Impact of financial crises on oral health indicators: an integrative review of the literature

Probst, Livia Fernandes; Pucca, Gilberto Alfredo; Pereira, Antonio Carlos; Carli, Alessandro Diogo De

doi:10.1590/1413-812320182412.23132019

person Livia Fernandes Probst

schoolFaculdade de Odontologia, Universidade Federal de Mato Grosso do Sul. Av. Costa e Silva s/n, Pioneiros. 79070-900 Campo Grande MS Brasil. liviaprobst@hotmail.com

0000-0002-4696-0862

person Gilberto Alfredo Pucca Junior

schoolDepartamento de Odontologia, Faculdade de Ciências da Saúde, Universidade de Brasília. Brasília DF Brasil.

0000-0002-8781-9857

person Antonio Carlos Pereira

schoolDepartamento de Odontologia Social, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Piracicaba SP Brasil.

0000-0003-1703-8171

person Alessandro Diogo De Carli

schoolFaculdade de Odontologia, Universidade Federal de Mato Grosso do Sul. Av. Costa e Silva s/n, Pioneiros. 79070-900 Campo Grande MS Brasil. liviaprobst@hotmail.com

0000-0002-4560-4524

Collaborations

LF Probst and AD De Carli participated in the initial project design, data collection, manuscript writing and final approval of the version to be published. AC Pereira and GA Pucca Junior participated in the critical review of the content and final approval of the version to be published.

Date of search	Database	Strategy details	Results
July 15, 2019	PUBMED	((Economic Recession OR Economic Recessions Recessions, Economic Recession, Economic OR Economic Depression OR Depression, Economic OR Depressions, Economic OR Economic Depressions OR austerity policy)) AND (Oral Health OR Health, Oral OR Stomatognathic Diseases OR Disease, Stomatognathic OR Diseases, Stomatognathic OR Stomatognathic Disease OR Mouth and Tooth Diseases OR Dental Diseases OR Dental Disease OR Disease, Dental OR Diseases, Dental)	141
July 15, 2019	EMBASE	'economic recession'/exp AND ('mouth disease'/exp OR 'dental health'/exp)	09
July 15, 2019	Lilacs	(tw:(Economic Recession OR Economic Recessions Recessions, Economic Recession, Economic OR Economic Depression OR Depression, Economic OR Depressions, Economic OR Economic Depressions OR austerity policy)) AND (tw:(Oral Health))	14
July 15, 2019	SCOPUS	(TITLE-ABS-KEY("Economic Recession" OR "Economic Recessions" OR "Economic Depression" OR "austerity policy") AND TITLE-ABS-KEY("Oral Health" OR "Stomatognathic Diseases" OR "Mouth and Tooth Diseases" OR "Dental Disease"))	16
Total			180

Date of search	Database	Strategy details	Results
July 15, 2019	Google Scholar	Economic Recession and Oral Health	100 (10 first pages)
Total			100

Author, year	Study design	Objective	Economic crisis considered	Country	Assessed Indicator
Suominen-Taipale and Widström, 1998¹⁸	Observational	To determine whether the economic recession in Finland during the early 1990s affected the use of dental services.	1991-1994	Finland	Use of oral health services
Wall et al, 2012¹⁹	Observational	To assess the trends in oral health service use from 1997 to 2010, covering a period before, during and after the recent economic recession.	December 2007 to June 2009	USA	Use of oral health services
Abasaeed et al, 2013²⁰	Observational	To determine whether the economic recession had an impact on the number of untreated caries in baby teeth.	2007-2009 crisis	USA	Untreated caries
McClure and Sæmundsson, 2014²¹	Observational	To verify changes in oral health behaviors and frequency of dental visits before and after the onset of Iceland's economic collapse of 2008	2008	Iceland	Frequency of dental visits and daily brushing and flossing habits
Rallis et al, 2015²²	Observational	To investigate the impact of the financial crisis on the etiology of maxillofacial trauma in Greece and to discuss the social parameters that may influence the injury change patterns.	2008 financial crisis and austerity measures adopted in 2010	Greece	Maxillofacial fractures
Beazoglou et al, 2015²³	Observational	To assess the impact of Medicaid rate increases and the economic recession in relation to changes in Medicaid's enrollment numbers, utilization rates and service mix.	2007-2009 crisis	USA	Use of oral health services (Medicaid)
Fernández et al, 2015²⁴	Observational	To estimate the effects of the crisis on unmet dental care needs in Spain and to analyze the evolution of socioeconomic inequalities on these unmet needs before (2007) and during (2011) the current crisis.	2011	Spain	Untreated caries
Elstad, 2017²⁵	Observational	To analyze income inequalities in self-perceived access to dental care during the crisis years in 23 European countries.	2008-2013	23 European countries	Dental care coverage (%)
Guay, 2019²⁶	Observational	To quantify how the Great Recession impacted the demand for overall oral health care and, specifically, orthodontic care.	December 2007 to June 2009, a period known as the Great Recession	EUA	1. Frequency of visits to the dentist (general practitioner) 2. Frequencies of visits to the dental surgeon (orthodontist)

