- Research
- Open access
- Published:
A scoping review linking early childhood caries to violence, neglect, internally displaced, migrant and refugee status
BMC Oral Health volume 23, Article number: 747 (2023)
Abstract
Background
The aim of the scoping review was to identify and synthesize the available literature concerning the relationship between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC) as it relates to the United Nation’s Sustainable Development Goal 16 (SDG 16).
Methods
Data regarding the links between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC), and the associations between ECC and maternal and child exposure to physical and sexual abuse, insecurity, crime, exploitation, torture, and displacement were extracted. The search was carried out in January 2023 across three databases (PubMed, Web of Science, and Scopus). Only publications in English with accessible full texts were included. Descriptive statistics were utilized to summarize the categories of the retrieved papers, and graphical representation was employed for visualization purposes. The relationships between the publications and each of the 10 targets of Sustainable Development Goal 16 (SDG 16) were also assessed.
Results
Forty-five studies were reviewed. Most studies (42.2%) originated from the Americas Regions, while no studies were identified from the Africa Region. A significant portion (46.7%) of the papers focused on abuse, violence, and neglect as risk factors for ECC. Migrants, refugees, and IDPs were the most investigated populations (44.4%). Only one study specifically focused on IDPs and migrants respectively. The prevalence of untreated caries was higher among migrants, refugees, and IDPs compared to the host community, ECC was more prevalent among children who experienced abuse, neglect, or were in protective care. The was no clear direction on the associations between ECC and intimate partner violence, adverse childhood experiences, and wars. In terms of the SDGs, the reviewed publications addressed four targets (SDG16.1, SDG16.2, SDG16.3, and SDG16.5) out of the ten targets outlined in SDG 16.
Conclusion
There is available evidence regarding the connections between ECC and war, refugees, migration, violence, and neglect, as outlined in SDG 16. Future studies are needed to investigate how forced movements directly affects ECC status, how disruptions of peace and stability is a risk factor for ECC, and the associations between ECC and other indicators related to SDG 16 targets.
Introduction
The oral health of children is influenced by various family and community related factors [1], which are encompassed by the sustainable development goals. Therefore, it is plausible to assume that addressing the United Nations’ sustainable development goals could ultimately have a positive impact on reducing the global burden of Early Childhood Caries (ECC). ECC is defined as the presence of tooth decay in primary teeth among children under the age of 71 months [2]. Sustainable Development Goal (SDG) 16, established by the United Nations, promotes the development of “peaceful and inclusive societies for sustainable development, provides access to justice for all, and builds effective, accountable, and inclusive institutions at all levels” [3]. The SDG 16 has 10 target indicators ranging from 16.1 that aims to reduce violence everywhere to 16 − 10 that ensures public access to information and protocol for fundamental freedoms.
Peace is defined as the absence of civil unrest or disturbance. It represents a condition of safety and organization within a community, upheld by legal or customary means, harmonious personal relationships, and a state or period of mutual agreement between governments [4]. Peace is an integral aspect of public health and closely intertwined with the right to health as fundamental human rights [4,5,6,7]. Establishing strong institutions is crucial for upholding peace, maintaining law and order, and effectively mobilizing human, financial, and other resources for the implementation of programs and initiatives that foster peace and promote health, including oral health [8, 9].
When the state of peace is disrupted and the institutions responsible for maintaining law and order are compromised, the well-being of women and children is disproportionately affected [10, 11]. Wars often result in austerity measures that contribute to child poverty, low birth weight, and declining health outcomes [18]. Furthermore, conflicts and wars disrupt the access of women and children to essential oral health care services, which play a crucial role in preserving oral health and preventing oral diseases [10]. Austerity measures commonly lead to food rationing and reduced access to sugar [12,13,14,15], resulting in lower rates of tooth decay [16]. Chemical warfare can also cause damage to the salivary glands, leading to decreased saliva production and increased susceptibility to tooth decay [17]. Wars and conflicts increase the risk of refugees, migrants, and Internally Displaced Persons’ (IDPs) [18] oral health status [19,20,21,22,23,24].
Ironically, war can heighten the vulnerability of children to ECC [25] through various pathways, including compromised maternal health, suboptimal feeding practices, inadequate oral hygiene, limited access to fluoridated toothpaste and water, insufficient availability of caries prevention measures, and reduced utilization of dental services [26]. Wars and conflicts also amplify the likelihood of both intimate and non-intimate sexual violence, creating harmful family environments that further elevate the risk of ECC [27,28,29,30,31,32]. The experience of violence increases women’s susceptibility to mental health issues [33,34,35], which, in turn, contributes to children’s exposure to cariogenic diets, poor oral hygiene practices, and an elevated risk of ECC [36,37,38].
There is little known about the potential connections between conflict, violence, insecurity, and the risk of ECC. The objective of this scoping review was to systematically examine the available evidence concerning the associations between ECC and elements such as peace, war, conflict, violence, justice, and strong institutions, as delineated in SDG 16. By mapping this evidence, we aimed to identify research gaps and provide recommendations to enhance the understanding of the relationship between SDG 16 and ECC.
Methods
A scoping review was conducted to investigate the connections between ECC and the status of refugees, migrants, and IDPs [13, 39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82]. Additionally, we identified any potential gaps in the literature concerning the relationship between ECC and SDG 16 [83, 84]. The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines [85] to ensure methodological rigor and transparency.
Research questions
This review aimed to address two key questions: (1) What is/are the existing evidence on the association between refugees, migrants, and internally displaced persons and ECC status? (2) What is/are the existing associations between ECC and maternal and child exposure to physical and sexual abuse, insecurity, crime, exploitation, torture, and displacement? These questions formed the foundation for exploring the relevant literature and gathering insights on these important topics.
