1 Literature Review
1.1 Introduction
This literature review critically evaluates the facilitators and challenges that may influence
PHCs when providing OH for patients. The chapter starts with the global OH epidemic.
Thereafter, it discusses the challenges of OH in PHCs. Subsequently, the chapter presents the
demand-side challenges of OH in PHCs, and then facilitators of OH in PHCs. Furthermore,
the chapter illustrates the significance of an integrated OH approach. Finally, this chapter
concludes with primary healthcare centres in Saudi Arabia.
1.2 The global epidemic of poor oral health
Oral diseases are a critical public health concern because of their extremely high prevalence
and the potential enormous effects on an individual's QoL (WHO, 2018a; CDC, 2018). The
etiological factors leading to these specific oral diseases are developmental problems, issues
around oral hygiene, poor genetic predispositions and even traumatic incidents (WHO,
2018a; CDC, 2018). OH is considered as significant as overall health and wellness (WHO,
2018a). In line with this the WHO (2018a) and CDC (2018) suggest that most risk factors for
NCDs, such as type 1 diabetes (DM), heart disease and obesity, are the same factors for
dental disease, in both developing and developing countries, and lead to poor OH. Public
knowledge about and awareness of OH are centrally important determinants of health (Dagli
et al., 2008; Harnagea et al., 2017), influencing physical, psychological and social well-being
(WHO, 2018; CDC, 2018).
According to the WHO, oral diseases are among the most common NCDs affecting
individuals during their generation, causing discomfort, pain, jaw deformities and even death
(WHO, 2018a). The WHO reports that five billion individuals globally suffer from dental
caries (ref). Additionally, oral diseases affect approximately 3.58 billion people worldwide
and dental caries in permanent teeth are the most prevalent dental disease (Global Burden of
Disease Study, 2016).
Severe periodontal (gum) disease results in tooth loss, and has been estimated to be the 11 th
most prevalent disease worldwide (Nazir, 2017; WHO, 2018a). Furthermore, severe tooth
, loss and edentulism were among the leading ten causes of Years which are Lived with
Disability (YLD) in some high-income countries (WHO, 2018a). Dental treatment is the most
costly medical treatment, averaging 5% of all total health expenditure and 20% of out-of-
pocket health expenditure in most high-income countries (Nazir, 2017; WHO, 2018a).
Ultimately, OH care places its greatest demand on the restricted capacities of the healthcare
systems of low- and middle-income countries (LMICs; Nazir, 2017; WHO, 2018a).
Neglect of the mouth leads to disability, impairment and discomfort, negatively impacting
QoL (WHO, 2018a). Oral disease restricts function, causes suffering and pain, and is
expensive (WHO, 2018a). OH treatment accounts for 5 to 10% of overall health expenses in
industrialised countries, more than in various developing countries (WHO, 2018a). This
appears less critical in most African countries (WHO, 2018b). Even taking into account
changes in living conditions, dental caries is expected to increase in developing African
countries, particularly with the growing consumption of sugar (WHO, 2018b).
Various risk factors contribute heavily to numerous oral diseases; these include the use
of tobacco, the drinking of alcohol and having an unhealthy diet which is high in sugar. Some
of these factors are also common with the four leading NCDs, namely chronic respiratory
diseases, cancer, cardiovascular diseases and DM (Wagner et al., 2017). Further, DM is
associated with the development and progression of periodontitis (Sanz et al., 2008). There is
a causal link between high sugar consumption and DM along with obesity and dental caries
(Wagner et al., 2017).
Access to high standards of dental care increases QoL (WHO, 2018a). Such access is heavily
impacted by a client’s ability to utilise OH care (WHO, 2018a). Access enhances OH,
because OH is the main component of general health (WHO, 2018a). Oral diseases are
mainly various periodontal diseases, which can provoke systemic illness and affect general
health (Petersen et al., 2003).
1.3 Challenges to OH care in PHCs
There are numerous challenges to the efficiency and integration of a person’s overall OH
when it comes to PHCs, which is why it is critical for them to enhance service quality (Rabiei
et al., 2012; Almutlaqah et al., 2018). In the literature, several barriers to public health service
users’ utilising dental health services are identified, including financial barriers, lack of OH
awareness, shortage of or unqualified OH care providers and inequalities in OH between rural
1.1 Introduction
This literature review critically evaluates the facilitators and challenges that may influence
PHCs when providing OH for patients. The chapter starts with the global OH epidemic.
