Oral Health Inequalities PDF

10/10/2024 ORAL HEALTH INEQUALITIES 1 HEALTH INEQUALITIES VS INEQUITIES The term health inequality generically refers to differences in the health of individuals or groups. Any measurable aspect of health that varies across individuals or...

10/10/2024 ORAL HEALTH INEQUALITIES 1 HEALTH INEQUALITIES VS INEQUITIES The term health inequality generically refers to differences in the health of individuals or groups. Any measurable aspect of health that varies across individuals or according to socially relevant groupings can be called a health inequality. Absent from the definition of health inequality is any moral judgment on whether observed differences are fair or just. A health inequity, or health disparity, is a specific type of health inequality that denotes an unjust difference in health. Health inequities are systematic differences in health that could be avoided by reasonable means 2 1  10/10/2024 HEALTH INEQUALITIES 3 HEALTH INEQUALITIES Origin of health inequalities: political, economic and social inequalities Different opportunities and resources. Moral and ethical dimension 4 2  10/10/2024 HEALTH INEQUALITIES In 1980 the United Kingdom Department of Health and Social Security published the Report of the Working Group on Inequalities in Health, also known as the Black Report. The Report showed in great detail the extent of which ill-health and death are unequally distributed among the population of Britain and suggested that these inequalities have been widening rather than diminishing since the establishment of the National Health Service in 1948. The Report concluded that these inequalities were not mainly attributable to failings in the NHS, but rather to many other social inequalities influencing health: income, education, housing, diet, employment, and conditions of work. 5 HEALTH INEQUALITIES In Spain, the perceived and registered health of the population show the influence of the socio-economic status on the general health. 6 3  10/10/2024 Infant mortality in Brazil (1990) Education level increases Infant mortality decreases 7 ORAL HEALTH INEQUALITIES Despite being largely preventable, oral diseases constitute a significant public health problem alongside the inequalities in the prevalence of the major diseases of the 21st century. Despite impressive worldwide improvements in oral health, inequalities in oral health status among and within countries remain a daunting public health challenge. Globally, those in higher socioeconomic groups enjoy both better clinical and subjective oral health outcomes, similar to the gradients seen in general health 8 4  10/10/2024 ORAL HEALTH INEQUALITIES Social inequalities in oral health are apparent in many countries In almost all circumstances, socially disadvantaged people have the worst self-rated oral health 9 ORAL HEALTH INEQUALITIES Evidence suggests that those at the lower end of the socioeconomic scale experience more functional and psychosocial impacts than their more advantaged counterparts Research among children suggests that oral disorders have little impact on the health-related quality of life of higher-income children but a marked impact on lower-income children 10 5  10/10/2024 ORAL HEALTH INEQUALITIES Oral health inequalities arise from a complex web of health determinants 1. Social 2. Behavioral 3. Economic 4. Genetic 5. Environmental 6. Health system factors Eliminating these inequalities cannot be accomplished in isolation of oral health from overall health, or without recognizing that oral health is influenced at multiple individual, family, community, and health systems levels. 11 ORAL HEALTH INEQUALITIES There are three main ways in which the link between Socio economic status (SES) and oral health has been described: 1. SES has a direct effect on the ability to access goods, services and other oral health promoting resources 2. There is an indirect mechanism in terms of differential exposure to oral health- related risk factors and behaviours 3. The relationship between SES and oral health is influenced by differences in psychological assets and psychosocial resources. 12 6  10/10/2024 ORAL HEALTH INEQUALITIES EUROPE Inequalities in health between people in higher and lower educational, occupational and income groups have been found in all Member States Lower socioeconomic groups are more susceptible to poor nutrition and to tobacco and alcohol dependency, all of which are major contributory factors in many diseases and conditions. 