Search strategy
In January 2023, initial searches were conducted in PubMed, Web of Science, and Scopus to retrieve relevant literature. The search terms and strategy employed are detailed in Appendix 1. It should be noted that no specific protocol was published for this review.
Eligibility criteria and article selection
For this review, only publications written in English up until January 2023 were included. Any type of published manuscript that presented findings related to the association between ECC and factors such as war, displacement, refugee and migrant status, violence (verbal, physical, or psychological) experienced by mothers, and adverse childhood experiences and child abuse was considered. The inclusion criteria required the study population to include children below the age of 72 months, and the publications had to have full texts available from which all relevant information could be extracted. Included publications encompassed letters, reviews, observational studies, and experimental studies. On the other hand, publications in the form of books and grey literature were excluded from this review.
Data extraction
The data extraction process consisted of four phases. In the first phase, IA conducted a search in the three databases and imported the articles into the reference management software Mendeley®. The second phase involved removing duplicate papers, which was done by the same researcher. During the third phase, IA and AN independently reviewed the titles, abstracts, and full articles to assess their suitability for inclusion. Additionally, the reference lists of the screened publications were manually searched for any relevant articles. Any discrepancies in the selection of studies were resolved through consensus among IA, AN, and MOF. In the fourth phase, the results were shared with two subject experts (MET and AA) for their review. Publications were retained when there was consensus among the experts and the initial reviewers. The final consensus document was then shared with members of the Early Childhood Caries Advocacy Group (www.eccag.com) for further review. In case of any disagreements regarding the inclusion or exclusion of studies, the two experts and the three initial reviewers collaborated to reach a resolution. No additional sources were identified through contact with authors or institutions.
Data charting
We created a data extraction form to capture relevant information from the selected publications. The extracted data encompassed details such as the publication year, study design, journal type (dental or non-dental), and the country where the study was conducted. In the case of reviews, we noted the countries associated with the first or last authors. For papers focusing on war, conflict, migrants, and refugees, we additionally identified the countries of origin and destination for the displaced individuals, as well as the specific SDG16 target addressed by each paper. A comprehensive summary of the extracted data, along with the corresponding manuscript references, can be found in Table 1.
We classified the target population into two categories: those who were affected by the consequences of peace disruption at the macro-level (refugees, migrants, and IDPs) and those who experienced the effects of violence at the meso-level (child neglect, abuse of mothers or children, children in protection services, and those who had adverse childhood experiences). We examined the documented associations between ECC and these macro- and meso-level risk factors. The categorization of the papers included in the study is illustrated in Fig. 1.
Analysis
Descriptive statistics, including frequencies and percentages, were utilized to present the data in this study. To visually represent the flow of data from one set of entities to another, we employed a Sankey diagram [86]. The Sankey diagram is particularly useful in illustrating the movement of displaced individuals from their country of origin to their destination countries, as observed in the papers examining the ECC situation among refugees and migrants. The countries were categorized according to the WHO regions [87], which include the Americas Regions (AMR), Eastern Mediterranean Region (EMR), African Region (AFR), European Region (EUR), Southeast Asian Region (SEAR), and Western Pacific Region (WPR).
Results
As shown in Fig. 2, the initial search of PubMed, Web of Science, and Scopus databases resulted in 680 potentially relevant publications. After removing duplicates, 668 publications remained for screening based on their titles, abstracts, and full texts. Out of these, 623 publications were excluded based on the predefined criteria, resulting in a final selection of 45 publications for inclusion in the analysis.
Figure 3 displays the regions where the studies were conducted. Many of the studies (42.2%) were from the AMR, including ten studies from the USA [39,40,41,42, 56, 59, 63, 66, 74, 76], seven studies from Canada [43, 44, 65, 67,68,69], and two studies from Brazil [48, 50]. Following that, there were nine studies (20%) from EUR, consisting of four studies from the United Kingdom [46, 47, 51, 62], two studies from the Netherlands [45, 53], one study from Sweden [49], one study from Germany [75], and one study from Norway [13]. Additionally, there were six studies (8.3%) from the WPR, including four studies from Australia [58, 69,70,71,72], one study from Japan [48], and one study from Malaysia [61]. The EMR had three studies (6.7%) - one from Iraq [64], one from Lebanon [79], and one from Syria [81]. There was one study (2.2%) from the SEAR, specifically India [52]. Finally, there were seven multi-country studies (15.6%) [54, 60, 63, 73, 77, 80, 82]. Collectively, the studies from the AMR and EUR accounted for 62.2% of all the papers, while no studies were identified from the AFR region.
Figure 4 illustrates that nearly 30 years passed between the publication of the first and second articles exploring the association between ECC and SDG 16. Furthermore, 35 articles (77.8%) were published after 2010, coinciding with the decade when the SDGs were introduced. The majority of articles (46.7%) focused on abuse, violence, and neglect as risk factors for ECC [39,40,41, 43,44,45, 47,48,49,50,51,52,53,54,55, 59, 61, 67]. The most frequently studied populations (44.4%) were migrants, refugees, and displaced individuals [61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80].
Three articles (6.7%) explored the relationship between war, political instability, and terrorism and the prevalence of ECC [13, 81, 82]. The first article focused on investigating the impact of World War II on ECC prevalence among Norwegian children in 1940 [13]. The second article examined the effect of the war in Syria on ECC prevalence among Syrian children [81]. The third paper explored the influence of political instability and terrorism on ECC prevalence across multiple countries [82].
