epiH Search

CLOSE



Epidemiol Health > Volume 41; 2019 > Article
Ghafari, Bahadivand-Chegini, Nadi, and Doosti-Irani: The global prevalence of dental healthcare needs and unmet dental needs among adolescents: a systematic review and meta-analysis

Abstract

OBJECTIVES

Access to dental healthcare services is a major determinant of dental health in communities. This meta-analysis was conducted to estimate the global prevalence of dental needs and of unmet dental needs in adolescents.

METHODS

PubMed, Web of Science, and Scopus were searched in June 2018. The summary measures included the prevalence of met and unmet dental needs. A meta-analysis was performed using the inverse variance method to obtain pooled summary measures. Out of 41,661 retrieved articles, 57 were ultimately included.

RESULTS

The pooled prevalence of orthodontic treatment needs was 46.0% (95% confidence interval [CI], 38.0 to 53.0), that of general treatment needs was 59.0% (95% CI, 42.0 to 75.0), that of periodontal treatment needs was 71.0% (95% CI, 46.0 to 96.0), and that of malocclusion treatment needs was 39.0% (95% CI, 28.0 to 50.0). The pooled prevalence of unmet dental needs was 34.0% (95% CI, 27.0 to 40.0).

CONCLUSIONS

The highest and lowest prevalence of unmet dental needs were found in Southeast Asia and Europe, respectively. The prevalence of dental needs was higher in the countries of the Americas and Europe than in other World Health Organization (WHO) regions. The prevalence of unmet dental needs was higher in Southeast Asia and Africa than in other WHO regions.

INTRODUCTION

Access to dental healthcare services is a major determinant of dental health in communities. Dental problems, including dental cavities, are most prevalent among adolescents [1].
The global weighted means of decayed, missing, and filled teeth for adolescents aged 12 years old in 2011 and 2015 were 1.67 and 1.86, respectively [2]. In 2010, approximately 2.4 billion people and 621 million children were affected by untreated caries in permanent and deciduous teeth, respectively, and untreated caries in permanent teeth was the most prevalent dental condition worldwide [3]. In the USA, it was reported that 21% of children aged 6-11 years and 58% of adolescents aged 12-19 years had experienced dental caries. In 2011-2012, the prevalence of untreated dental caries was about 6.0% in children and 15.3% in adolescents [4].
Untreated dental cavities have been reported to cause severe pain, infection, and problems with eating, speaking, and learning in children and adolescents [1].
Adolescents constitute a noteworthy age group, as they have specific healthcare needs [5]. Dental healthcare is an important need in this group, given its effects on quality of life and its potential to improve general health. Dental problems remain a huge burden in children and adolescents in certain regions of the world [6]; nevertheless, the prevalence of dental needs in these age groups has not been estimated in some communities [7,8].
Unmet healthcare needs have been defined as the difference between the healthcare services required to cope with a health problem and the services received [9]. Unmet healthcare needs are common in adolescents and are an independent risk factor for health outcomes in adults [10], meaning that they can impose heavy costs on the community, health system, and individuals [7]. Unmet dental needs in adolescents can have consequences that affect quality of life in adulthood. Several studies have been published regarding the prevalence of needs and unmet needs for dental healthcare. However, there are discrepancies in the results of the published studies. The present systematic review and meta-analysis was therefore conducted to estimate the global prevalence of dental needs and unmet dental needs in adolescents by the type of dental care, World Health Organization (WHO) region, and sex.

MATERIALS AND METHODS

The design of this study is a systematic review and meta-analysis.
As part of a comprehensive systematic review, the present review was conducted to determine the prevalence of dental healthcare needs and unmet dental needs in adolescents. This systematic review was conducted and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [11] (Supplementary Material 1).

Eligibility criteria

The present review included all retrieved cross-sectional studies that were conducted to estimate dental healthcare needs and unmet dental needs in adolescents. The studies included were not limited regarding the year, location, or language of the study, the sex and race of adolescents studied, or the type of dental health needs and unmet needs studied. According to the WHO, adolescents include individuals aged 10-19 years [12].
Unmet needs were defined as the difference between the healthcare needs present and the healthcare needs that were fulfilled to address the health problems under consideration [9].

Identifying the relevant studies

The international databases PubMed, Web of Science, and Scopus were searched in June 2018. The keywords used for searching PubMed were as follows: (adolescent [MeSH Terms] OR “teen” [Text Word] OR homeless youth [MeSH Terms] OR “street adolescents” [Text Word]) AND (health services needs and demand [MeSH Terms] OR “unmet needs” [Text Word] OR needs assessment [MeSH Terms] OR “health needs” [Text Word] OR “unmet health needs” [Text Word] OR “health service needs” [Text Word] OR “delay medical care” [Text Word]) AND (oral health [MeSH Terms] OR dental health services [MeSH Terms]). In Web of Science and Scopus, we searched the mentioned keywords as the topic (TS) and TITLE-ABS-KEY, respectively.

Data extraction and assessing the risk of bias

Endnote X7 software was used to the manage the results of our initial search. Two authors (TN and SBC) were in charge of screening the titles and abstracts of the studies obtained from the databases. The full texts of the selected studies were then evaluated based on the eligibility criteria. Any disagreements between the investigators were resolved through discussion and consultation with a third author (ADI). The kappa value for agreement between two authors in the screening of the title and abstract was 84%.
Three authors (TN, SBC, and ADI) were responsible for data extraction. The data extracted from the included studies comprised the name of the first author, the year of publication, the location (country) of the study, the type of study population, the sex and mean/median age of participants, the type of health need(s) and unmet need(s), the sample size, the number of participants with health needs, and the number of participants with unmet health needs.
Two authors (TN and SBC) were in charge of quality assessments. The Joanna Briggs Institute critical appraisal checklist was used for evaluating the studies that reported prevalence rates and for assessing the risk of bias [13]. The items selected from the Joanna Briggs Institute checklist included (1) the appropriateness of the sampling frame in terms of addressing the target population, (2) the appropriateness of the sampling method, (3) the adequacy of the sample size, (4) the provision of a detailed description of the subjects and the study setting, (5) the use of a valid method for identifying the outcomes (i.e., dental needs and unmet dental needs), (6) the appropriateness of the statistical analysis, and (7) the adequacy of the response rate and the appropriate management of a potential low rate.