13 ORAL HEALTH INEQUALITIES IADR-GOHIRA® Budapest declaration, 2014 The International Association for Dental Research (IADR) Global Oral Health Inequalities Research Agenda (IADR-GOHIRA®) was established in 2010 by IADR, with the endorsement and support of the World Health Organization (WHO) and the World Dental Federation (FDI). “A call to action” (World Congress on Preventive Dentistry, 2013) The key objectives of the Network include advocacy, stimulation, promotion and fostering of inter-sectoral collaborative research on oral health inequalities and involving the wider health community. 14 7  10/10/2024 ORAL HEALTH INEQUALITIES “Oral health is a basic human right, fundamental to people’s quality of life and contributions to society, and the oral health of children and older people merits particular attention. The existing inequalities in oral health within and between countries are unfair, unjust, and avoidable.” (IADR-GOHIRA® Budapest declaration, 2014) 15 ORAL HEALTH INEQUALITIES An estimated 3.9 billion people suffer from poor oral health, as measured by untreated dental caries, severe periodontal disease, and extensive tooth loss (Marcenes et al., 2013). The population prevalence of oral cancer, oral infections, cancrum oris, craniofacial trauma, and developmental disorders also should be included to cover the full scale of the global burden of oral diseases and disorders. All of these compromise lives of people are measured using Years Lived with Disability (YLDS) and Disability Adjusted Life Years (DALYS). 16 8  10/10/2024 ORAL HEALTH INEQUALITIES Estimating the global costs resulting from oral diseases and disorders should include not only economic costs related to treatment or management of those conditions, but also psychological and societal costs through inability to enhance development of the population, via the loss of hours at school and work or other measures of dysfunction. 17 ORAL HEALTH INEQUALITIES A multi-sectorial approach to oral health inequalities research needs to be applied, linking the health sector with sectors of society such as education, agriculture, trade, environment, energy, social welfare, housing, and others that have an impact on oral health. Given that the links between oral health and general health reflect shared risk factors, those factors should be considered in the design of intervention studies to reduce inequalities. 18 9  10/10/2024 ORAL HEALTH INEQUALITIES Implementation research on targeted public health programs tailored to addressing inequality in oral health is urgently required in all countries. The effective translation of knowledge into health- promoting approaches should be encouraged, identifying important barriers to and facilitators of effective actions. 19 ORAL HEALTH INEQUALITIES The oral health workforce should gain capacity in research methods and in implementation of actions for reducing inequalities in oral health through intervention on shared risk factors for dental, oral, and general health, applying the principle of proportionate universalism. The skills associated with implementation sciences include epidemiological, psychological, and social science skills as well as those in health services and communication sciences. 20 10  10/10/2024 ORAL HEALTH INEQUALITIES Communication strategies and research on communication strategies should be targeted to addressing oral health inequalities, thus enhancing the probabilities of successful advocacy and dissemination of evidence-based information. This work should be pursued in close collaboration with IADR, WHO, and FDI. 21 ORAL HEALTH INEQUALITIES The major oral diseases are avoidable through effective prevention and health promotion Reducing social inequities in oral health depends solely on political will. 22 11  10/10/2024 Most of humanity does not have the option to choose freely on a multitude of issues that concern their health 23 DISTRIBUTION OF ORAL DISEASES 24 12  10/10/2024 25 DISTRIBUTION OF ORAL DISEASES During the last decades, measures to combat dental caries and periodontitis have been developed, tested and implemented in many populations worldwide and are thought to have benefitted millions of people. Despite the huge effort made, a large part of the world’s population still suffers from these two oral diseases, which are the main causes of tooth loss. 26 13  10/10/2024 DISTRIBUTION OF ORAL DISEASES Quantifying periodontal diseases in a meaningful and reproducible manner has been an ongoing challenge for oral epidemiologists and clinicians. Unification under a single case definition has been a challenge, without a satisfying solution. The World Health Organization introduced the Community Periodontal Index of Treatment Needs (CPITN) in 1987, recommending the use of pocket depth (PD) as a criterion for identifying cases of SP. 27 DISTRIBUTION OF ORAL DISEASES Concerning periodontal disease, most young people show signs of gingivitis and in the adult population the early signs of periodontal disease are very common, although severe periodontitis affects a minority The world population of 35-44 years according to the Community Periodontal Index (CPI): Moderate periodontal diseases (code 3 CPI) affect 30-40% Severe periodontal disease (code 4 CPI) affect 7-15% 28 14  10/10/2024 DISTRIBUTION OF ORAL DISEASES Severe periodontitis is the sixth most common disease globally. Prevalence and incidence of periodontitis are highly age-dependent There is a marked geographic variation. 