Author, year	Main results	Conclusions
Suominen-Taipale e Widström, 1998¹⁸	The only significant alteration during the years of the study on the use of dental services was observed among the groups entitled to subsidized care, which were those who reduced consultations and demand for dental care.	The intensified competition caused by the increase in the number of dental surgeons probably partially counterbalanced the effects of the economic recession; however, this market dispute between professionals favored individuals with higher income and levels of schooling.
Wall et al, 2012¹⁹	Among the children, there was a steady increase in the use of dental services between 1997 and 2010, coinciding with a shift from private to public insurance.	A desaceleração econômica entre 2007 e 2009 não resultou em um declínio estatisticamente significativo na taxa de utilização de atendimento odontológico entre a população como um todo. Mas a tendência agregada mascara uma variação significativa por idade e nível de pobreza.
Abasaeed et al, 2013²⁰	On the other hand, the adult population showed a reduction in access to dental services, particularly when assessing the lower income ranges. This is due to the fact that adult dental services are not a mandatory benefit under Medicaid.	The economic deceleration between 2007 and 2009 did not result in a statistically significant decline in the rate of dental care use among the population as a whole. But the aggregate trend masks a significant variation by age and poverty level.
McClure e Sæmundsson, 2014²¹	It was observed that a smaller number of children are receiving necessary dental care because of the 2007-2009 economic crisis, which led to a reduction in recent gains in the treatment of dental caries in children from North Carolina.	The deleterious effects of the Great Recession on the oral health of North Carolina kindergarten students were small but statistically significant.
Rallis et al, 2015²²	Overall, there was no general change in oral health behaviors (e.g., annual visits to the dentist and adequate brushing / flossing habits).	Economically vulnerable students are less likely to seek dental care during an economic crisis, while specific groups (unemployed men and women) increase healthier behaviors.
Beazoglou et al, 2015²³	The rate of facial fractures caused by car accidents before the crisis worsened was significantly reduced in the post-2010 period. In turn, the incidence of fractures due to interpersonal violence increased during the period of severe economic crisis.	The authors attribute the decrease in the rate of facial fractures caused by motor vehicle accidents to high gasoline prices, which led to a significant reduction in individual transport use. On the other hand, they attribute the increased incidence of fractures due to interpersonal violence to the increase in poverty and unemployment, which generated a wave of violence in the country.
Fernández et al, 2015²⁴	The combination of increased Medicaid reimbursement rates for enrolled dentists, better program management, and the economic recession led to an unprecedented increase in utilization rates of program-related oral health services. Specifically, service utilization rates increased, while the United States experienced the worst economic recession since the Great Depression of 1929.	Although it was impossible to quantify the separate effects of rising recession rates, there is considerable indirect evidence that the recession contributed to higher utilization rates.
Elstad, 2017²⁵	There was an increase in the need for oral health care. The Spanish health system provides basic coverage for preventive and restorative dental care with public funding for children. However, unlike other health services, publicly funded dental care for adults is limited to acute care.	The economic crisis resulted in an increase in the number of unemployed individuals and a decrease in the available income, both determinant factors of unmet dental care needs by the adult population.
Guay, 2019²⁶	There was a loss of 3.1% in dental care coverage considering the gross national average. The results show that countries with higher basic dental care coverage - whether from public health, compulsory social insurance or both - tend to have better access to dental treatment for the low-income strata, as well as lower income-related inequalities in dental care. The demand for oral health services declined during the recession for both general practitioners (GP) and orthodontic services. In 2015, the low-income group ended up slightly below the 2003 level, whereas the higher income group experienced a steady increase in the number of dental appointments (GP) during the study period, ending at a higher level in 2015 in comparison to 2003. For orthodontic consultations, in turn, the highest income group showed a decline in the first half of the study period and recovered it during the second half. The low-income group experienced a slight increase in dental visits, ending at a higher rate of visits in 2015 when compared to 2003. For both services, direct spending decreased slightly (4.8% for general oral health care and 0.04% for orthodontics). This difference can be explained by the often characteristic contractual payments for orthodontic care, which may moderate the effects of changes in short-term demand. The significant increase in payments made by government assistance programs is evident for both types of services, indicating that these programs either isolate overall economic trends or increase in response to a general economic deceleration.	The results indicate that the lowest income stratum (i.e., the fourth lowest in the country's income hierarchy) reported that the previous dental assistance was significantly more frequent than the upper income stratum in all 23 assessed countries, both in 2008/2009 and 2012/2013.
Guay, 2019²⁶		The deceleration in the status of the overall economy during the Great Recession period resulted in a decrease in the demand for general oral health care and orthodontic care in the United States.