Twenty-three articles (51.1%) were published in dental journals [41, 43, 44, 46, 47, 50, 52,53,54,55, 57, 59, 60, 62, 66, 68,69,70, 72, 75, 79, 82], while 22 articles (48.9%) were published in non-dental journals. These articles covered a wide range of topics, including public health, family health, child health, child abuse and neglect, and migrant health [13, 39, 40, 42, 45, 48, 49, 51, 56, 58, 63,64,65, 67, 73, 74, 76,77,78, 80, 81].
There were 18 (40.0%) cross-sectional studies [42, 43, 48, 52, 53, 56, 58, 62, 64, 66,67,68, 70, 72, 74, 75, 79, 80] and seven (15.6%) case-control studies [39, 41, 46, 49, 50, 63, 65]. Additionally, there was one study with a repeated cross-sectional design [13], three ecological studies [54, 60, 82], one case-control study [78], one cohort study [59], two case reports [45, 55], four narrative reviews [40, 51, 57, 81], and one letter to the editor [71]. Furthermore, there were three scoping reviews [44, 69, 80], three systematic reviews [47, 73, 77], and one randomized clinical trial [76].
Among the 22 articles exploring the links between meso-level factors and caries, seven examined the associations between caries and child abuse [39,40,41, 43, 50, 51, 55], five focused on caries and child neglect [45, 46, 48, 51, 57], two investigated caries in children exposed to abuse and neglect [53, 56], three explored caries in children in foster care [42, 46, 58], two examined the relationship between adverse childhood experiences and caries [56, 59], and three investigated the impact of maternal exposure to violence as risk factors associated with ECC [44, 54, 60].
Figure 5 illustrates the migration patterns of displaced individuals from their origin countries to destination countries as depicted in the 20 papers examining ECC in refugees and migrants. Among these papers, fourteen (70%) focused on describing the caries profile of children from various countries of origin who resettled in Canada [65,66,67,68,69, 78], the USA [63, 66, 76], Australia [70, 72], Germany [7], or multiple other countries [73, 77, 80]. Two papers examined the caries profile of children from Vietnam seeking refuge in either the UK [61] or Malaysia [62]. Additionally, two papers investigated the caries profile of children from EMR countries, specifically Syrian refugees in Lebanon [79] and Somali refugees in the USA [74]. One study explored the caries profile of internally displaced persons (IDPs) from Iraq [64], another examined migrants [78], and six studies examined both refugees and migrants [67,68,69,70, 72, 73].
All the studies examining the status of IDPs, refugees, and migrants [13, 59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80] indicate that forced displacement is likely to be associated with a higher prevalence [62, 63, 65, 67, 69, 73, 77] and severity of caries [59,60,61,62, 64,65,66, 68, 75], particularly untreated caries [62, 68]. Moreover, forced displacement is also linked to a high prevalence and severity of caries in the primary dentition [75]. The duration of stay appears to affect the risk of caries among refugees, as children of new immigrants exhibit a higher prevalence and severity of ECC [13, 68, 79]. Additionally, the risk of caries may vary depending on the country of origin [62, 72]. For instance, refugees from Africa have a lower prevalence of caries compared to other refugee groups, while refugees from Vietnam who have resided in Britain for an extended period exhibit a higher prevalence of caries compared to newly arrived refugees. Caries prevalence and severity may also differ based on race [63, 66], as black and white/other refugees tend to have more untreated caries than white children in the US, and black refugees demonstrate a lower prevalence of caries compared to Asians.
Thirteen studies (28.9%) specifically focused on caries in the primary teeth of children under the age of 6 years (early childhood caries, ECC) [45, 48, 54, 59,60,61,62, 64, 66, 68, 70, 81, 82]. Most of these studies (except for three) indicated an association between meso-level factors and a higher risk of ECC. However, Folayan et al. [54, 60] found no statistically significant association between intimate partner violence and other forms of violence experienced by women and ECC, while Kopycka-Kedzierawski et al. [59] found no association between ACE and ECC. Among IDPs, refugees, and migrants, the prevalence of ECC may not always be higher than that of the host community [63, 71], but the prevalence of untreated caries may be higher [66, 69]. Regarding the impact of war, the findings appeared paradoxical. While a study from the 1940s among Norwegian children suggested that war was associated with a lower prevalence of ECC [80], a study among children in Syria indicated that war was associated with an increase in the prevalence of ECC [81], and an ecological study [82] suggested that wars and conflicts were associated with a higher risk of ECC.
Figure 6 provides a visual representation of the relationship between SDG 16 and ECC. Most of the studies included in the analysis focused on specific targets within SDG 16. Specifically, most studies addressed SDG16.1, which aims to reduce all forms of violence [44, 54, 60]. Additionally, there were several studies that examined SDG16.2, which aims to end all forms of abuse, violence, and torture of children [39,40,41,42,43, 45,46,47,48,49,50,51,52,53, 55,56,57,58,59]. Furthermore, some studies explored SDG16.3, which aims to promote the rule of law and ensure justice for all [13, 61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82]. Only one study specifically addressed SDG16.5, which aims to substantially reduce corruption and bribery [82].
