The Oral Health Inequities between Special Needs Children and Normal Children in Asia: A Systematic Review and Meta-Analysis

Abstract

This meta-analysis aimed to analyze the oral health inequalities among special needs children during 2004–2019 in Asia to reveal the importance and the needs of establishing integrated and equitable special needs dentistry care system in Indonesia. PubMed, Scopus, Cochrane Library, Web of Science, and Wiley Online Library were systematically searched for full-text observational studies published from 1 January 2004 to 15 January 2020, in English in Asia. Studies that included children under 18 years of age with special needs and compared them to healthy controls were selected. Study quality was assessed using the Joanna Briggs Institute 2017 Critical Appraisal Checklist. Risk of bias was assessed using the ROBINS-E tool. The decayed, missing, and filled permanent teeth (DMFT) index indicated that special needs children who suffer from intellectual disability or autism spectrum disorder had significantly more caries than normal children (p < 0.001). The special needs children who had more caries than normal children lived in countries that had a high average DMFT value among 12 years old children (p < 0.001), and these two variables showed a positive correlation in meta-regression analysis (p < 0.001). Having an integrated and equitable care system and elevating children’s oral health are important to maintain special needs children’s oral health.

Total Edentulism and Its Epidemiological Surveillance in Oaxaca, Mexico from 2009<strong>–</strong>2019.

“…The schooling often is used to determine socioeconomic position [13]; in Oaxaca, the prevalence of edentulism decreased with higher educational attainment, indicating the existence of inequalities in oral health; this data supported other studies carried out in low-income regions using various indicators of both health and socioeconomic position [12,[18][19][20][21]. In addition, health evidence suggests an association between health and social status: individuals with better socioeconomic status enjoy better health [22][23][24].…”

Total Edentulism and Its Epidemiological Surveillance in Oaxaca, Mexico from 2009–2019

“…Schooling often is used to determine socioeconomic position [13]; in Oaxaca, the prevalence of edentulism decreased with higher educational attainment, indicating the existence of inequalities in oral health; this data supported other studies carried out in low-income regions using various indicators of both health and socioeconomic position [12,[18][19][20][21]. In addition, health evidence suggests an association between health and social status: individuals with better socioeconomic status enjoy better health [22][23][24].…”

Parental Knowledge Towards Children’s Dental and Oral Hygiene

“…This shows that even though parents have good knowledge, however, most children with special needs have less awareness in keeping dental and oral health so that there is still a lot of those who have poor dental and oral hygiene. Children with special needs are at higher risk that normal children because they may have impaired cognitive abilities, behavioral problems, poor motor coordination, uncontrolled body movements, neuromuscular problem such as drooling, swallowing problem (Ningrum et al, 2021). These problems can hamper them to clean their own teeth or use the common brushing method.…”

“…Children with special needs require more assistance because of their mental as well as physical challenges, even if they are over seven years old. Because some of them may learn slowly and being uncooperative, have difficulty to understand the behavior of dental hygiene such as brushing teeth (Ningrum, et al, 2021). It was mentioned that children with special need is prone having a high dental carries index and inadequate oral hygiene (Pini, et al, 2016).…”