1 University of Colorado Anschutz Medical Campus, School of Dental Medicine, Aurora, CO, USA.
2 Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, South Australia, Australia.
J Dent Res. 2018 Jul;97(8):869-877. doi: 10.1177/0022034518763605. Epub 2018 Mar 19.
Indigenous populations around the world experience a disproportionate burden in terms of oral diseases and conditions. These inequalities are likely due to a complex web of social determinants that includes poverty, historical consequences of colonialism, social exclusion, government policies of assimilation, cultural annihilation, and racism in all its forms (societal, institutional). Despite documented oral health disparities, prevention interventions have been scarce in Indigenous communities. This review describes oral health interventions and their outcomes conducted for Indigenous populations of the United States, Canada, Brazil, Australia, and New Zealand. The review includes research published since 2006 that are available in English in electronic databases, including MEDLINE. A total of 13 studies were included from the United States, Canada, Brazil, and Australia. The studies reviewed provide a wide range of initiatives, including interventions for prevention and treatment of dental disease, as well as interventions that improve oral health knowledge, behaviors, and other psychosocial factors. Overall, 6 studies resulted in improved oral health in the study participants, including improvements in periodontal health, caries reduction, and oral health literacy. Preferred intervention methodologies included community-based research approaches, culturally tailored strategies, and use of community workers to deliver the initiative. Although these studies were conducted with discrete Indigenous populations, investigators reported similar challenges in research implementation. Recommendations for future work in reducing oral health disparities include addressing social determinants of health in various Indigenous populations, training future generations of dental providers in cultural competency, and making Indigenous communities true partners in research.
世界各地的土著居民在口腔疾病和状况方面承受着不成比例的负担。这些不平等很可能是由于一系列复杂的社会决定因素造成的，其中包括贫困、殖民主义的历史后果、社会排斥、同化政策、文化灭绝以及各种形式的种族主义（社会、制度）。尽管有记录表明口腔健康存在差异，但土著社区的预防干预措施仍然很少。本综述描述了为美国、加拿大、巴西、澳大利亚和新西兰的土著居民进行的口腔健康干预及其结果。综述包括自 2006 年以来以英文发表并可在电子数据库（包括 MEDLINE）中获得的研究。从美国、加拿大、巴西和澳大利亚共纳入了 13 项研究。综述中所审查的研究提供了广泛的举措，包括预防和治疗牙科疾病的干预措施，以及改善口腔健康知识、行为和其他心理社会因素的干预措施。总的来说，有 6 项研究使研究参与者的口腔健康得到了改善，包括牙周健康改善、龋齿减少和口腔健康素养提高。首选的干预方法包括基于社区的研究方法、量身定制的文化策略以及利用社区工作者来实施该举措。尽管这些研究是针对离散的土著居民进行的，但研究人员报告称，在研究实施方面存在类似的挑战。减少口腔健康差距的未来工作建议包括解决不同土著居民的健康社会决定因素、在文化能力方面培训未来几代牙科提供者，以及使土著社区成为研究的真正合作伙伴。