Statistical analysis

The chi-square test was used to examine heterogeneity among the results of the included studies. Between-study variance was assessed using the tau-square test, and the I-square statistic was used to quantify heterogeneity [14].
The summary measures, including the prevalence of dental healthcare needs and unmet dental needs, were extracted from the included studies, and their standard errors were calculated. Meta-analysis was performed using the inverse variance method to obtain the pooled summary measure. In the cases of out-of-range confidence intervals (CIs) in the subgroup analysis, the metaprop command was used. A random-effects model was also applied. A p-value of less than 0.05 was considered to indicate statistical significance. The data were analyzed in Review Manager 5.3 (Cochrane Collaboration, Copenhagen, Denmark) and Stata version 11 (StataCorp., College Station, TX, USA).

Ethics statement

The study protocol was approved by the Ethics Committee of Hamadan University of Medical Sciences (IR.UMSHA.RES.1397.69).

RESULTS

Included studies

Out of the 41,661 studies retrieved from searching the international databases and 62 found from scanning the references of the selected studies, 57 studies [15-71] were ultimately included in this systematic review (Figure 1). A study by Al-Sarheed et al. [22] was divided into 3 studies for the purposes of this analysis because it reported dental healthcare needs in 3 groups of adolescents: the general population, visually-impaired adolescents, and adolescents with hearing loss. Table 1 presents the characteristics of the included studies, which included 167,316 adolescents who were evaluated in terms of their dental healthcare needs and 123,821 who were evaluated in terms of their unmet dental healthcare needs. Results of the risk of bias assessment are shown in the forest plots in Figures 2-4.

Prevalence of dental healthcare needs

The overall prevalence of dental healthcare needs was 49.0% (95% CI, 42.0 to 56.0) across all types of dental care. Table 2 presents the overall prevalence by WHO region, sex, and year of publication of the study. The present review reported the prevalence of each type of dental healthcare need. Orthodontic treatment needs were reported in 54.2% of the studies, general needs in 23.7%, periodontal needs in 6.8%, and malocclusion needs in 12.3%.
The prevalence of orthodontic treatment needs was reported in 32 studies. The pooled prevalence of orthodontic treatment needs was 46.0% (95% CI, 38.0 to 53.0; I2=99%) (Figure 2). With regard to WHO region, the highest prevalence was associated with countries in Europe (51.6%; 95% CI, 42.8 to 60.4) and the lowest with countries in Southeast Asia (28.8%; 95% CI, 26.9 to 30.7) (Table 3).
Twelve studies reported the prevalence of general treatment needs in adolescents. The pooled prevalence of general treatment needs was 59.0% (95% CI, 42.0 to 75.0) (Figure 3A). The highest prevalence rates were found in the Eastern Mediterranean region (84.2%; 95% CI, 82.3 to 86.0) and the Africa (78.0%; 95% CI, 77.0 to 80.0). The lowest prevalence was observed in Europe (24.0%; 95% CI, 22.0 to 25.0).
None of the 12 studies were conducted in the Western Pacific region (Table 3).
The pooled prevalence of periodontal treatment needs was 71.0% (95% CI, 46.0 to 96.0) (Figure 3B). The highest prevalence, 93.0% (95% CI, 91.6 to 94.5), was found in the Eastern Mediterranean region (Table 3).
Nine studies reported the prevalence of malocclusion treatment needs in adolescents. The pooled prevalence of this type of need was 39.0% (95% CI, 28.0 to 50.0) (Figure 3C).

Prevalence of unmet dental healthcare needs

Nine studies reported the prevalence of unmet dental healthcare needs. The pooled prevalence of unmet dental needs was 34.0% (95% CI, 27.0 to 40.0) (Figure 4). The highest prevalence of unmet needs was found in Southeast Asia (72.3%; 95% CI, 70.1 to 74.5) and the lowest in Europe (11.8%; 95% CI, 3.4 to 20.3) (Table 2). Table 3 presents the prevalence of unmet needs by type of dental need and WHO region.

