African Journal of Dentistry ISSN: 2167-0405 Vol. 3 (1), pp. 028-031, September, 2014.

Available online at
www.internationalscholarsjournals.org © International Scholars Journals

Review

Utilization of dental health services by adult

immigrants: A narrative review
Kambale Mastaki J
Independent Researcher in Epidemiology, Via Ippolito Nievo, 2160015 Falconara M. (Italy).
E-mail: [email protected], Tel: +39 3496331454
Accepted 30 July, 2014.

Poverty, wars, complex disasters and globalization have, for long time, been associated with significant
migrations from areas “unsecure” to those assumed to be more secure. Migrants usually bring in host
countries their specific problems including health-related. Underutilization of dental health services (DHS)
is an example among many others. Most immigrants seek curative than preventive care services. Barriers
to dental services utilization, as reported by most immigrants, include low income, lack of dental insurance,
older age, male sex and acculturation. Healthcare policymakers of host countries have to urgently and
appropriately tackle this unfavourable disparity in healthcare which has a non-negligible burden.

Key words: Dental health services; utilization; migrants.

INTRODUCTION

Healthcare services are undoubtedly an important areas. Poverty, lack of access to health centres, clinics
determinant of health however not the most influential. and pharmacies and lack of awareness and knowledge
Optimal utilization of available healthcare services is an about how to use drugs are common in these areas
important means to improve one’s health status. (Merson 2000). Several studies have measured migrants’
Evidence from literature has showed that preventive care access to healthcare with non-conclusive results.
is surely the best strategy to efficiently attain the goal of a Although the majority of adults had received care from a
better health (Merson 2000, Pencheon 2004, WHO 2008, physician within the study period, many did not. Those
McMichael 2000, Lalonde 1974, Liedekerken 1990). analyses that examined dental care found a similar trend.
Consistent evidence has showed that preventive care Some of these studies showed higher likelihood of
is mainly used by individuals from affluent socioeconomic preventive service utilization among immigrants and
classes in spite of being at lower risk of health problems. others higher among non-immigrants. In selected ones,
Conversely subjects from less advantaged associations were not significant once multivariate
socioeconomic classes more frequently use curative analyses were performed (Uiters 2006, Muennig 2002,
healthcare services, emergency departments often being Perez 2002, Newbold 2006, Marino 2001, Green 2005).
the first line contact (Uiters 2006, Norredam 2004, Leduc Analyses from above studies have also showed mixed
2004, Gwatkin 1998). Economic deprivation is surely a results in factors affecting utilization. Some of them
relevant determinant in countries where the private emphasized the role of enabling variables such as
healthcare is predominant; however it cannot fully explain insurance status and having an usual source of care in
the problem (Muennig 2002, Perez 2002). In fact even in promoting access to healthcare while others found that
affluent countries with a welfare state committed to predisposing factors such as race/ethnicity and sex were
universal coverage, underutilization of healthcare significantly associated with utilization of healthcare
services by this population subgroup is practically the (Norredam 2004, Leduc 2004, Wang 2007, Carrasquillo
rule. Sociocultural factors and lack of an appropriate 2004, Wolinsky 1978). The oral cavity is an essential part
information probably have an important role (Uiters 2006, of the body and contributes to total health and well-being.
Leduc 2004, Laroche 2001, Wang 2007, Blanchard Recent research indicates that a poor oral health affects
2006). the general health and that some systemic diseases can
In developing countries, preventive care for the poor is affect oral health (Joshipura 2000). A variety of diseases
likely to be scarce or no existent, especially in rural involve the oral cavity, most are frequent and preventable
Kambale 028