29 Fuente: Organización Mundial de la Salud. Informe sobre la situación mundial de la salud bucodental: hacia la cobertura sanitaria universal para la salud bucodental de aquí a 2030: resumen ejecutivo. 18 de noviembre de 2022. MÓDULO 1. Impacto de la salud oral en la calidad de vida 30 15  10/10/2024 DISTRIBUTION OF ORAL DISEASES 31 DISTRIBUTION OF ORAL DISEASES SPAIN Between 12 -15 years old, the percentage of individuals with calculus is 28% and 34%. We find a healthy periodontium of 40.8% and 36.7% respectively. In the cohorts 35-44 and 65-74 years old, we find prevalence of deep periodontal pockets (≥6 mm) of 7.6 % and 11.6%. The prevalence of periodontal pockets of 4-5 mm are 17.9 % and 22.9 %. The prevalence of calculus are 41.4 % and 31.4 % respectively. There is an absence of periodontal pathology signs in 18.1% of Young adults and 9.6% of Elder adults. 32 16  10/10/2024 DISTRIBUTION OF ORAL DISEASES CARIES Untreated cavitated dentine carious lesions make up the single most common disease that affects humans worldwide. Untreated caries in permanent teeth affects 2.4 billion people Untreated caries in deciduous teeth affects 621 million children worldwide. 33 DISTRIBUTION OF ORAL DISEASES The prevalence of cavitated dentine carious lesions has reduced tremendously as has its severity in young children, adolescents and adults over the last 30-40 years. 34 17  10/10/2024 DISTRIBUTION OF ORAL DISEASES Causes of reduced prevalence and severity of caries: Improved biofilm control Reduced sugar intake Increased use of fluoride, particularly in toothpaste Increase in regular check-ups in several countries. 35 DISTRIBUTION OF ORAL DISEASES The prevalence and severity of cavitated dentine carious lesions among 5 and 12-years-old have declined over the last decades Lower prevalence among 12-years-old and among 35 to 44-year-olds in high-income countries. The number of teeth present at an older age has increased over the last four decades and this may be due to fewer teeth being extracted because of dental caries. The lifetime prevalence of dental caries experience measured by the DMF index has declined in the last 40 years in many developed countries although individuals are susceptible to caries throughout life. 36 18  10/10/2024 Fuente: Organización Mundial de la Salud. Informe sobre la situación mundial de la salud bucodental: hacia la cobertura sanitaria universal para la salud bucodental de aquí a 2030: resumen ejecutivo. 18 de noviembre de 2022. MÓDULO 1. Impacto de la salud oral en la calidad de vida 37 Fuente: Organización Mundial de la Salud. Informe sobre la situación mundial de la salud bucodental: hacia la cobertura sanitaria universal para la salud bucodental de aquí a 2030: resumen ejecutivo. 18 de noviembre de 2022. MÓDULO 1. Impacto de la salud oral en la calidad de vida 38 19  10/10/2024 Fuente: Organización Mundial de la Salud. Informe sobre la situación mundial de la salud bucodental: hacia la cobertura sanitaria universal para la salud bucodental de aquí a 2030: resumen ejecutivo. 18 de noviembre de 2022. MÓDULO 1. Impacto de la salud oral en la calidad de vida 39 DISTRIBUTION OF ORAL DISEASES Caries is the fourth-most expensive chronic disease to treat according to the WHO. 40 20  10/10/2024 DISTRIBUTION OF ORAL DISEASES If left untreated, caries may cause severe pain and mouth infection which affects: Children's school attendance and performance Adult's productivity at work. 41 DISTRIBUTION OF ORAL DISEASES Untreated caries represents a major biological, social and financial burden on individuals and healthcare systems. Policy makers need to be aware of a predictable further increase in untreated caries due to the growing world population that is associated with an increasing life expectancy and a massive decrease in the prevalence of tooth loss 42 21  10/10/2024 DISTRIBUTION OF ORAL DISEASES The burden of untreated caries is shifting from children to adults. The prevalence peak at age 25 might represent a delay in caries development, possibly due to promoting oral health to schoolchildren and then neglecting this aspect of health in