DISCUSSION

According to the results of the present systematic review, dental healthcare is a major global need in adolescents. Across all types of dental care, about 50% of adolescents worldwide were found to require dental healthcare services, and 34.0% were found to have unmet dental healthcare needs. The highest prevalence of these needs was observed in countries in the Americas and Europe, and the lowest was seen in Africa and the Western Pacific region. The seemingly higher prevalence observed in the Americas and Europe compared to Africa and the Western Pacific can be explained by the lower number of studies conducted in developing countries and their lower sample sizes compared to studies conducted in developed countries. The larger number of studies conducted on dental healthcare in developed countries suggests the greater perceived importance of dental health among adolescents in these countries. Developed countries therefore appear to have made more serious efforts than developing countries to identify dental health problems in adolescents.
In contrast, the prevalence of unmet dental healthcare needs was lower in Europe and the Americas than in the other regions of the WHO. This prevalence was higher in Southeast Asia and Africa than in the other regions. Unmet dental needs therefore appear to be mainly associated with developing countries. In low-income and middle-income countries, the cost of dental healthcare can put a substantial financial burden on households [72]. In addition, members of the general public in these countries are not adequately protected against the high costs of dental healthcare [72]. A study conducted in Iran showed that the cost of essential dental care was an important determinant of catastrophic healthcare expenditures [73]. The high expenditures required for dental healthcare and the lack of associated insurance coverage in many countries, especially low-income and middle-income countries, can contribute to the high prevalence of unmet dental healthcare needs in these countries.
Globally, unmet dental needs are common in adolescents. Unmet dental needs are an independent risk factor for oral health outcomes in adulthood [10], meaning that they can impose a high burden on the community, health system, and individuals [7]. Therefore, addressing unmet dental needs is important in terms of public health. Unmet dental needs affect the dental health-associated quality of life in adolescents [74]. Improving dental healthcare services and meeting dental healthcare needs can therefore promote overall quality of life in adolescents; nevertheless, given the high expenditures required for dental healthcare, policy-makers are recommended to more effectively provide households with the financial support they need for this highly expensive care. Moreover, the total number of people with unmet oral healthcare needs increased from 2.5 billion in 1990 to 3.5 billion in 2015, suggesting that oral health remains a global public health challenge [75], as emphasized by the global results of the present study in adolescents.
Worldwide, there is a lack of knowledge about certain types of dental healthcare needs; for instance, no compelling evidence was found regarding the global prevalence of unmet periodontal and malocclusion treatment needs. The lack of knowledge regarding the prevalence of unmet dental healthcare needs is more serious at a global than at a local scale. The 9 studies included in the present review regarding unmet dental needs were limited to unmet general and orthodontic dental treatment needs. We therefore recommend that further studies be conducted on unmet dental healthcare needs in adolescents, especially in low-income and middle-income countries.
The present systematic review and meta-analysis was faced with high heterogeneity between the results obtained in the included studies. Homogeneity was not achieved, despite conducting the subgroup analysis by WHO region and type of dental healthcare. The high heterogeneity observed can be explained by differences in the setting, time, and location of studies, in the type of dental healthcare, in the methods of evaluating of dental health needs and unmet needs, and in the quality of the included studies.
The major limitations of the present systematic review and meta-analysis included the low quality of some of the included studies and their use of different tools and criteria for detecting dental healthcare needs. In addition, our results may be affected by selection bias due to lack of access to the full text of some papers as well as the potential existence of studies in the gray literature, such as theses and annual unpublished reports by nations regarding the prevalence of need and unmet needs.

CONCLUSION

The results obtained from this systematic review suggest that the prevalence of dental healthcare needs and unmet dental healthcare needs is globally significant in adolescents. The prevalence of dental healthcare needs was higher in the countries of the Americas and Europe than in other WHO regions. Unmet needs were more prevalent in Southeast Asia and Africa than in other WHO regions.

SUPPLEMENTARY MATERIALS

Supplementary material is available at http://www.e-epih.org/.
epih-41-e2019046-supplementary.pdf

CONFLICT OF INTEREST

The authors have no conflicts of interest to declare for this study.

NOTES

AUTHOR CONTRIBUTIONS
Conceptualization: MG, ADI. Data curation: SBC, TN, ADI. Formal analysis: ADI. Methodology: ADI, SBC, TN. Funding acquisition: ADI. Project administration: MG. Visualization: MG, ADI, TN, SBC. Writing – original draft: MG, ADI, TN, SBC. Writing – review & editing: MG, ADI, TN, SBC.

ACKNOWLEDGEMENTS

We would like to thank the Vice Chancellor for Research and Technology at Hamadan University of Medical Sciences for the support of this study (ID: 970225943).