Thereafter, it discusses the challenges of OH in PHCs. Subsequently, the chapter presents the
demand-side challenges of OH in PHCs, and then facilitators of OH in PHCs. Furthermore,
the chapter illustrates the significance of an integrated OH approach. Finally, this chapter
concludes with primary healthcare centres in Saudi Arabia.
1.2 The global epidemic of poor oral health
Oral diseases are a critical public health concern because of their extremely high prevalence
and the potential enormous effects on an individual's QoL (WHO, 2018a; CDC, 2018). The
etiological factors leading to these specific oral diseases are developmental problems, issues
around oral hygiene, poor genetic predispositions and even traumatic incidents (WHO,
2018a; CDC, 2018). OH is considered as significant as overall health and wellness (WHO,
2018a). In line with this the WHO (2018a) and CDC (2018) suggest that most risk factors for
NCDs, such as type 1 diabetes (DM), heart disease and obesity, are the same factors for
dental disease, in both developing and developing countries, and lead to poor OH. Public
knowledge about and awareness of OH are centrally important determinants of health (Dagli
et al., 2008; Harnagea et al., 2017), influencing physical, psychological and social well-being
(WHO, 2018; CDC, 2018).
According to the WHO, oral diseases are among the most common NCDs affecting
individuals during their generation, causing discomfort, pain, jaw deformities and even death
(WHO, 2018a). The WHO reports that five billion individuals globally suffer from dental
caries (ref). Additionally, oral diseases affect approximately 3.58 billion people worldwide
and dental caries in permanent teeth are the most prevalent dental disease (Global Burden of
Disease Study, 2016).
Severe periodontal (gum) disease results in tooth loss, and has been estimated to be the 11 th
most prevalent disease worldwide (Nazir, 2017; WHO, 2018a). Furthermore, severe tooth
, loss and edentulism were among the leading ten causes of Years which are Lived with
Disability (YLD) in some high-income countries (WHO, 2018a). Dental treatment is the most
costly medical treatment, averaging 5% of all total health expenditure and 20% of out-of-
pocket health expenditure in most high-income countries (Nazir, 2017; WHO, 2018a).
Ultimately, OH care places its greatest demand on the restricted capacities of the healthcare
systems of low- and middle-income countries (LMICs; Nazir, 2017; WHO, 2018a).
Neglect of the mouth leads to disability, impairment and discomfort, negatively impacting
QoL (WHO, 2018a). Oral disease restricts function, causes suffering and pain, and is
expensive (WHO, 2018a). OH treatment accounts for 5 to 10% of overall health expenses in
industrialised countries, more than in various developing countries (WHO, 2018a). This
appears less critical in most African countries (WHO, 2018b). Even taking into account
changes in living conditions, dental caries is expected to increase in developing African
countries, particularly with the growing consumption of sugar (WHO, 2018b).
Various risk factors contribute heavily to numerous oral diseases; these include the use
of tobacco, the drinking of alcohol and having an unhealthy diet which is high in sugar. Some
of these factors are also common with the four leading NCDs, namely chronic respiratory
diseases, cancer, cardiovascular diseases and DM (Wagner et al., 2017). Further, DM is
associated with the development and progression of periodontitis (Sanz et al., 2008). There is
a causal link between high sugar consumption and DM along with obesity and dental caries
(Wagner et al., 2017).
Access to high standards of dental care increases QoL (WHO, 2018a). Such access is heavily
impacted by a client’s ability to utilise OH care (WHO, 2018a). Access enhances OH,
because OH is the main component of general health (WHO, 2018a). Oral diseases are
mainly various periodontal diseases, which can provoke systemic illness and affect general
health (Petersen et al., 2003).
1.3 Challenges to OH care in PHCs
There are numerous challenges to the efficiency and integration of a person’s overall OH
when it comes to PHCs, which is why it is critical for them to enhance service quality (Rabiei
et al., 2012; Almutlaqah et al., 2018). In the literature, several barriers to public health service
users’ utilising dental health services are identified, including financial barriers, lack of OH
awareness, shortage of or unqualified OH care providers and inequalities in OH between rural
