G, Ordell S, Klock KS, Lie SA, Åstrøm AN. Exploring the association of dental care utilization with oral impacts on daily performances (OIDP) – a prospective study of ageing people in Norway and Sweden. Acta Odontol Scand. 2018;76(1):21–9. https://doi.org/10.1080/00016357.2017.1375555 DOI: https://doi.org/10.1080/00016357.2017.1375555

Petersen PE, Baez RJ, World Health Organization. Oral health surveys: basic methods. 5th ed. Geneva: World Health Organization; 2013.

Kongstad J, Ekstrand K, Qvist V, Christensen LB, Cortsen B, Grønbaek M, et al. Findings from the oral health study of the Danish Health Examination Survey 2007–2008. Acta Odontol Scand. 2013;71(6):1560–9. https://doi.org/10.3109/00016357.2013.776701 DOI: https://doi.org/10.3109/00016357.2013.776701

Krustrup U, Petersen PE. Dental caries prevalence among adults in Denmark – the impact of socio-demographic factors and use of oral health services. Community Dent Health. 2007;24(4):225–32.

Krustrup U, Erik Petersen P. Periodontal conditions in 35–44 and 65–74-year-old adults in Denmark. Acta Odontol Scand. 2006;64(2):65–73. https://doi.org/10.1080/00016350500377859 DOI: https://doi.org/10.1080/00016350500377859

Tandlægeforeningen. Undersøgelse om opfattelse af egen tandsundhed blandt danskere over 40 år. Copenhagen, Denmark: 2020.

Andersson P, Hakeberg M, Karlberg G, Ostberg AL. Clinical correlates of oral impacts on daily performances. Int J Dent Hyg. 2010;8(3):219–26. https://doi.org/10.1111/j.1601-5037.2010.00456.x DOI: https://doi.org/10.1111/j.1601-5037.2010.00456.x

Rosing K, Jeppe-Jensen D, Øzhayat EB. Tooth-loss related masticatory and aesthetic experiences among middle-aged and older adult Danes. Community Dent Health. 2024;41(4):222–6.

Andersson P, Kavakure J, Lingström P. The impact of oral health on daily performances and its association with clinical variables in a popu-lation in Zambia. Int J Dent Hyg. 2017;15(2):128–34.https://doi.org/10.1111/idh.12171 DOI: https://doi.org/10.1111/idh.12171

Mohebbi SZ, Sheikhzadeh S, Batebi A, Bassir SH. Oral impacts on daily performance in 20- to 50-yearolds demanding dental care in Teh-ran, Iran: association with clinical findings and self-reported health. Oral Health Prev Dent. 2014;12(1):29–36.

Soundarya Chowdary M, Sudhir KM, Reddy VC, Krishna Kumar RV, Srinivasulu G. Oral impacts on daily performances in white-collar port workers in Nellore, India – a cross-sectional study. Int Marit Health. 2016;67(4):205–13. https://doi.org/10.5603/IMH.2016.0038 DOI: https://doi.org/10.5603/IMH.2016.0038

Srisilapanan P, Sheiham A. The prevalence of dental impacts on daily performances in older people in Northern Thailand. Gerodontology. 2001;18(2):102–8. https://doi.org/10.1111/j.1741-2358.2001.00102.x DOI: https://doi.org/10.1111/j.1741-2358.2001.00102.x

Agudelo-Suárez AA, Muñoz-Pino N, Vivares-Builes AM, Ronda-Pérez E. Oral health and Oral health service utilization in native and immi-grant population: a cross-sectional analysis from the PELFI cohort in Spain. J Immigr Minor Health. 2020;22(3):484–93. https://doi.org/10.1007/s10903-020-00972-0 DOI: https://doi.org/10.1007/s10903-020-00972-0

Olerud E, Hagman-Gustavsson ML, Gabre P. Oral health status in older immigrants in a medium-sized Swedish city. Spec Care Dentist. 2016;36(6):328–34. https://doi.org/10.1111/scd.12195 DOI: https://doi.org/10.1111/scd.12195

Aarabi G, Reissmann DR, Seedorf U, Becher H, Heydecke G, Kofahl C. Oral health and access to dental care – a comparison of elderly migrants and non-migrants in Germany. Ethn Health. 2018;23(7):703–17. https://doi.org/10.1080/13557858.2017.1294658 DOI: https://doi.org/10.1080/13557858.2017.1294658

Riggs E, Gussy M, Gibbs L, van Gemert C, Waters E, Kilpatrick N. Hard to reach communities or hard to access services? Migrant mothers’ experiences of dental services. Aust Dent J. 2014;59(2):201–7. https://doi.org/10.1111/adj.12171 DOI: https://doi.org/10.1111/adj.12171

Paisi M, Baines R, Burns L, Plessas A, Radford P, Shawe J, et al. Barriers and facilitators to dental care access among asylum seekers and refugees in highly developed countries: a systematic review. BMC Oral Health. 2020;20(1):337. https://doi.org/10.1186/s12903-020-01321-1 DOI: https://doi.org/10.1186/s12903-020-01321-1

Skov Kristensen M, Ersbøll AK, Andersen I, Øzhayat EB. Utilization of a public subsidy scheme for dental care services among socially vul-nerable citizens out of labor in Copenhagen, Denmark. Acta Odontol Scand. 2024;83:112–9. https://doi.org/10.1080/00016357.2023.2279606 DOI: https://doi.org/10.1080/00016357.2023.2279606

Keboa MT, Hiles N, Macdonald ME. The oral health of refugees and asylum seekers: a scoping review. Global Health. 2016;12(1):59. https://doi.org/10.1186/s12992-016-0200-x DOI: https://doi.org/10.1186/s12992-016-0200-x

Michaëlis C, Kristiansen M, Norredam M. Quality of life and coping strategies among immigrant women living with pain in Denmark: a qualitative study. BMJ Open. 2015;5(7):e008075. https://doi.org/10.1136/bmjopen-2015-008075 DOI: https://doi.org/10.1136/bmjopen-2015-008075

Calvasina P, Gastaldo D, Quiñonez C, Muntaner C. Developing a research agenda on the political economy of immigrants’ oral health. J Immigr Minor Health. 2018;20(3):759–61. https://doi.org/10.1007/s10903-017-0666-5 DOI: https://doi.org/10.1007/s10903-017-0666-5

Faugier J, Sargeant M. Sampling hard to reach populations. J Adv Nurs. 1997;26(4):790–7. https://doi.org/10.1046/j.1365-2648.1997. 00371.x DOI: https://doi.org/10.1046/j.1365-2648.1997.00371.x

Kaur N, Kandelman D, Potvin L. Effectiveness of “Safeguard Your Smile,” an oral health literacy intervention, on oral hygiene self-care behaviour among Punjabi immigrants: a randomized controlled trial. Can J Dent Hyg. 2019;53(1):23–32.

Al Naasan Z, Broadbent J, Smith M, Duncan W. Evaluation of a tailored oral health promotion intervention for Syrian former refugees in New Zealand. Health Promot Int. 2022;37(4):daac132. https://doi.org/10.1093/heapro/daac132 DOI: https://doi.org/10.1093/heapro/daac132

Published

2025-09-02