Figure 1.
Flowchart depicting the stages through which articles were retrieved and eligibility criteria were checked for the meta-analysis.
epih-41-e2019046f1.jpg
Figure 2.
Prevalence of orthodontic treatment needs among adolescents. SE, standard error; CI, confidence interval; df, degree of freedom.
epih-41-e2019046f2.jpg
Figure 3.
Prevalence of (A) general dental treatment needs, (B) periodontal treatment needs, and (C) malocclusion treatment needs among adolescents. SE, standard error; CI, confidence interval; df, degree of freedom.
epih-41-e2019046f3.jpg
Figure 4.
Total prevalence of unmet dental needs among adolescents. SE, standard error; CI, confidence interval; df, degree of freedom.
epih-41-e2019046f4.jpg
Table 1.
Characteristics of included studies
Study Country WHO region Study population Age (yr) Sex Sample size (n) Need Unmet Type of dental health need(s)
Bilgic et al., 2015 [26] Turkey Southeast Asia General 12-16 Both 2,250 648 Orthodontic treatment
DHC
Bolin et al., 2006 [29] USA Americas Adolescents in a juvenile detention facility 12-17 Both 419 310 208 Overall dental treatment needs
Dental caries
Vignarajah, 1994 [71] Antigua and Barbuda Americas General 12-19 Both 702 494 Periodontal treatment needs
De Baets et al., 2012 [37] Belgium European General 11-16 Female 223 180 Orthodontic treatment
DHC
Agaku et al., 2015 [16] USA Americas General 6-17 Both 65,593 10,338 Overall dental treatment needs
Appropriate and timely preventive or therapeutic dental healthcare
Kulkami et al., 2002 [49] India Southeast Asia General 11-15 Both 2005 1,159 Overall dental treatment needs
Dental caries
Ajayi et al., 2010 [17] Nigeria African General 12-19 Both 1,532 165 135 Traumatized treatment
Traumatized anterior teeth
Ghijselings et al., 2014 [44] Belgium European General 11-16 Both 386 310 Orthodontic treatment
DHC
Al-Haddad et al., 2010 [18] Yemen Eastern Mediterranean General 6-14 Both 1,489 1,253 Overall dental treatment needs
Nagarajappa et al., 2012 [56] India Southeast Asia General 12-15 Both 900 740 Periodontal treatment needs
Al-Huwaizi et al., 2009 [20] Iraq Eastern Mediterranean General 13 Both 998 413 Orthodontic treatment
DAI
Bissar et al., 2007 [28] Germany European General 11-13 Both 502 51 38 Overall dental treatment needs
Restorative treatment need
Otuyemi et al., 1997 [60] Nigeria African General 12-18 Both 704 271 Orthodontic treatment
DHC
Rubin et al., 2016 [63] Uganda African General 5-17 Female 153 151 Overall dental treatment needs
Borzabadi-Farahani et al., 2009 [30] Iran Eastern Mediterranean General 11-14 Both 496 281 Orthodontic treatment
DHC
Alonge et al., 1999 [21] Saint Vincent and the Grenadines Americas General 7-15 Both 1,646 662 Periodontal treatment needs
Safavi et al., 2009 [65] Iran Eastern Mediterranean General 14-16 Both 5,091 4,079 Orthodontic treatment
DHC
Burden et al., 1994 [31] Northern Ireland European General 15-16 Both 506 154 82 Orthodontic treatment
Salinas-Martínez et al., 2014 [66] Mexico Americas General 13 Both 301 223 Overall dental treatment needs
Al-Sarheed et al., 2003 [22] Saudi Arabia Eastern Mediterranean Visually impaired adolescents 11-16 Both 77 21 Orthodontic treatment
DHC
Al-Sarheed et al., 2003 [22] Saudi Arabia Eastern Mediterranean Hearing-impaired adolescents 11-16 Both 210 62 Orthodontic treatment
DHC
Al-Sarheed et al., 2003 [22] Saudi Arabia Eastern Mediterranean General 11-16 Both 494 108 Orthodontic treatment
DHC
Carvalho et al., 2013 [34] Brazil Americas General 12-14 Both 300 198 Overall dental treatment needs
Dental caries
Danaei et al., 2007 [35] Iran Eastern Mediterranean General 12-15 Both 900 269 Orthodontic treatment
DAI
Dandi et al., 2011 [36] India Southeast Asia General 12 Both 2,203 1,573 1,137 Overall dental treatment needs
Dental pain
Artun et al., 2006 [23] Kuwait Eastern Mediterranean General 13-14 Both 1,583 330 290 Orthodontic treatment
El-Angbawi et al., 1982 [38] Saudi Arabia Eastern Mediterranean General 13-15 Both 1,174 1,092 Periodontal treatment needs
Baubiniene et al., 2009 [25] Lithuania European General 10-15 Male 4,235 1,806 Orthodontic treatment
Eslamipour et al., 2010 [40] Iran Eastern Mediterranean General 11-20 Both 748 331 Orthodontic treatment
DAI
Abdullah et al., 2001 [15] Malaysia Western Pacific General 12-13 Both 5,112 2,449 Orthodontic treatment
DHC
Abu Alhaija et al., 2004 [19] Jordan Eastern Mediterranean General 12-14 Both 1,002 252 Orthodontic treatment
DHC
Baca-Garcia et al., 2004 [24] Spain European General 14-20 Both 744 308 Orthodontic treatment
DAI
Birkeland et al., 1996 [27] Norway European General 11 Both 359 191 Orthodontic treatment
DAI
Burden et al., 1994 [33] UK European General 11-12 Both 1,829 600 Overall dental treatment needs
Burden et al., 1995 [32] Ireland European General 11-12 Both 1,107 697 Orthodontic treatment
Esa et al., 2001 [39] Malaysia Western Pacific General 12-13 Both 1,519 566 Malocclusion and orthodontic treatment need
Espeland et al., 1999 [41] Norway European General 16-20 Both 250 82 Orthodontic treatment
Estioko et al., 1994 [42] Australia Western Pacific General 12-16 Both 268 98 Malocclusion and orthodontic treatment need
Foster et al., 1974 [43] UK European General 11-12 Both 1,000 599 Malocclusion and orthodontic treatment need
Hamdan., 2001 [45] Jordan Eastern Mediterranean General 14-17 Both 320 160 Orthodontic treatment
DHC
Hedayati et al., 2007 [46] Iran Eastern Mediterranean General 11-14 Both 1,965 869 Orthodontic treatment
DHC
Josefsson et al., 2007 [47] Sweden European General 12-13 Both 476 307 Orthodontic treatment
DHC
Kerosuo et al., 2004 [48] Kuwait Eastern Mediterranean General 14-18 Both 139 82 Orthodontic treatment
DHC
Lewis et al., 2005 [50] USA Americas Children with special healthcare needs ≤17 Both 38,866 30,815 3,205 Overall dental treatment needs
Liepa et al., 2003 [51] Latvia European General 12-13 Both 505 222 Malocclusion and orthodontic treatment need
Manzanera et al., 2009 [52] Spain European General 12-16 Both 655 139 Orthodontic treatment
DHC
Marques et al., 2007 [53] Brazil Americas General 13-15 Both 600 462 Malocclusion and orthodontic treatment need DAI
Mashoto et al., 2009 [54] Tanzania African General 10-19 Both 1,780 790 Overall dental treatment needs
Mugonzibwa et al., 2004 [55] Tanzania African General 9-18 Both 295 164 Orthodontic treatment
DHC
Nalweyiso et al., 2004 [57] Uganda African General 12 Both 181 65 Overall dental treatment needs
Nobile et al., 2007 [58] Italy European General 11-15 Both 546 325 Orthodontic treatment
DHC
Otuyemi et al., 1997 [60] Nigeria African General 12-18 Both 703 159 Malocclusion and orthodontic treatment need
Perillo et al., 2010 [61] Italy European General 12 Both 703 451 Orthodontic treatment
DHC
Puertes-Fernández et al., 2011 [62] Spain European General 12 Both 248 97 Orthodontic treatment
DHC
Rwakatema et al., 2007 [64] Tanzania African General 12-15 Both 289 102 Orthodontic treatment
DAI
Shivakumar et al., 2009 [67] India Southeast Asia General 12-15 Both 1,000 199 Malocclusion and orthodontic treatment need
Shivakumar et al., 2010 [68] India Southeast Asia General 12-15 Both 1,800 362 Malocclusion and orthodontic treatment need
Souames et al., 2006 [69] France European General 9-12 Both 511 255 Orthodontic treatment
DHC
Thilander et al., 2001 [70] Colombia Americas General 5-17 Both 4,724 1,504 Malocclusion and orthodontic treatment need

