Improving Access to Oral Healthcare

ADOPTED by FDI General Assembly October, 1998 in Barcelona, Spain
REVISED by FDI General Assembly September, 2021 in Sydney, Australia

Context

Despite being largely preventable, oral diseases are highly prevalent conditions,

affecting more than 3.5 billion people around the world.1 Oral diseases have substantial effects and consequences, causing pain and sepsis, reduced quality of life, lost school and work days, family disruption and decreased work productivity. The costs of dental treatment can be considerable for both the individual and the wider healthcare system.2 Many factors influence oral health and the prevalence and severity of oral diseases. Access to adequate, quality and affordable oral health services, however, remains a major obstacle in achieving optimal oral health.

The major barriers to accessing and utilizing oral healthcare include oral health literacy and cost, uneven distribution of the oral health workforce, low prioritization of oral health, cultural values and beliefs that do not promote healthy lifestyles, the episodic availability of preventive and routine care, a lack of health or dental insurance, a lack of political will to include oral health in the essential health services and other socio-economic factors.3,4

Thus, this revised Policy Statement affirms FDI’s position that supports the goal of equal access to oral health services for all populations, addresses barriers to access to oral healthcare and promotes the belief that universal health coverage (UHC) provides an opportunity for oral health services to become more integrated into the wider healthcare system and to be more accessible and responsive to the oral healthcare needs of the population.5

 

Scope

This Policy Statement addresses barriers to accessing and utilizing oral health services at personal, community, organization, institution and system levels. It suggests strategies that are evidence-based and community-based, and which integrate oral health into general health and involve all oral health team members and other non-dental personnel. FDI believes that the key test of access is equity.  This Policy Statement consequently complements other FDI Policy Statements that are devoted to the subset of populations at risk of unequal access to oral healthcare, such as displaced persons6, the underserved and vulnerable7, persons with disabilities8 and ageing populations.9

 

Definitions

  1. Access: Freedom or ability to obtain or make use of10
  2. Accessibility: The ease with which healthcare can be reached in the face of financial, organizational, cultural, geographical and emotional barriers11
  3. Utilization: To make the actual use of a service
  4. Universal health coverage: “Ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship.12

PRINCIPLES: Target 3.8 of the 2030 United Nations Sustainable Development Goal 3 (the health goal) aims to “achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”13

 

Policy

1. FDI states that:

  • oral health is inseparable from general health;
  • oral diseases share common risk factors with other non-communicable diseases (NCDs), such as tobacco use, physical inactivity, obesity, unhealthy diet, excess sugar consumption, harmful alcohol consumption and HPV infection;
  • poor oral health is linked with many NCDs, mostly bi-directional, such as diabetes, cardiovascular disease, cancer and adverse birth outcomes. 

2. FDI supports:

  • the integration of oral health care into UHC to improve oral health outcomes and reduce inequalities in access to care;
  • that any efforts to increase access to healthcare through reforms to insurance programmes should include oral health benefits.

3. FDI recommends:

  • empowering patients to utilize oral healthcare by raising awareness, using culturally competent and plain language materials of health literacy for oral health education, coordinating oral healthcare services and eliminating individual and structural barriers to oral healthcare;
  • integration of oral health promotion and educational activities with disease prevention and control related to other NCDs to improve population health and reduce health disparities;
  • integration of oral health into health promotion services and activities in all types of settings such as schools, nursing homes and end-of-life care facilities;
  • integration of oral health education, screening, prevention and promotion into primary healthcare to assure the equitable and holistic provision of oral health throughout life;
  • integration of oral health into general health and vice versa in professional education, training and research;
  • integration of oral health into the advocacy for legislative action on general public health including the legislation on tobacco control, harmful alcohol use, added sugar intake and obesity prevention;
  • effective and appropriate use of all members of the dental team, as defined by their scope of practice in each country/region for better serving the public;
  • improving patient access to specialist care, when needed, either in the dental clinic or hospital setting; 
  • collection of data through effective surveillance to support, inform and evaluate health policies to improve oral health;
  • expanding the reach of the oral health workforce by innovative methods such as teledentistry and mobile dentistry;
  • adoption of the “dental home” concept, namely the ongoing dentist-patient relationship with the inclusion of all aspects of oral healthcare being delivered continuously in a patient-centred way.14

4. FDI states that all healthcare professionals (other than members of the dental team) have roles to play in oral health. Improved oral health can be achieved by non-oral health professionals via patient referral for oral healthcare after initial screening, application of topical fluorides, educating patients on tobacco cessation, healthy eating, reduction in sugar intake and harmful alcohol consumption, and effective oral hygiene care.

5. FDI encourages governments to incentivize dentists and other members of the dental team who provide services in underserved areas.

 

Keywords

Access to oral healthcare, utilization of oral healthcare, universal health coverage, dental home, prevention

 

Disclaimer

The information in this Policy Statement was based on the best scientific evidence available at the time. It may be interpreted to reflect prevailing cultural sensitivities and socio-economic constraints.

 

References

  1. Vos T, Abajobir AA, Abate KH et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100): 1211-1259. Available from: doi.org/10.1016/S0140-6736(17)32154-2.
  1. Peres M, Macpherson L, Weyant RJ, et al. Oral diseases: a global public health challenge. Lancet. 2019;394: 249–260. Available from: doi:10.1016/S0140-6736(19)31146-8.
  1. Freeman R. Barriers to accessing dental care: patient factor. Br Dent J 1999;187: 141–144. Available from: doi:10.1038/sj.bdj.4800224.
  1. Kandelman D, Arpin S, Baez RJ, et al. Oral health care systems in developing and developed countries. Periodontol 2000. 2012;60(1): 98-109. Available from: doi:10.1111/j.1600-0757.2011.00427.
  1. Fisher J, Selikowitz HS, Mathur M, Varenne B. Strengthening oral health for universal health coverage. Lancet. 2018;392(10151): 899-901. Available from: doi:10.1016/S0140-6736(18)31707-0.
  1. FDI World Dental Federation. Providing Basic Oral Healthcare for Displaced Persons. Available from https://www.fdiworlddental.org/providing-basic-oral-healthcare-displace… [Accessed 26 July 2021].
  1. FDI World Dental Federation. Access to Oral Healthcare for Vulnerable and Underserved. Available from https://www.fdiworlddental.org/access-oral-healthcare-vulnerable-and-un… [Accessed 26 July 2021].
  2. FDI World Dental Federation. Oral Health and Dental Care of People with Disabilities. Available from https://www.fdiworlddental.org/oral-health-and-dental-care-people-disab… [Accessed 26 July 2021].
  3. FDI World Dental Federation. Oral Health for Healthy Ageing. Available from https://www.fdiworlddental.org/oral-health-healthy-ageing [Accessed 26 July 2021].
  4. Palmer RH. Definitions and data. In: Greene R, ed. Assuring quality in medical care. Cambridge, MA: Ballinger Publishing Co. 1976. p.11-60. 
  1. Mathur MR, Williams DM, Reddy KS, Watt RG. Universal Health Coverage. A Unique Policy Opportunity for Oral Health. J Dent Res. 2015:94(3): 3S–5S.
  1. United Nations. Sustainable Development Goals. Available from: https://www.un.org/sustainabledevelopment/sustainable-development-goals/ [Accessed 14 November 2019].
  2.  American Academy of Pediatric Dentistry. Definition of dental home. The Reference Manual of Pediatric Dentistry. Chicago: American Academy of Pediatric Dentistry; 2018 Available from: https://www.aapd.org/media/Policies_Guidelines/D_DentalHome.pdf [Accessed 09 August  2020].

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