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For the study, dentists Ali Al-Ani (left) and Dr Moutaz Takriti (right) examined refugees to determine their oral health status. The volunteers originated from countries in eastern Europe, the Middle East, Africa and Asia. (Photographs: Takriti, Al-Ani)
0 Comments Nov 17, 2017 | News Europe

Large prevention gap: Study details poor oral health status of refugees

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GREIFSWALD, Germany: Since 2015, a large number of refugees have made their way to Europe. Coming from countries in which public dental care is often not freely accessible and where oral health care is not as much of a focus as it is in most parts of western Europe, the majority of them are in significant need of information and treatment. Researchers at the University of Greifswald in Germany have examined more than 540 refugees and found that the overall oral health status of children and adolescents was comparable to that of Germans 30 years ago. In adults, several untreated carious defects were found.

In a study that aimed to determine significant oral health problems and possible treatment costs, the researchers investigated a total of 544 refugees between the end of 2016 and the middle of 2017 who had come to Germany from 28 countries. The study participants were between 3 and 65 years old and lived in different areas of Germany. The results of the research, which is the first of its kind, have just been published by the German Dental Association.

In addition to a high rate of periodontal disease in the adult refugees, the study found that the examined children and adolescents had a greater rate of caries compared with their German counterparts. According to study leader Prof. Christian Splieth, head of the university’s Department of Preventative and Pediatric Dentistry, both findings indicate a lack of preventative care in the refugees’ countries of origin.

According to the study, 3-year-olds had an average of 2.62 caries-affected teeth. For children aged 6–7 years, the mean DMFT (decayed, missing, filled teeth) index was 5.22. In 8- to 11-year-olds, this figure dropped slightly to 3.60 owing to the eruption of the permanent dentition. The majority of carious lesions were untreated.

The researchers found that only 35 per cent of the 12-year-olds still had a healthy natural permanent dentition, while this was the case for 80 per cent of this age group in Germany. The mean DMFT index of 2.0 for the refugees was four times higher than that recorded for Germans (0.5) and corresponded to the prevalence of caries among German youth in the mid-1990s.

In adolescents and adults, caries values continued to increase with age, reaching a DMFT index of 16 for participants aged 45–64 years. However, oral disease occurrence in comparison with German adults was similar from age 35. Still, both groups differed in that extraction was the previous primary therapy for refugees, while restoration with filling materials was more typical in the German population.

The calculated caries values also corresponded to data from studies conducted in the refugees’ home countries and the results of other studies on refugees conducted in Australia, the US and Sweden.

Plaque and calculus scores were rather high in adult refugees, and the periodontal screening index for those aged 45–64 years indicated hardly any participants with good oral health. According to the researchers, this can be attributed to the difficult conditions in their home countries, the conditions of their escape, difficulties at the initial reception centres and the challenges in establishing a normal daily life with a good oral hygiene routine.

The amount of prosthodontic work was low with regard to the number of missing teeth; however, on average, the 35- to 44-year-old refugees had more partial dentures than their German counterparts did. Complete dentures were found in only 0–4 per cent of adult refugees, mostly in the 45- to 64-year-olds and in the upper jaw. Of the few participants older than 65, only one had complete dentures.

Approximately one-third of the child and adolescent refugees were in need of orthodontic treatment, a figure that corresponds to the number of German children and adolescents requiring such dental care. The most common malocclusion was a unilateral crossbite.

Acute pain was present in about 5 per cent of the refugees at the time of the examination. The vast majority of the refugees had additional untreated oral disease, especially multiple open carious lesions, which could be treated by fillings, extractions and possibly also root canal therapy, including adjunctive care.

With reference to the study data, the researchers estimated that the cost of treatment for full oral rehabilitation, including all dental specialties, would be between €178 and € 1,759 per refugee.

To address prevention gaps and to counteract the high caries rates, Splieth advised, among other things, the expansion of prophylactic measures under the German Asylum Seekers Benefits Act. He also recommended integrating prevention information in integration or language courses as a useful measure.

The final report of the study, titled Flüchtlinge in Deutschland—Mundgesundheit, Versorgungsbedarfe und deren Kosten [refugees in Germany—oral health, treatment needs and the associated costs], including a summary in English, can be found here.

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