Poor oral health prioritization, literacy persist in Southeast Asia

A recent study on disability and oral health (DOH) has found low prioritization and poor oral health literacy among member states of the Association of Southeast Asian Nations (ASEAN) and suggests a need to train more dental providers.

In addition, social perceptions remain a challenge in special care dentistry (SCD) services within the region, and that more state-level support is necessary to improve DOH in ASEAN.

“This is the conundrum of a disadvantaged cohort, an overlooked health aspect, within impoverished communities,” the researchers said. “A purposeful multi-sector effort is paramount to internally align national strategies, in order to achieve equity for DOH in each country of ASEAN.”

This study employed a novel quasi-qualitative survey electronically distributed to dentists with DOH specialty training in ASEAN within the International Association of Disability and Oral Health’s network from September 2018 to June 2020. The researchers then categorized the “barriers” and “improvements” into five dimensions of healthcare.

Of the responses received from Brunei, Indonesia, Malaysia, Thailand, Singapore, and the Philippines, 21 were deemed valid. [Proc Singap Healthc 2022;doi:10.1177/20101058221111579]

Healthcare providers pointed to adequate training (appropriateness) as the factor that should be given the highest priority. On the other hand, patients deemed low oral health literacy (ability to perceive) as the most important. Collectively, social perception was considered a key “challenge in dental practices.”

Finally, suggested “ways to collaborate” were classified as follows: engagement, advocacy, policies, specialty, and upskilling.

Theory of change

“When implementing improvements for disadvantaged cohorts, one has to reflect if the suggested solutions would indeed create the intended social impact (ie, betterment of oral health in persons with disability [PWD]),” the researchers said.

“This is further elaborated in the concept of ‘theory of change’,” they added. [Stanford Soc Innov Rev 2010;8:47-51]

Public health promotion is a possible target of theory of change to address the low “ability to perceive,” according to the researchers. Disability support communities, training institutions, or healthcare services could implement caregiver oral health training.

Previous studies showed how oral health educational programs for care service providers and caregivers successfully improved oral hygiene in the long term, particularly across different cultural landscapes and profiles of PWD. [Int Dent J 1999;49:82-89; Community Dent Health 2015;32:137-142; Rev Odontol UNESP 2017;45:284-291; J Intellect Dev Disabil 2012;50:219-232]

“This ‘theory of change’ has to be person-centred to address the first step – ‘approachability’ – [and] therefore spur subsequent steps of health-seeking behaviours,” the researchers said. [https://apps.who.int/iris/handle/10665/44575; http://www.myhealth.gov.my/en/dental-treatment-home-possible/]

SCD as specialty

Another common theme among the survey responses was commissioning SCD as a recognized dental specialty, which was also raised as an area of collaboration for the ASEAN DOH community.

“Comparing the financial structures, such as state-funded or privately-sustained programs, health literacy levels, and varying stages of health system development, the limited literature imply [that] there could be considerable difficulties when implementing a specialty such as SCD in the public health system,” the researchers said. [J Int Oral Health 2020;12:1-7; Tzu Chi Med J 2019;31:232-239]

Of note, the UN Convention on the Rights of Persons with Disabilities has been ratified by all member states in the ASEAN.