The conceptual framework of early childhood caries and peace (SDG 16)
16 − 1 Reduce violence everywhere
16 − 2 Protect children from abuse, exploitation, trafficking and violence
16 − 3 Promote the rule of law and ensure equal access to justice
16 − 4 Combat organized crime and illicit financial and arms flows
16 − 5 Substantially reduce corruption and bribery
16 − 6 Develop effective, accountable and transparent institutions
16 − 7 Ensure responsive, inclusive and representative decision-making
16 − 8 Strengthen the participation in global governance
16 − 9 Provide universal legal identity
16 − 10 Ensure public access to information and protocol fundamental freedoms
Discussion
The results of this scoping review reveal a diverse range of studies examining the association between SDG 16 and oral health, but only a limited number of studies specifically focusing on the relationship between SDG 16 and ECC. Most of the studies emphasized the meso-level determinants of ECC, such as ACEs, abuse, and neglect, while fewer studies investigated the macro-level determinants of ECC. It is noteworthy that most of the studies were conducted in resource-rich settings and primarily involved populations of refugees, migrants, and IDPs. Furthermore, most of the studies were observational in nature, with only one clinical trial conducted in the United States examining the impact of education on reducing the risk of caries among children with refugee status. Notably, there were no studies identified that specifically assessed the association between ECC and SDG 16.4, 16.6–16.10, 16 A, and 16B.
This scoping review represents the first comprehensive analysis examining the specific connection between SDG 16 and ECC. Our initial evaluation of the available research literature on the relationship between SDG 16 and ECC indicates that factors such as child abuse, neglect, being in protective care, and having refugee/migrant/IDP status are associated with a higher prevalence and severity of ECC. However, the association between maternal abuse and ECC showed no significant correlation, although a trend was observed. Additionally, the relationship between adverse childhood experiences (ACE), war, and ECC remains unclear, and further research is needed to determine the magnitude of the impact of SDG 16 indicators on the prevalence and severity of ECC.
Furthermore, the studies suggest that individuals with refugee, migrant, and IDP status are at increased risk for ECC. Refugees are individuals who leave their home countries due to threats to their safety, lives, and human rights violations, while migrants seek opportunities for work, education, or to escape poverty, natural disasters, or political instability, without facing the same risks as refugees [10]. Refugees and migrants cross international borders, whereas IDPs relocate within their own country without crossing an international boundary [10]. A study reported that differences in the status of those who were forced to move, can affect their access to care and expose them to distinct physical and psychological threats [88]. However, the existing research evidence lack sufficient information about the link between different populations of refugees, migrants, and IDPs.
In 2022, the global number of forcibly displaced persons reached approximately 100 million, with IDPs accounting for up to 53.2 million individuals [89]. Surprisingly, we only identified one study investigating ECC among IDPs in Iraq [64]. Additionally, there were no studies on ECC among refugees from significant origin countries such as Venezuela, Ukraine, Afghanistan, and South Sudan, which collectively account for 50% of all current global refugees [90]. Moreover, no studies on ECC among refugees in Turkey, Colombia, Pakistan, and Uganda were found, despite these countries hosting 28% of the refugee population [90]. Furthermore, no studies from Africa were available. Low- and middle-income countries, where a significant population of IDPs, migrants, and refugees reside, are already grappling with a growing burden of oral diseases [91] and struggling with inadequate oral health systems to address this burden [92]. Therefore, there is a critical need for studies that explore the risk, magnitude, and variations in ECC among large populations of IDPs compared to similar populations in their country of origin or host countries. Such data would be invaluable in improving the planning and implementation of population-specific oral health interventions for IDPs.
Moreover, most of the available evidence supports the association between abuse, neglect, violence, and conflict with an increased prevalence and severity of ECC. A detailed analysis revealed that children who experience physical or sexual abuse are at a higher risk of untreated caries [43]. However, the association between maternal exposure to intimate partner violence and ECC risk remains unclear, although a positive but non-significant trend was observed [44, 54, 60]. A prospective cohort study conducted in New York, USA, over a period of two years found no significant association between family conflict and disorganization with the onset of ECC [59]. Conducting a meta-analysis of the existing evidence would be valuable in assessing the strength of the current findings and identifying any gaps that need to be addressed.
Our study highlights that most studies examining meso-level factors associated with ECC are predominantly conducted in resource-rich settings, despite the higher risk of abuse, neglect, and ACE in low and middle-income countries [93]. It is worth noting that low and middle-income countries are less likely to report on three out of the seven strategies proposed by the World Health Organization (Implementation of laws; Norms change; Safe environments; Parental support; Income strengthening; Response services provision and Education - INSPIRE) to address child abuse [94]. The failure to implement comprehensive programs and practices to address child abuse may have a detrimental impact on ECC control, as exposure to violence can be a contributing factor to ECC.
Further research is warranted to investigate the potential impact of other SDG indicators on ECC. For instance, SDG 16.4 aims to reduce financial and arms flow while strengthening the return of stolen assets. Evidence suggests that investments in arms and the misappropriation of country assets divert funds away from education and health sectors, resulting in direct and indirect negative effects on children’s health [95,96,97,98]. However, currently, there is no available evidence on how these resource diversions specifically impact the risk of ECC. Conducting studies to assess the influence of such policies on disease profiles presents challenges, yet they are crucial to strengthening the rule of law and reducing investments in arms [99,100,101].
Novel methodologies should be explored to establish the link between other SDG 16 indicators and ECC. These studies would provide valuable evidence to support policies that promote peace and ensure access to oral care services for infants, toddlers, and pre-school children, thereby reducing the risk of ECC. Additionally, it is important to acknowledge the resilience and resourcefulness of migrants as they adapt to new environments. Exploring these strengths to inform strategies aimed at enhancing access to protective factors and buffering the impact of the risk factors for ECC among children in migrant populations.
