Research Article: Impact of acculturation on oral health among immigrants and ethnic minorities: A systematic review

Date Published: February 28, 2019

Publisher: Public Library of Science

Author(s): Rana Dahlan, Parvaneh Badri, Humam Saltaji, Maryam Amin, Frédéric Denis.


Cultural changes faced by immigrants and ethnic minorities after moving to a host country may have a detrimental or beneficial influence on their oral health and oral health-related behaviors. Therefore, this paper reviews the literature to see the impact of acculturation on immigrants and ethnic minorities’ oral health outcomes.

We searched seven electronic databases up to January 2018. All cross-sectional and longitudinal quantitative studies that examined associations between acculturation and oral health status and/or oral health behaviors among ethnic minority and immigrant population[s] were included. Study selection, data extraction, and risk of bias assessment were completed in duplicate. The Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies. A meta-analytic approach was not feasible.

A total of 42 quantitative studies were identified. The studies showed a positive association between acculturation and oral health status/behaviors. The most frequently used acculturation indicators were language spoken by immigrant and ethnic minorities and length of stay at the host country. High-acculturated immigrant and ethnic minority groups demonstrated better oral health outcomes, oral health behaviors, dental care utilization, and dental knowledge.

According to existing evidence, a positive effect of acculturation on oral health status and behaviors was found.

Dental practitioners should be culturally competent to provide the appropriate services and treatments to immigrant and ethnic minorities. Policymakers should also be sensitive to cultural diversities and properly address the unique needs of each group in order to maintain oral health equity.

Partial Text

Global immigration rates have increased dramatically over the past few decades. According to the United Nations, approximately 258 million immigrants in 2017 represented a rise of 49% since 2000 [1]. Upon their arrival in new countries, most immigrants face a number of challenges that negatively influence their quality of life including language and cultural barriers, housing and employment problems, low socioeconomic status, and lack of medical and dental insurance coverage [2–4]. While the prevailing trend for immigrants is to move to a more developed nation than the one they left behind, many arrive in the host countries healthier than their native-born counterparts [3–5]. This difference in health status can be partially explained by the rigorous selection and health screening processes that immigrants are required to undergo [3, 4]. However, after migration, the health of immigrants deteriorates due mainly to changes in lifestyle [6]. The adoption of a westernized diet can be particularly concerning, given its high caloric content that can lead to chronic conditions such as heart disease, diabetes, and hypertension [6].

The association between acculturation and health, in general, and oral health (OH), in particular, has received increased attention in the past decade because of growing migration worldwide. Therefore, this paper is considered as an extention of the previous systematic review as we systematically reviewed the existing reports on the impact of acculturation and its attributes on OH outcomes of immigrants and ethnic minorities [21]. overall, acculturation has been proven to positively influence dental services utilization and OH behaviors of migrants such as brushing frequency and increased flossing. Acculturation was also associated with immigrant and ethnic minoritys’ improved OH status, improved OH knowledge, and reduced orofacial pain.

According to existing evidence, a positive effect of acculturation on OH status and behaviors was found. High acculturated immigrants and etnhic minorities with a longer time of residency in the host country, local language proficiency, and younger age at migration had better OH status and behaviors than their counterparts. Therefore, dental practitioners should be sensitive to cultural differences when providing services to immigrant and ethnic minority groups. Policymakers should also be mindful of cultural barriers and adequately address the unique needs of these individuals to maintain OH equity. Further qualitative and longitudinal studies are needed to better understand acculturation influence on OH. Using validated multidimensional scales instead of acculturation proxies will generate more comprehensive and comparable data. Finally, greater attention should be given to understudied aspects of OH and its association with acculturation.




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