and others rare and life-threatening (Bratthall 2006, The post-World War II period is sometimes designated
Barmes 2000). Regular dental check-ups are part of a by popular media as the “age of migration”. According to
broad range of interventions usually performed by scholars Bonifazi and Lucassen, there had been even
dentists in order to protect and improve the oral health of more important migration flux in some remote historic
th
individuals and populations (Bratthall 2006, Barmes periods: migration flux that occurred from the midst 19
th
2000). century to the two first decades of 20 century which
Encyclopaedia Britannica defines dentistry as “the populated “new” continents and those which happened
profession concerned with the teeth and mouth” from the end of World War II to the beginning of the 1970
(Encyclopaedia Britannica Concise 2006). A more (OECD 2009, Bonifazi 2001, Bonifazi 1999, Lucassen
detailed definition is given by the American Dental 2005, www.iom.int accessed on date June 09, 2014). The
Association (ADA): specific characteristic of this recent migration flux is
“Dentistry is the evaluation, diagnosis, prevention perhaps its impact and visibility on host societies. It is
and/or treatment (non-surgical, surgical or related also interesting to point out that the period 1975-1985
procedures) of diseases, disorders and/or conditions of was characterised by a notable stasis (Bonifazi 2001,
the oral cavity, maxillofacial area and/or the adjacent and Lucassen 2005). Recent data showed a sustained
associated structures and their impact on the human increase in immigrants’ entry and settlements mainly in
body" (www.ada.com accessed on date December 11, USA, Canada and Germany and at less intensity in other
2007). developed countries. Sensibility to this migratory
Oral hygiene maintenance, as other aspects of general phenomenon is equally distributed and perceived in host
hygiene, is a health behaviour not yet widely diffused in countries (OECD 2009, Bonifazi 2001, Lucassen 2005).
populations of developing countries. Dental care services Immigrants bring with them a lot of problems, real or
are also scarce in these areas and people emigrating perceived. These include health and healthcare-related
from these countries are generally expected to be at behaviours.
higher risk of oral and dental diseases thereby the great
usefulness, in host countries, of health institutions such
as dental homes (Graham 2005). The practice of Dental Health Services Utilization
dentistry goes up to remote ages in different civilisations
from Egypt, Orient, Europe and America (Wilmerding A low utilization rate of dental health services (DHS) by
2007, www.bda.co.uk accessed on date December 11, immigrants in comparison to “indigenous” is practically
2007). the rule, at least according to available published
This paper aims at synthesing available published literature. The rate is variable and can range from lower
literature about DHS utilization patterns in adult levels such as twenty percent as is reported in one study
immigrants living in affluent countries. conducted in the USA to higher ones up to sixty-nine
percent as has been recorded among long-term
immigrants in Canada (Quandt 2007, Bedos 2004,
“MODERN” IMMIGRATION Fuentes-Afflick 2009). However Anderson and al., in a
study conducted at New York City, found that older
Peoples have always moved within regions or from one immigrants were more likely to use dental services than
region to another in order to improve their standard of older natives (odds ratio=1.30) despite numerous barriers
living, to give to their children better opportunities to get (Anderson 2010).
ahead, or to escape from poverty, war and famine. This is This variability was function of factors such as
the iron rule of migration that has governed since the geographic location, immigrant group, age, sex,
beginning of time (OECD 2009, www.iom.int accessed on education attainment, finances, availability of dental
date June 9, 2014). services etc.
Today, with modern transportation and Regarding geographic location, the highest (sixty-nine
telecommunications, more people are motivated and able percent!) and lowest (twenty percent!) rates of utilization
to move. The poor and disadvantaged can now see with have been, to our best knowledge, reported in Canada
their own eyes the wide disparity between their standard and in the USA respectively (Newbold 2006, Quandt
of living and that of the richer and more advantaged 2007, Bedos 2004).
people in the world. They want to share in the wealth, A differential pattern in DHS utilization has also been
and by the means of modern transportation, they are able reported among immigrant groups. In a study conducted
to get to richer lands in a matter of hours. With economic in the USA, Russian and Chinese immigrants recorded
globalisation and the proliferation of international respectively sixty percent and forty-seven percent rates
business, there is also increasing demand for mobility of of utilization; significant differentials have also been
professionals (OECD 2009, EU Migration Network Report reported among other US immigrant groups (Wu 2005,
2006, Lluul 2008, www.iom.int accessed on date June, Watson 1995, Stewart 2002, Shelley 2011, Cruz 2010).
09, 2014). In Europe, scholars Hjern (Sweden) and Selikowitz
 029 Afri. J. Educ. Pschol.

(Norway) found comparable differentials between Polish population subgroup should be considered as an
and Chilean immigrants and between urban and rural important public health issue (Vered 2009, Milgrom
Pakistani respectively (Hjern 2000, Selikowitz 1986). This 2004). Healthcare policymakers of host countries should
trend is consistent with the fact that different countries of better tackle this unfavourable disparity in healthcare
the world usually have different heath systems utilization.
organizations and interested populations different health
status or healthcare behaviours (Merson 2000, Perez
2002, Laroche 2001, Wang 2007). CONFLICT OF INTEREST STATEMENT
Age and sex are other important determinants of DHS
utilization. Young people and male subjects frequently We declare absence of conflicting interest.
record lower rates while females seem to have better
dental health behaviours (Quandt 2007, Lukes 2002).
Education attainment, finances, social support, length ACKNOWLEDGEMENTS
of stay in host countries and acculturation have also been
showed to have an important influence on DHS We are grateful to Professor Emilia Prospero of the
utilization. High educated and wealthy groups of Polytechnic University of Ancona (Italy) for the guidance
immigrants are most likely to have better dental health and constant support during our doctorate training.
and healthcare behaviours than lower educated and
poorer counterparts. In the USA, where care funding
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