In conclusion, ECC is a complex condition influenced by various social determinants, including factors associated with humanitarian crises, as emphasized in this study. It is crucial for humanitarian organizations, social activists, and health institutions to implement community-based initiatives and oral health promotion programs that specifically target children who are migrants, refugees, or residing in displaced centres. Furthermore, further research is necessary to investigate how forced movements contribute to the risk of ECC in infants, toddlers, and pre-school children, and other pathways linking the United Nations’ SDG 16 and ECC. This knowledge will enable the development of effective strategies to mitigate the detrimental impact of ECC on the growth and development of these children.
Data Availability
All data generated or analysed during this study are included in this published article and its supplementary information.
Abbreviations
- AOR:
-
Adjusted Odds Ratio
- CI:
-
Confidence Interval
- ECC:
-
Early Childhood Caries
- dmft:
-
Decayed, Missing and Filled primary Teeth
- DMFT:
-
Decayed, Missing and Filled permanent Teeth
- OR:
-
Odds Ratio
- PRISMA-ScR:
-
Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines
- pufa:
-
Pulpal involvement Ulceration Fistula Abscess
- PR:
-
Prevalence Ratio
- SD:
-
Standard Deviation
- SDG:
-
Sustainable Development Goal
- USA:
-
United States of America
References
Fisher-Owens SA, Gansky SA, Platt LJ, Weintraub JA, Soobader MJ, Bramlett MD, Newacheck PW. Influences on children’s oral health: a conceptual model. Pediatrics. 2007;120(3):e510–20. https://doi.org/10.1542/peds.2006-3084.
Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. J Public Health Dent. 1999;59(3):192–7. https://doi.org/10.1111/j.1752-7325.1999.tb03268.x.
Ritchie R. Mispy, Ortiz-Ospina. Measuring progress towards the Sustainable Development Goals. SDG-Tracker.org. 2018. Available at: https://sdg-tracker.org/peace-justice. Accessed: 19th May 2023.
Levy BS. Health and peace. Croat Med J. 2002;43(2):114–6.
Santa Barbara J. Impact of war on children and imperative to end war. Croat Med J. 2006;47(6):891–4.
Murthy RS, Lakshminarayana R. Mental health consequences of war: a brief review of research findings. World Psychiatry. 2006;5(1):25–30.
Levy BS, Sidel VW, editors. War and public health. Updated ed. Washington (DC): american Public Health Association; 2000. 3 Stockholm International Peace Research Institute. SIPRI Yearbook 2001: armaments, disarmament and international security. Oxford: Oxford University Press; 2001.
Küfeoğlu S. SDG-16: peace, Justice and strong institutions. Emerging Technologies. Sustainable Development Goals Series. Springer, Cham. 2022. https://doi.org/10.1007/978-3-031-07127-0_18.
Lancet E. No free expression, no health. Lancet. 2016;387(10031):1880.
Bendavid E, Boerma T, Akseer N, et al. The effects of armed conflict on the health of women and children. Lancet. 2021;397(10273):522–32. https://doi.org/10.1016/S0140-6736(21)00131-8.
Folayan MO, El Tantawi M, Vukovic A, et al. Governance, maternal well-being and early childhood caries in 3-5-year-old children. BMC Oral Health. 2020;20(1):166. https://doi.org/10.1186/s12903-020-01149-9.
Sugar in War Time. JAMA. 2018;319(17):1826. https://doi.org/10.1001/jama.2017.12358.
Toverud G. Dental caries in norwegian children during and after the last World War; a preliminary report. Proc R Soc Med. 1949;42(4):249–58.
Sognnaes RF. Analysis of wartime reduction of dental caries in european children: with Special Regard to Observations in Norway. Am J Dis Child. 1948;75(6):792–821. https://doi.org/10.1001/archpedi.1948.02030020810002.
Takeuchi M. Epidemiological studies on dental caries in japanese children before and after World War II. Int Dent J. 1961;11:443–57.
Jamel H, Plasschaert A, Sheiham A. Dental caries experience and availability of sugars in iraqi children before and after the United Nations sanctions. Int Dent J. 2004;54(1):21–5.
Mottaghi A, Hoseinzade A, Zamani E, Araghizade HA. Status of dental health in chemical warfare victims: the case of Isfahan, Iran. Indian J Dent Res. 2012;23(4):506–8. https://doi.org/10.4103/0970-9290.104959.
Amnesty international. Refugees, asylum seekers and migrants. 2023. Available at: https://www.amnesty.org/en/what-we-do/refugees-asylum-seekers-and-migrants/#definitions. Accessed: 18th January 2023.
Keboa MT, Hiles N, Macdonald ME. The oral health of refugees and asylum seekers: a scoping review. Global Health. 2016;12(1):59. https://doi.org/10.1186/s12992-016-0200-x. PMID: 27717391; PMCID: PMC5055656.
Lamb CE, Whelan AK, Michaels C. Refugees and oral health: lessons learned from stories of Hazara refugees. Aust Health Rev. 2009;33(4):618–27. https://doi.org/10.1071/ah090618. PMID: 20166911.
Davidson N, Skull S, Calache H, Murray SS, Chalmers J. Holes a plenty: oral health status a major issue for newly arrived refugees in Australia. Aust Dent J. 2006;51(4):306–11. https://doi.org/10.1111/j.1834-7819.2006.tb00448.x.
Marino R, Wright FA, Minas IH. Oral health among vietnamese using a community health centre in Richmond. Aust Dent J. 2001;46(3):208–15. https://doi.org/10.1111/j.1834-7819.2001.tb00284.x.