WHO, World Health Organization; DHC, dental health component; DAI, Dental Aesthetic Index.

Table 2.
Prevalence of any dental healthcare need and unmet needs among adolescents based on WHO region and sex
Variables Need
Unmet need
n Prevalence (95% CI) I2 p-value n Prevalence (95% CI) I2 p-value
WHO region Americas 8 64.1 (45.3, 82.8) 99.9 <0.001 3 23.2 (18.0, 28.5) 99.7 <0.001
Southeast Asia 6 46.7 (25.4, 68.0) 99.8 <0.001 1 72.3 (70.1, 74.5) - -
African 7 34.4 (19.5, 49.4) 99.4 <0.001 2 58.9 (13.9, 100) 99.0 <0.001
European 18 43.7 (13.7, 73.7) 99.6 <0.001 2 11.8 (3.4, 20.3) 94.5 <0.001
Eastern Mediterranean 15 47.2 (32.6, 61.8) 99.8 <0.001 1 18.3 (16.4, 20.2) - -
Western Pacific 3 40.8 (32.3, 49.3) 96.9 <0.001 - - - -
Sex Male 19 50.0 (37.5, 63.5) 99.7 <0.001 3 37.9 (4.6, 71.2) 99.9 <0.001
Female 21 49.8 (36.8, 62.9) 99.7 <0.001 3 33.8 (29.0, 38.7) 99.8 <0.001
Both 33 47.9 (38.4, 57.3) 99.8 <0.001 6 33.3 (19.1, 47.6) 99.4 <0.001
Year (range) 1974-1999 12 47.8 (31.8, 63.8) 99.7 <0.001 1 16.2 (13.0, 19.4) - -
2000-2004 13 40.1 (34.2, 47.1) 98.6 <0.001 1 35.9 (28.9, 42.9) - -
2005-2009 19 48.2 (36.5, 59.9) 99.9 <0.001 4 21.1 (11.9, 30.3) 99.1 <0.001
2010-2016 13 60.0 (41.0, 79.1) 99.9 <0.001 3 56.6 (10.3, 99.0) 99.8 <0.001
Sample size (n) ≤500 19 54.5 (41.9, 67.2) 99.3 <0.001 2 43.0 (29.6, 56.5) 90.1 <0.001
501-1,000 18 44.8 (34.1, 55.5) 99.5 <0.001 2 11.8 (3.40, 20.3) 94.5 <0.001
≥1,001 20 47.8 (36.0, 59.6) 99.9 <0.001 5 38.9 (30.5, 47.2) 99.9 <0.001
Total 57 49.0 (42.0, 56.0) 99.9 <0.001 9 34.0 (27.0, 40.0) 99.9 <0.001

WHO, World Health Organization; CI, confidence interval.

Table 3.
Prevalence of specific dental healthcare needs and unmet needs among adolescents based on WHO region
Variables Need
Unmet need
n Prevalence (95% CI) I2 n Prevalence (95% CI) I2
Orthodontic treatment Americas - - - - - -
Southeast Asia 1 28.8 (26.9, 30.7) - - - -
African 3 43.0 (31.9, 54.2) 93.6 - - -
European 14 51.6 (42.8, 60.4) 98.9 1 16.2 (13.0, 19.4) -
Eastern Mediterranean 13 40.8 (25.6, 56.0) 99.7 1 18.3 (16.4, 20.2) -
Western Pacific 1 47.9 (46.5, 49.3) - - - -
General dental treatment needs Americas 4 73.7 (67.9, 79.5) 90.1 3 23.2 (18.0, 28.5) 99.7
Southeast Asia 2 64.6 (51.3, 77.9) 98.8 1 72.3 (70.1, 74.5) -
African 3 78.0 (77.0, 80.0) 99.8 2 58.9 (13.9, 100) 99.0
European 2 24.0 (22.0, 25.0) 99.9 1 7.6 (5.3, 9.9) -
Eastern Mediterranean 1 84.2 (82.3, 86.0) - - - -
Western Pacific - - - - - -
Malocclusion treatment Americas 2 54.4 (10.1, 98.6) 99.8 - - -
Southeast Asia 2 20.0 (18.6, 21.5) 00.0 - - -
African 1 22.6 (19.5, 25.7) - - - -
European 2 52.0 (36.4, 67.6) 97.1 - - -
Eastern Mediterranean - - - - - -
Western Pacific 2 37.2 (34.9, 39.4) 00.0 - - -
Periodontal treatment needs Americas 2 55.3 (25.7, 84.8) 99.5 - - -
Southeast Asia 1 82.2 (79.7, 84.7) - - - -
African - - - - - -
European - - - - - -
Eastern Mediterranean 1 93.0 (91.6, 94.5) - - - -
Western Pacific - - -

WHO, World Health Organization region; CI, confidence interval.

