1
1 Literature Review
1.1 Introduction
This literature review critically evaluates the facilitators and challenges that may influence
Primary Healthcare Centres when providing oral healthcare 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). There are several oral diseases namely dental caries, severe periodontal
disease, edentulism (no natural teeth), cleft lip & palate, oral manifestations of HIV, teeth
loss and oral cancer. OH is considered as significant as overall health and wellness (WHO,
2018a) because majority of the oral conditions result from the same risk factors that lead to
some chronic diseases. Oral health is very significant because it affects directly physical
health and is connected with severe chronic diseases. The risk factors may be usage of
tobacco, consuming alcohol and taking foods rich in sugars that lead to chronic diseases such
as diabetes, respiratory conditions and even cancer. It can affect the psychological wellbeing
of a person by lowering their self-esteem due to missing teeth.
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). 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. There should be proper
, 2
Public knowledge and awareness on OH which are centrally important determinants of
healthcare (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 in the 21st century; 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). Approximately 2.4 billion persons and 486 million children worldwide
are affected by dental caries on permanent and primary teeth respectively. The prevalence of
oral disorders fluctuates in most countries each year because of transformations in living
conditions and urbanization. The increased markets of sugar foods, alcohol and tobacco has
led to increased oral diseases globally. 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).
The oral diseases are prevalent in both third world and developed nations affecting a
percentage of around 20 to 50 persons worldwide. Recently, the disorders are common on
adolescents, aged population and adults, which has made it a public health issue. The diseases
can lead to an acceleration of the risk of getting cardiovascular disease, unfavourable
pregnancies and diabetes. It causes 19% acceleration to the risk of getting hear diseases and
the risk affects over 44% of persons aged over 65years.
There are several oral diseases that are prevalent for instance; 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 in North America, Latin America and Europe (WHO, 2018a). Dental
treatment is prevalent globaly based on the statistics that illustrate it is the the most costly
medical treatment, averaging 5% of all total health expenditure per person and 20% of out-of-
pocket health expenditure in most high-income countries in Europe and America (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 as shown in figure
1 below (LMICs; Nazir, 2017; WHO, 2018a).
1 Literature Review
1.1 Introduction
This literature review critically evaluates the facilitators and challenges that may influence
Primary Healthcare Centres when providing oral healthcare 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). There are several oral diseases namely dental caries, severe periodontal
disease, edentulism (no natural teeth), cleft lip & palate, oral manifestations of HIV, teeth
loss and oral cancer. OH is considered as significant as overall health and wellness (WHO,
2018a) because majority of the oral conditions result from the same risk factors that lead to
some chronic diseases. Oral health is very significant because it affects directly physical
health and is connected with severe chronic diseases. The risk factors may be usage of
tobacco, consuming alcohol and taking foods rich in sugars that lead to chronic diseases such
as diabetes, respiratory conditions and even cancer. It can affect the psychological wellbeing
of a person by lowering their self-esteem due to missing teeth.
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). 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. There should be proper
, 2
Public knowledge and awareness on OH which are centrally important determinants of
healthcare (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 in the 21st century; 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). Approximately 2.4 billion persons and 486 million children worldwide
are affected by dental caries on permanent and primary teeth respectively. The prevalence of
oral disorders fluctuates in most countries each year because of transformations in living
conditions and urbanization. The increased markets of sugar foods, alcohol and tobacco has
led to increased oral diseases globally. 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).
The oral diseases are prevalent in both third world and developed nations affecting a
percentage of around 20 to 50 persons worldwide. Recently, the disorders are common on
adolescents, aged population and adults, which has made it a public health issue. The diseases
can lead to an acceleration of the risk of getting cardiovascular disease, unfavourable
pregnancies and diabetes. It causes 19% acceleration to the risk of getting hear diseases and
the risk affects over 44% of persons aged over 65years.
There are several oral diseases that are prevalent for instance; 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 in North America, Latin America and Europe (WHO, 2018a). Dental
treatment is prevalent globaly based on the statistics that illustrate it is the the most costly
medical treatment, averaging 5% of all total health expenditure per person and 20% of out-of-
pocket health expenditure in most high-income countries in Europe and America (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 as shown in figure
1 below (LMICs; Nazir, 2017; WHO, 2018a).