Kingsford Smith D, Szuster F. Aspects of tooth decay in recently arrived refugees.Aust N. Z J Public Health. 2000;24(6):623–6. https://doi.org/10.1111/j.1467-842X.2000.tb00529.x.
Kagabo R, Singh TP, Frost CJ, Gren LH. Assessment of Dental Caries and oral Health Challenges of School-Age Children in Rhino Camp Refugee settlements in Arua, Uganda. Int J Oral Dent Health. 2019;5:088. https://doi.org/10.23937/2469-5734/1510088.
Rajmil L, Hjern A, Spencer N, et al. Austerity policy and child health in european countries: a systematic literature review. BMC Public Health. 2020;20:1–9. https://doi.org/10.1186/s12889-020-08732-3.
Joury E. Syria Profile of the Epidemiology and Management of Early Childhood Caries before and during the time of Crisis. Front Public Health. 2019;7:271. https://doi.org/10.3389/fpubh.2019.00271.
United Nations and World Bank. Pathways for peace: inclusive approaches to preventing violent conflict. World Bank; 2018.
United Nations. Report of the Secretary-General on Conflict-Related Sexual Violence (Report). 2017.
Vu A, Adam A, Wirtz A, Pham K, Rubenstein L, Glass N, Beyrer C, Singh S. The prevalence of sexual violence among female Refugees in Complex Humanitarian Emergencies: a systematic review and Meta-analysis. PLoS Curr. 2014;6. ecurrents.dis.835f10778fd80ae031aac12d3b533ca7.
Clark CJ, Everson-Rose SA, Suglia SF, Btoush R, Alonso A, Haj-Yahia MM. Association between exposure to political violence and intimate-partner violence in the occupied palestinian territory: a cross-sectional study. Lancet. 2010;375(9711):310–6. https://doi.org/10.1016/S0140-6736(09)61827-4.
Ekhator-Mobayode UE, Hanmer LC, Rubiano-Matulevich E, Arango DJ. The effect of armed conflict on intimate partner violence: evidence from the Boko Haram insurgency in Nigeria. World Dev. 2022;153:105780. https://doi.org/10.1016/j.worlddev.2021.105780.
Lorber MF, Slep AM, Heyman RE, et al. Noxious family environments in relation to adult and childhood caries. J Am Dent Assoc. 2014;145(9):924–30.
Trevillion K, Oram S, Feder G, Howard LM. Experiences of domestic violence and mental disorders: a systematic review and meta-analysis. PLoS ONE. 2012;7(12):e51740.
Rees S, Silove D, Chey T, et al. Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function. JAMA. 2011;306(5):513–21.
Devries KM, Mak JY, Bacchus LJ, et al. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med. 2013;10(5):e1001439.
Auger N, Low N, Lee G, Lo E, Nicolau B. Maternal Mental Disorders before Delivery and the risk of Dental Caries in Children. Caries Res. 2020;54(3):242–9. https://doi.org/10.1159/000505906.
Lorber MF, Maisson DJN, Slep AMS, et al. Mechanisms linking interparental aggression to child dental caries. Caries Res. 2017;51(2):149–59.
Tsuchiya S, Tsuchiya M, Momma H, et al. Influence of maternal postpartum depression on children’s toothbrushing frequency. Community Dent Oral Epidemiol. 2022;50(4):300–10. https://doi.org/10.1111/cdoe.12672.
Greene P, Chisick MC. Child abuse/neglect and the oral health of children’s primary dentition. Mil Med. 1995;160(6):290–3.
Jessee SA. Orofacial manifestations of child abuse and neglect. Am Fam Physician. 1995;52(6):1829–34.
Greene PE, Chisick MC, Aaron GR. A comparison of oral health status and need for dental care between abused/neglected children and nonabused/non-neglected children. Pediatr Dent. 1994;16(1):41–5.
Takayama JI, Wolfe E, Coulter KP. Relationship between reason for placement and medical findings among children in foster care. Pediatrics. 1998;101(2):201–7.
Valencia-Rojas N, Lawrence HP, Goodman D. Prevalence of early childhood caries in a population of children with history of maltreatment. J Public Health Dent. 2008;68(2):94–101.
Lang R, Lorenzetti DL, Milaney K, et al. The relation between exposure to intimate Partner Violence and Childhood Dental Decay: a scoping review to identify Novel Public Health Approaches to early intervention. J Can Dent Assoc [Internet]. 2019;84:j5.
Smitt HS, Mintjes N, Hovens R, de Leeuw J, de Vries T. Severe caries are a clue for child neglect: a case report. J Med Case Rep. 2018;12(1):109.
Keene EJ, Skelton R, Day PF, Munyombwe T, Balmer RC. The dental health of children subject to a child protection plan. Int J Paediatr Dent. 2015;25(6):428–35.
Bhatia SK, Maguire SA, Chadwick BL, et al. Characteristics of child dental neglect: a systematic review. J Dent. 2014;42(3):229–39.
Lourenço CB, Saintrain MVDL, Vieira APGF. Child, neglect and oral health. BMC Pediatr. 2013;13(1):188. https://doi.org/10.1186/1471-2431-13-188.
Kvist T, Annerback E-M, Dahllof G. Oral health in children investigated by Social services on suspicion of child abuse and neglect. CHILD Abus & Negl. 2018;76:515–23.
Duda JG, Biss SP, de Paiva Bertoli FM, et al. Oral health status in victims of child abuse: a case-control study. Int J Paediatr Dent. 2017;27(3):210–6.
Harris JC. The mouth and maltreatment: safeguarding issues in child dental health. Arch Dis Child. 2018;103(8):722–9.