REFERENCES

1. Centers for Disease Control and Prevention. Children’s dental health; 2017 [cited 2019 Apr 24]. Available from: https://www.cdc.gov/features/childrens-dental-health/index.html.

2. World Health Organization. Oral health databases. [cited 2019 Oct 9]. Available from: https://www.who.int/oral_health/databases/en/.

3. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of untreated caries: a systematic review and metaregression. J Dent Res 2015; 94: 650-658.
crossref
4. Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012. NCHS Data Brief 2015; 1-8.

5. World Health Organization. Adolescent responsive health systems. [cited 2018 Jan 28]. Available from: https://www.who.int/maternal_child_adolescent/topics/adolescence/health_services/en/.

6. Wang Z, Deng Y, Liu SW, He J, Ji K, Zeng XY, et al. Prevalence and years of life lost due to disability from dental caries among children and adolescents in Western China, 1990–2015. Biomed Environ Sci 2017; 30: 701-707. PMID: 29122090
pmid
7. Marshall EG. Do young adults have unmet healthcare needs? J Adolesc Health 2011; 49: 490-497.
crossref
8. Sawyer SM, McNeil R, McCarthy M, Orme L, Thompson K, Drew S, et al. Unmet need for healthcare services in adolescents and young adults with cancer and their parent carers. Support Care Cancer 2017; 25: 2229-2239.
crossref pdf
9. Sanmartin C, Houle C, Tremblay S, Berthelot JM. Changes in unmet health care needs. Health Rep 2002; 13: 15-21. PMID: 12743957
pmid
10. Hargreaves DS, Elliott MN, Viner RM, Richmond TK, Schuster MA. Unmet health care need in US adolescents and adult health outcomes. Pediatrics 2015; 136: 513-520.
crossref
11. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097. PMID: 19621072
crossref pmid pmc
12. World Health Organization. Recognizing adolescence. [cited 2018 Apr 21]. Available from: http://apps.who.int/adolescent/second-decade/section2/page1/recognizing-adolescence.html.

13. Joanna Briggs Institute (JBI). Critical appraisal tools for use in JBI systematic reviews checklist for prevalence studies; 2017 [cited 2018 Apr 21]. Available from: https://joannabriggs.org/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Prevalence_Studies2017_0.pdf.

14. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560.
crossref
15. Abdullah MS, Rock WP. Assessment of orthodontic treatment need in 5,112 Malaysian children using the IOTN and DAI indices. Community Dent Health 2001; 18: 242-248. PMID: 11789703
pmid
16. Agaku IT, Olutola BG, Adisa AO, Obadan EM, Vardavas CI. Association between unmet dental needs and school absenteeism because of illness or injury among U.S. school children and adolescents aged 6-17 years, 2011-2012. Prev Med 2015; 72: 83-88.
crossref
17. Ajayi MD, Denloye O, Abiodun Solanke FI. The unmet treatment need of traumatized anterior teeth in selected secondary school children in Ibadan, Nigeria. Dent Traumatol 2010; 26: 60-63.
crossref
18. Al-Haddad KA, Al-Hebshi NN, Al-Ak’hali MS. Oral health status and treatment needs among school children in Sana’a City, Yemen. Int J Dent Hyg 2010; 8: 80-85.
crossref
19. Abu Alhaija ES, Al-Nimri KS, Al-Khateeb SN. Orthodontic treatment need and demand in 12-14-year-old north Jordanian school children. Eur J Orthod 2004; 26: 261-263.
crossref pdf
20. Al-Huwaizi AF, Rasheed TA. Assessment of orthodontic treatment needs of Iraqi Kurdish teenagers using the Dental Aesthetic Index. East Mediterr Health J 2009; 15: 1535-1541. PMID: 20218147
pmid
21. Alonge OK, Narendran S. Periodontal health status of school children in St. Vincent and the Grenadines. Odontostomatol Trop 1999; 22: 18-22. PMID: 11372121
pmid
22. Al-Sarheed M, Bedi R, Hunt NP. Orthodontic treatment need and self-perception of 11-16-year-old Saudi Arabian children with a sensory impairment attending special schools. J Orthod 2003; 30: 39-44.
crossref
23. Artun J, Kerosuo H, Behbehani F, Al-Jame B. Residual need for early orthodontic treatment and orthodontic treatment experience among 13- to 14-year-old school children in Kuwait. Med Princ Pract 2006; 15: 343-351.
crossref
24. Baca-Garcia A, Bravo M, Baca P, Baca A, Junco P. Malocclusions and orthodontic treatment needs in a group of Spanish adolescents using the Dental Aesthetic Index. Int Dent J 2004; 54: 138-142.
crossref
25. Baubiniene D, Sidlauskas A, Miseviciene I. The need for orthodontic treatment among 10-11- and 14-15-year-old Lithuanian schoolchildren. Medicina (Kaunas) 2009; 45: 814-821.
crossref
26. Bilgic F, Gelgor IE, Celebi AA. Malocclusion prevalence and orthodontic treatment need in central Anatolian adolescents compared to European and other nations’ adolescents. Dental Press J Orthod 2015; 20: 75-81. PMID: 26691973
crossref pmid pmc pdf
27. Birkeland K, Boe OE, Wisth PJ. Orthodontic concern among 11- year-old children and their parents compared with orthodontic treatment need assessed by index of orthodontic treatment need. Am J Orthod Dentofacial Orthop 1996; 110: 197-205.
crossref
28. Bissar AR, Oikonomou C, Koch MJ, Schulte AG. Dental health, received care, and treatment needs in 11- to 13-year-old children with immigrant background in Heidelberg, Germany. Int J Paediatr Dent 2007; 17: 364-370.
crossref
29. Bolin K, Jones D. Oral health needs of adolescents in a juvenile detention facility. J Adolesc Health 2006; 38: 755-757.
crossref
30. Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F. Orthodontic treatment needs in an urban Iranian population, an epidemiological study of 11-14 year old children. Eur J Paediatr Dent 2009; 10: 69-74. PMID: 19566372
pmid
31. Burden DJ, Holmes A. The need for orthodontic treatment in the child population of the United Kingdom. Eur J Orthod 1994; 16: 395-399.
crossref pdf
32. Burden DJ. Need for orthodontic treatment in Northern Ireland. Community Dent Oral Epidemiol 1995; 23: 62-63.
crossref
33. Burden DJ, Mitropoulos CM, Shaw WC. Residual orthodontic treatment need in a sample of 15- and 16-year-olds. Br Dent J 1994; 176: 220-224.
crossref pdf
34. Carvalho JC, Rebelo MA, Vettore MV. The relationship between oral health education and quality of life in adolescents. Int J Paediatr Dent 2013; 23: 286-296.
crossref
35. Danaei SM, Amirrad F, Salehi P. Orthodontic treatment needs of 12-15-year-old students in Shiraz, Islamic Republic of Iran. East Mediterr Health J 2007; 13: 326-334. PMID: 17684855
pmid
36. Dandi KK, Rao EV, Margabandhu S. Dental pain as a determinant of expressed need for dental care among 12-year-old school children in India. Indian J Dent Res 2011; 22: 611.
crossref
37. De Baets E, Lambrechts H, Lemiere J, Diya L, Willems G. Impact of self-esteem on the relationship between orthodontic treatment need and oral health-related quality of life in 11- to 16-year-old children. Eur J Orthod 2012; 34: 731-737.
crossref
38. El-Angbawi MF, Younes SA. Periodontal disease prevalence and dental needs among schoolchildren in Saudi Arabia. Community Dent Oral Epidemiol 1982; 10: 98-99.
crossref
39. Esa R, Razak IA, Allister JH. Epidemiology of malocclusion and orthodontic treatment need of 12-13-year-old Malaysian schoolchildren. Community Dent Health 2001; 18: 31-36. PMID: 11421403
pmid
40. Eslamipour F, Borzabadi-Farahani A, Asgari I. Assessment of orthodontic treatment need in 11- to 20-year-old urban Iranian children using the Dental Aesthetic Index (DAI). World J Orthod 2010; 11: e125-e132. PMID: 21490981
pmid
41. Espeland L, Stenvik A. Residual need in orthodontically untreated 16-20-year-olds from areas with different treatment rates. Eur J Orthod 1999; 21: 523-531.
crossref pdf
42. Estioko LJ, Wright FA, Morgan MV. Orthodontic treatment need of secondary schoolchildren in Heidelberg, Victoria: an epidemiologic study using the Dental Aesthetic Index. Community Dent Health 1994; 11: 147-151. PMID: 7953933
pmid
43. Foster TD, Day AJ. A survey of malocclusion and the need for orthodontic treatment in a Shropshire school population. Br J Orthod 1974; 1: 73-78.
crossref
44. Ghijselings I, Brosens V, Willems G, Fieuws S, Clijmans M, Lemiere J. Normative and self-perceived orthodontic treatment need in 11- to 16-year-old children. Eur J Orthod 2014; 36: 179-185.
crossref pdf
45. Hamdan AM. Orthodontic treatment need in Jordanian school children. Community Dent Health 2001; 18: 177-180. PMID: 11580095
pmid
46. Hedayati Z, Fattahi HR, Jahromi SB. The use of index of orthodontic treatment need in an Iranian population. J Indian Soc Pedod Prev Dent 2007; 25: 10-14.
crossref