adult life just after leaving school 43 DISTRIBUTION OF ORAL DISEASES Across Europe, a high relative risk of oral health diseases is related to socio-economical determinants 44 22  10/10/2024 DMFT SCORES FOR 12-YEARS- OLDS IN EU COUNTRIES 2000 ONWARDS 45 DISTRIBUTION OF ORAL DISEASES Caries free children in European countries, 2011 46 23  10/10/2024 DISTRIBUTION OF ORAL DISEASES DMFT index of children in European countries, 2011 47 DISTRIBUTION OF ORAL DISEASES 48 24  10/10/2024 DISTRIBUTION OF ORAL DISEASES 49 DISTRIBUTION OF ORAL DISEASES 50 25  10/10/2024 DISTRIBUTION OF ORAL DISEASES Secondary College school 51 DISTRIBUTION OF ORAL DISEASES SPAIN Caries prevalence in 5-6 yrs old Edades 1993 2015 individuals (temporary dentition) shows 5-6 años (temporales) 0.97 1.28 a stable evolution 12 años 2.29 0.58 15 años 3.82 0.94 35-44 años 10.87 7.4 In permanent dentition, in 12 and 15 65-74 21.16 14.99 years old individuals, caries prevalence has decreased considerably. 52 26  10/10/2024 DISTRIBUTION OF ORAL DISEASES AMERICA In North America the situation is positive. 70% of children between 5 and 6 years old are free of caries. DMFT index (12 years olds): U.S.A=1,3 Canada=1,6 In South America, the situation is different (DMFT= 3) The decayed component (D) is the highest and the filled indexes(F) are very low. In Cuba, the situation is atipical (National Health Service) there is a low DMFT index and and high filled indexes (near 60%) 53 DISTRIBUTION OF ORAL DISEASES AFRICA Dental caries and periodontal disease have historically been considered the most important oral health problems around the world. However, in African countries, these appear to be neither as common nor of the same order of severity as in the developed world. Most of African countries show very low caries levels in permanent teeth (DMFT 1.5-2). The exceptions are Gabon, Centro African Republic, Madagascar And Mauricio (DMFT 4.5-5) 54 27  10/10/2024 DISTRIBUTION OF ORAL DISEASES WHO South-East Asia Countries SOUTH-EAST ASIA Bangladesh Bhutan Democratic People’s Republic of Korea India Very low caries levels. (DMFT 12 yrs: 1.5) Indonesia The implementation of preventive oral Maldives Myanmar health programs, like the school program in Nepal Thailand have decreased importantly the Sri Lanka caries levels in this region. Thailand Timor-Leste 55 DISTRIBUTION OF ORAL DISEASES WESTERN PACIFIC Most of the countries show very low or low caries levels There are two exceptions: Brunei and the Philipines (DMFT index close to 5) 56 28  10/10/2024 DISTRIBUTION OF ORAL DISEASES EASTERN MEDITERRANEAN In the Eastern Mediterranean Region, dental caries prevalence rates among children are high for some countries whereas other countries show lower levels of dental caries; the pattern highly reflects the distinct lifestyles in health, the level of exposure to fluorides and development of oral health systems. 57 DISTRIBUTION OF ORAL DISEASES INDUSTRIALIZED COUNTRIES 60-70% of the infants are free of caries lesions. The remaining 30-40% have a high caries index (There is an accumulation of pathology in the minority) Between 15-20% of the teenagers accumulate more than 50% of the pathology (corresponding to specific ethnic groups, low socioeconomic level or immigrants). 58 29  10/10/2024 DISTRIBUTION OF ORAL DISEASES INDUSTRIALIZED COUNTRIES A strong correlation is observed between dmft and DMFT at 12 years old which reinforces the importance of early preventive measurements to control caries levels in teenagers. Most caries lesions in children and teenagers are concentrated in the occlusal surface of molars and premolars (80%) 59 DISTRIBUTION OF ORAL DISEASES INDUSTRIALIZED COUNTRIES – CAUSES FOR IMPROVEMENT OF ORAL HEALTH. Fluoride toothpaste (most important cause) Improvement of the socioeconomic level (65% of reductions) Sugar consumption has been constant,. but it has reduced its impact in communities protected by fluoride. 60 30  10/10/2024 BIBLIOGRAPHY Int J Health Serv. 1982;12(3):349-80. Inequalities in health. The Black Report: a summary and comment. Gray AM. Oral health inequalities: Relationships between Environmental and Individual factors. E. Gupta, PG Robinson, CM Marya, SR Baker. Journal of Dental Research 2015 vol 94(10)1362-1368 Self-rated oral health and oral health-related factors: the role of social inequality. G Mejía, JM Armfield, LM Jamieson. Australian Dental Journal 2014: 59: 226-233. Budapest Declaration: IADR-GOHIRA®P.A. Mossey1* and P.E. Petersen2. Journal of Dental Research – clinical research supplement July 2014º Inequalities in health. Definitions, concepts and theories. MC Arcaya, AL Arcaya, SV Subramanian. 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