Gurunathan D, Shanmugaavel AK. Dental neglect among children in Chennai. J Indian Soc Pedod Prev Dent. 2016;34(4):364–9.
Sillevis Smitt H, de Leeuw J, de Vries T, Smitt HS, de Leeuw J, de Vries T. Association between severe Dental Caries and child abuse and neglect. J ORAL Maxillofac Surg. 2017;75(11):2304–6.
Folayan MO, El Tantawi M, Vukovic A, et al. Women’s economic empowerment, participation in decision-making and exposure to violence as risk indicators for early childhood caries. BMC Oral Health. 2020;20(1):54. https://doi.org/10.1186/s12903-020-1045-5.
Tokue H, Tokue A, Tsushima Y. Detection of child abuse on computed tomography imaging due to presence of severe caries: a case report. Oral Radiol. 2022;38(3):430–2.
Simon A, Cage J, Akinkugbe AA. Adverse childhood experiences and oral health outcomes in u.S. children and adolescents: a cross-sectional study of the 2016 national survey of children’s health. Int J Environ Res Public Health. 2021;18(23).
Kiatipi M, Davidopoulou S, Arapostathis K, Arhakis A. Dental Neglect in Children: a Comprehensive Review of the literature. J Contemp Dent Pract. 2021;22(2):199–204.
Shmerling E, Creati M, Belfrage M, Hedges S. The health needs of Aboriginal and Torres Strait Islander children in out-of-home care. J Paediatr Child Health. 2020;56(3):384–8.
Kopycka-Kedzierawski DT, Billings RJ, Feng C et al. A prospective longitudinal study of early childhood caries onset in initially Caries-Free Children. JDR Clin Trans Res 2022 Jun 9:23800844221101800. https://doi.org/10.1177/23800844221101800.
Folayan MO, Obiyan MO, El Tantawi M, et al. An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007–2017. AAS Open Res. 2022;4:39. https://doi.org/10.12688/aasopenres.13237.3.
Scheutz F, Heidmann J, Poulsen S. Dental health of vietnamese Boat people on Pulau Bidong, Malaysia. Community Dent Oral Epidemiol. 1983;11(4):255–8.
Todd R, Gelbier S. Dental caries prevalence in vietnamese children and teenagers in three London boroughs. Br Dent J. 1990;168(1):24–6.
Cote S, Geltman P, Nunn M, Lituri K, Henshaw M, Garcia RI. Dental caries of refugee children compared with US children. Pediatrics. 2004;114(6):e733–40.
Noaman BR, Khalid RF, Fattah LD. Maternal Dental Health Knowledge and its relation to the Dental Caries experience of their children in Mamyzawa Camp of Refugees in Erbil, Iraq. Acta Med Acad. 2019;48(3):294–302.
Moreau A-M, Hennous F, Dabbagh B, dos Santos B. Oral Health Status of Refugee Children in Montreal. J Immigr Minor Heal. 2019;21(4):693–8.
Ogawa JT, Kiang J, Watts D-J, Hirway P, Lewis C. Oral Health and Dental Clinic Attendance in Pediatric Refugees. Pediatr Dent. 2019;41(1):31–4.
Hoover J, Vatanparast H, Uswak G. Risk determinants of Dental Caries and oral Hygiene Status in 3–15 year-old recent immigrant and Refugee Children in Saskatchewan, Canada: a pilot study. J Immigr Minor Heal. 2017;19(6):1315–21.
Azrak ME, Huang A, Hai-Santiago K, Bertone MF, DeMaré D, Schroth RJ. The oral health of Preschool Children of Refugee and immigrant families in Manitoba. J Can Dent Assoc. 2017;82:h9.
Reza M, Amin M, Sgro A et al. Oral health status of immigrant and refugee children in North America: a scoping review. J Can Dent Assoc (Tor). 2016;82.
Nicol P, Anthonappa R, King N, Slack-Smith L, Cirillo G, Cherian S. Caries burden and efficacy of a referral pathway in a cohort of preschool refugee children. Aust Dent J. 2015;60(1):73–9.
Francis J, Mutch RC, Rutherford DM, Cherian S. Universal paediatric refugee health screening. J Paediatr Child Health. 2012;48(11):1048–9.
Quach A, Laemmle-Ruff IL, Polizzi T, Paxton GA. Gaps in smiles and services: a cross-sectional study of dental caries in refugee-background children. BMC Oral Health. 2015;15:10. https://doi.org/10.1186/1472-6831-15-10.
Lauritano D, Moreo G, Carinci F, Campanella V, Della Vella F, Petruzzi M. Oral health status among migrants from middle-and low-income countries to europe: a systematic review. Int J Environ Res Public Health. 2021;18(22):12203. https://doi.org/10.3390/ijerph182212203.
Flynn PM, Petersen A, Entinger J, Shire A. The Association of Social Determinants of Health with Somali Refugee mother–child caries. J Immigr Minor Heal. 2021;23(3):615–23.
Al-Ani A, Takriti M, Schmoeckel J, Alkilzy M, Splieth CH. National oral health survey on refugees in Germany 2016/2017: caries and subsequent complications. Clin Oral Investig. 2021;25(4):2399–405.
Alrashdi M, Mendez MJC, Farokhi MR. A randomized clinical trial preventive outreach targeting dental caries and oral-health-related quality of life for refugee children. Int J Environ Res Public Health. 2021;18(4):1–10.
Bhusari S, Ilechukwu C, Elwishahy A, Horstick O, Winkler V, Antia K. Dental caries among refugees in europe: a systematic literature review. Int J Environ Res Public Health. 2020;17(24):1–12.