47. Josefsson E, Bjerklin K, Lindsten R. Malocclusion frequency in Swedish and immigrant adolescents--influence of origin on orthodontic treatment need. Eur J Orthod 2007; 29: 79-87.
crossref pdf
48. Kerosuo H, Al Enezi S, Kerosuo E, Abdulkarim E. Association between normative and self-perceived orthodontic treatment need among Arab high school students. Am J Orthod Dentofacial Orthop 2004; 125: 373-378.
crossref
49. Kulkami SS, Deshpande SD. Caries prevalence and treatment needs in 11-15 year old children of Belgaum city. J Indian Soc Pedod Prev Dent 2002; 20: 12-15. PMID: 12435027
pmid
50. Lewis C, Robertson AS, Phelps S. Unmet dental care needs among children with special health care needs: implications for the medical home. Pediatrics 2005; 116: e426-e431.
crossref
51. Liepa A, Urtane I, Richmond S, Dunstan F. Orthodontic treatment need in Latvia. Eur J Orthod 2003; 25: 279-284.
crossref pdf
52. Manzanera D, Montiel-Company JM, Almerich-Silla JM, Gandía JL. Orthodontic treatment need in Spanish schoolchildren: an epidemiological study using the Index of Orthodontic Treatment Need. Eur J Orthod 2009; 31: 180-183.
crossref pdf
53. Marques CR, Couto GB, Orestes Cardoso S. Assessment of orthodontic treatment needs in Brazilian schoolchildren according to the Dental Aesthetic Index (DAI). Community Dent Health 2007; 24: 145-148. PMID: 17958074
pmid
54. Mashoto KO, Åstrøm AN, David J, Masalu JR. Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: a cross-sectional study. Health Qual Life Outcomes 2009; 7(1):73. PMID: 19643004
crossref pmid pmc
55. Mugonzibwa EA, Kuijpers-Jagtman AM, Van ‘t Hof MA, Kikwilu EN. Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children. Am J Orthod Dentofacial Orthop 2004; 125: 426-434.
crossref
56. Nagarajappa R, Kenchappa M, Ramesh G, Nagarajappa S, Tak M. Assessment of periodontal status and treatment needs among 12 and 15 years old school children in Udaipur, India. Eur Arch Paediatr Dent 2012; 13: 132-137.
crossref pdf
57. Nalweyiso N, Busingye J, Whitworth J, Robinson PG. Dental treatment needs of children in a rural subcounty of Uganda. Int J Paediatr Dent 2004; 14: 27-33.
crossref
58. Nobile CG, Pavia M, Fortunato L, Angelillo IF. Prevalence and factors related to malocclusion and orthodontic treatment need in children and adolescents in Italy. Eur J Public Health 2007; 17: 637-641.
crossref pdf
59. Otuyemi OD, Ogunyinka A, Dosumu O, Cons NC, Jenny J. Malocclusion and orthodontic treatment need of secondary school students in Nigeria according to the dental aesthetic index (DAI). Int Dent J 1999; 49: 203-210.
crossref
60. Otuyemi OD, Ugboko VI, Adekoya-Sofowora CA, Ndukwe KC. Unmet orthodontic treatment need in rural Nigerian adolescents. Community Dent Oral Epidemiol 1997; 25: 363-366.
crossref
61. Perillo L, Masucci C, Ferro F, Apicella D, Baccetti T. Prevalence of orthodontic treatment need in southern Italian schoolchildren. Eur J Orthod 2010; 32: 49-53.
crossref pdf
62. Puertes-Fernández N, Montiel-Company JM, Almerich-Silla JM, Manzanera D. Orthodontic treatment need in a 12-year-old population in the Western Sahara. Eur J Orthod 2011; 33: 377-380.
crossref pdf
63. Rubin PF, Winocur E, Erez A, Birenboim-Wilensky R, Peretz B. Dental treatment needs among children and adolescents residing in an Ugandan Orphanage. J Clin Pediatr Dent 2016; 40: 486-489.
crossref
64. Rwakatema DS, Kemoli AM. Orthodontic treatment needs amont 12-15 year-olds in Moshi, Tanzania. East Afr Med J 2007; 84: 226-232.
crossref
65. Safavi SM, Sefidroodi A, Nouri M, Eslamian L, Kheirieh S, Bagheban AA. Orthodontic treatment need in 14-16 year-old Tehran high school students. Aust Orthod J 2009; 25: 8-11. PMID: 19634457
pmid
66. Salinas-Martínez AM, Hernández-Elizondo RT, Núñez-Rocha GM, Ramos Peña EG. Psychometric properties of the Spanish version of the short-form Child Perceptions Questionnaire for 11-14-year-olds for assessing oral health needs of children. J Public Health Dent 2014; 74: 168-174.
crossref
67. Shivakumar KM, Chandu GN, Subba Reddy VV, Shafiulla MD. Prevalence of malocclusion and orthodontic treatment needs among middle and high school children of Davangere city, India by using Dental Aesthetic Index. J Indian Soc Pedod Prev Dent 2009; 27: 211-218.
crossref
68. Shivakumar K, Chandu G, Shafiulla M. Severity of malocclusion and orthodontic treatment needs among 12- to 15-year-old school children of Davangere District, Karnataka, India. Eur J Dent 2010; 4: 298-307. PMID: 20613919
crossref pmid pmc pdf
69. Souames M, Bassigny F, Zenati N, Riordan PJ, Boy-Lefevre ML. Orthodontic treatment need in Spanish schoolchildren: an epidemiological study using the Index of Orthodontic Treatment Need. Eur J Orthod 2006; 28: 605-609.
crossref pdf
70. Thilander B, Pena L, Infante C, Parada SS, de Mayorga C. Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development. Eur J Orthod 2001; 23: 153-167.
crossref pdf
71. Vignarajah S. Periodontal treatment needs in 12 and 15 to 19-year-old school children in the Caribbean Island of Antigua, 1990. J Periodontal Res 1994; 29: 324-327.
crossref
72. Masood M, Sheiham A, Bernabé E. Household expenditure for dental care in low and middle income countries. PLoS One 2015; 10: e0123075. PMID: 25923691
crossref pmid pmc
73. Kavosi Z, Rashidian A, Pourreza A, Majdzadeh R, Pourmalek F, Hosseinpour AR, et al. Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan 2012; 27: 613-623.
crossref pdf
74. Kunz F, Platte P, Keß S, Geim L, Zeman F, Proff P, et al. Correlation between oral health-related quality of life and orthodontic treatment need in children and adolescents-a prospective interdisciplinary multicentre cohort study. J Orofac Orthop 2018; 79: 297-308.
crossref pdf
75. Kassebaum NJ, Smith AG, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990-2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res 2017; 96: 380-387. PMID: 28792274
crossref pmid pmc


ABOUT
ARTICLE CATEGORY

Browse all articles >

BROWSE ARTICLES
FOR AUTHORS AND REVIEWERS
Editorial Office
Graduate School of Cancer Science and Policy, National Cancer Center
323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea
TEL: +82-2-745-0662   FAX: +82-2-764-8328    E-mail: enh0662@gmail.com

Copyright © 2020 by Korean Society of Epidemiology. All rights reserved.

Developed in M2community

Close layer
prev next