Oral health status and access to oral healthcare among adult refugees in Egypt: a cross-sectional study

TL;DR

This study found that adult refugees in Egypt have poor oral health, with high rates of dental caries and gum disease linked to factors like age, education, and income.

Contribution

The study provides the first detailed assessment of oral health and access to care among adult refugees in Egypt.

Findings

Refugees had a mean DMFT score of 9.25, indicating significant dental caries.

Gingivitis was present in 64.51% of participants, and periodontal pockets in 12.16%.

Factors like low education, income, and sugary snacks were strongly associated with worse oral health.

Abstract

Refugees oral health remains underexplored despite high disease prevalence. This study assessed oral health, access to care, and factors associated with dental caries and periodontal disease among refugees in Alexandria, Egypt.

A cross-sectional study was conducted at Caritas office from June-September 2024. Arabic-speaking refugees aged ≥18 years, residing in Alexandria for ≥6 months were included. Data were collected via a questionnaire and oral examination using Silness and Loe Plaque Index, Decayed, Missing, and Filled Teeth (DMFT) index, and Community Periodontal Index (CPI). Negative binomial regression identified factors associated with DMFT, and binary logistic regression identified factors for periodontal pockets.

A total of 510 refugees participated (64.1% females, mean age 46.7 ± 14.2 years, 79.0% Sudanese). Mean DMFT was 9.25 ± 5.82 (DT = 5.01, MT = 3.34, FT = 1.02), and mean Plaque Index was 1.49 ± 0.68. Gingivitis was found in 64.51% and periodontal pockets in 12.16%. In multivariable analysis, increased caries prevalence was associated with age (PRR = 1.16, 95% CI: 1.03–2.34), education (illiterate vs. university educated, PRR = 1.32, 95% CI: 1.08–3.49; secondary vs. university educated, PRR = 1.19, 95% CI: 1.05–4.32), low income (PRR = 1.06, 95% CI: 1.01–1.63), sugary snacks (PRR = 1.39, 95% CI: 1.29–3.51), and Plaque Index (PRR = 1.46, 95% CI: 1.20–3.53). Shorter residence (≤5 years) (PRR = 0.90, 95% CI: 0.71–0.93) and access to oral healthcare (PRR = 0.88, 95% CI: 0.56–0.98) were associated with lower DMFT count. Periodontal pockets were associated with male gender (AOR = 1.87, 95% CI: 1.34–5.17), older age (AOR = 4.48, 95% CI: 2.68–10.62), education (illiterate AOR = 5.15, 95% CI: 1.28–17.64; secondary AOR = 2.61, 95% CI: 1.92–14.32), sugary snacks (AOR = 2.47, 95% CI: 1.20–6.09), smoking (AOR = 3.18, 95% CI: 1.56–9.12), Plaque Index (AOR = 3.60, 95% CI: 1.92–8.30), and DMFT (AOR = 2.78, 95% CI: 1.09–6.98).

Refugees had a high burden of oral disease, with significant sociodemographic, behavioral, and clinical factors. Tailored oral health promotion programs are needed for this vulnerable group.