Werneck RI, Lawrence HP, Kulkarni GV, Locker D. Early childhood caries and access to dental care among children of portuguese-speaking immigrants in the city of Toronto. J Can Dent Assoc. 2008;74(9):805.
Joury E, Meer R, Abou Chedid JC, Shibly O. Burden of oral diseases and impact of protracted displacement: a cross-sectional study on syrian refugee children in Lebanon. Br Dent J.
Salim NA, Sawair FA, Meyad FH, Satterthwaite JD, Abukaraky A, Sartawi S. Pattern, frequency and causes of dental extraction among children/adolescents syrian refugees: an observational study. BMC Pediatr. 2022;22(1).
Joury E. Syria Profile of the Epidemiology and Management of Early Childhood Caries before and during the time of Crisis. Front Public Heal. 2019;7.
Folayan MO, El Tantawi M, Vukovic A et al. Governance, maternal well-being and early childhood caries in 3-5-year-old children. BMC Oral Health. 2020;20(1).
Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119–26. https://doi.org/10.11124/jbies-20-00167.
Thomas A, Lubarsky S, Durning SJ, Young ME. Knowledge syntheses in medical education: demystifying scoping reviews. Acad Med. 2017;92(2):161–6. https://doi.org/10.1097/ACM.0000000000001452.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:71.
Google Charts. Sankey diagram: an overview. Available at: https://developers.google.com/chart/interactive/docs/gallery/sankey. Accessed: 23 January, 2023.
World Health Organization. Countries. Available at: https://www.who.int/countries. Accessed: 23 January, 2023.
World Health Organization. Refugee and Migrant Health: Key facts. 2 May 2022. Available at: https://www.who.int/news-room/fact-sheets/detail/refugee-and-migrant-health. Accessed: 24 January, 2023.
UNHCR, Refugee Statistics. 2023. Available at: https://www.unrefugees.org/refugee-facts/statistics/. Accessed: 18th January 2023.
UNHCR. Refugee data finder. 2001-23. https://www.unhcr.org/refugee-statistics/#~:text=At%20the%20end%20of%202021,below%2018%20years%20of%20age.&text=Between%202018%20and%202021%2 C%20an,a%20refugee%20life%20per%20year. Accessed: 18th January 2023.
World Health Organisation. World oral health report. Geneva: WHO; 2022.
El Tantawi M, Folayan MO, Mehaina M, et al. Prevalence and data availability of early childhood caries in 193 United Nations Countries, 2007–2017. Am J Public Health. 2018;108(8):1066–72. https://doi.org/10.2105/AJPH.2018.304466.
Hillis S, Mercy J, Amobi A, Kress H. Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics. 2016;137(3):e20154079.
World Health Organization. Global status report on preventing violence against children. 2020. Available at: https://www.who.int/teams/social-determinants-of-health/violence-prevention/global-status-report-on-violence-against-children-2020. Accessed: 18th January 2023.
Choonara I. Global peace dividend and child health. BMJ Paediatrics Open. 2022;6:e001442. https://doi.org/10.1136/bmjpo-2022-001442.
UNICEF. The state of the worlds children 2021. Available: https://www.unicef.org/reports/state-worlds-children-2021.
Royal College of Paediatrics & Child Health. Available: https://www.rcpch.ac.uk/resources/protection-children-conflict-child-refugees-position-statement-2016.
Mohamed KS, Abasse KS, Abbas M, Sintali DN, Baig MMFA, Cote A. An overview of Healthcare Systems in Comoros: the Effects of two decades of political instability. Ann Glob Health. 2021;87(1):84. https://doi.org/10.5334/aogh.3100.
Cairney P, Oliver K. Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy? Health Res Policy Syst. 2017;15(1):35. https://doi.org/10.1186/s12961-017-0192-x.
The World Bank. Collaborating to improve the measurement of results from support for Governance and Public Sector Management reforms. Available at: http://siteresources.worldbank.org/PUBLICSECTORANDGOVERNANCE/Resources/285741-1354024300711/ISPMS.pdf?.
Whaites A. Achieving the impossible: can we be SDG 16 believers? GovNet Background Paper No2, 2016. Available at: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://peaceinfrastructures.org/Home%20Documents/Achieving%20the%20Impossible-Can%20we%20be%20SDG%2016%20believers/Whaites_OECD_Achieving%20SDGs_2016.pdf. Accessed: 9th January 2023.
Acknowledgements
We appreciate all the participants who provided data and contributed their time to make this study possible.
Funding
Not applicable.
Author information
Authors and Affiliations
Contributions
M.O.F conceived the study. The Project was managed by M.O.F. Data curating was done by MET, IA and AN. Data analysis was conducted by MOF, IA, AN IGS and MET. MOF and MET developed the first draft of the document. RJS, IA, AN, OBA-B, JIV, BG, DD, IGS, SM, CAF and MET read the draft manuscript and made inputs prior to the final draft. All authors approved the final manuscript for submission.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
Duangporn Duangthip is an Associated Editor with the BMC Oral Health. Jorma Virtanen is a Senior Editor Board member with BMC Public Health. Morenike Oluwatoyin Folayan and Maha El Tantawi are Senior Editor Board members with BMC Oral Health. All other authors declare no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Folayan, M.O., Schroth, R.J., Ayouni, I. et al. A scoping review linking early childhood caries to violence, neglect, internally displaced, migrant and refugee status. BMC Oral Health 23, 747 (2023). https://doi.org/10.1186/s12903-023-03459-0
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12903-023-03459-0