Amid a Growing Refugee Crisis, the Oral Health of Millions Risks Further Decay

With ongoing conflict, violence, and climate disasters around the world, the refugee and asylum-seeking communities continue to grow. As such, oral health is increasingly recognized as a priority in their care.

By Susan Richards

Following World War II, the United Nations High Commissioner for Refugees (UNHCR) was temporarily established to help Europeans who had lost their homes or were forced to flee. It was intended to be a three-year program. However, assistance was always needed in other corners of the world and the office was never disbanded.

Today, the UNHCR, also known as the UN Refugee Agency, estimates there are 84 million people around the world who have been forcibly displaced from their homes. More than 26 million of these people are refugees, with that number continuing to rise as the Russian invasion has pushed almost 4 million Ukrainians out of their homeland in recent weeks. 

The international legal definition of “refugee” was developed under the 1951 Convention Relating to the Status of Refugees, commonly referred to as The Geneva Convention, in response to the unique situation of survivors of World War II.  A “refugee” is defined as “a person who is outside his or her country of nationality or habitual residence; [and] has a well-founded fear of being persecuted because of his or her race, religion, nationality, membership of a particular social group or political opinion.”

Shelter, Food, and Healthcare

While most of us can take these basics for granted, many refugees are not only faced with the need to seek safe harbor, but they may battle hunger, the elements, trafficking, disease, and more. According to the U.K. non-profit Evidence Aid, the most pressing healthcare concerns they address in the refugee populations are tuberculosis, skin conditions, vaccine-preventable diseases, and mental health issues.

However, the organization recently recognized that oral healthcare must also be a priority in humanitarian efforts for the refugee crises and officially expanded their own mission to reflect that.

Refugees and Oral Health

While people have sought refuge from and in many regions around the world, the majority (68%) currently originate from five countries: Myanmar, South Sudan, Afghanistan, Syria, and now Ukraine. Their level of oral health can be reflected by both the country they fled and where they settle. Refugee Health Technical Assistance Center notes relevant factors to be aware of when refugees first arrive, and later:

  • Lack of prior or current access to oral healthcare
  • Alternative methods of dental care, such as teeth-cleaning twigs
  • Limited nutrition as well as change to unfamiliar regional diet
  • Communication issues with lack of interpretation in the dental setting
  • Dental and health care workers in host countries may find refugees unfamiliar with common hygiene habits like flossing, many have missing dental records, and general mistrust of medical personnel can exacerbate matters.

A 2021 National Institutes of Health (NIH) review of refugees and asylum-seekers in Europe revealed an urgent need for more interventions and access to oral healthcare, particularly treatment of periodontal disease and dental decay.

One study of refugees in Germany, primarily from Syria and Iraq, showed a high number of untreated caries and bacterial plaque despite a good level of oral hygiene knowledge. This demonstrated a clear gap between attitude and practice that needs to be addressed.

The Most Vulnerable

Children are undoubtedly the most vulnerable to health issues in high-risk refugee and immigrant communities. Whether due to the crisis they’ve escaped or cultural differences in their country of origin, many of the youngest refugees have not had adequate dental healthcare, according to another NIH study.

Other factors influenced children’s oral health as well. For example, researchers discovered that despite having less structured dental care, children from East African countries had lower rates of caries than those from Eastern Europe due to more prevalent water fluoridation and traditional diets that are low in sugar.

Cultural traditions have also impacted children’s dental care, such as the traditional practice of canine tooth bud removal in parts of Ethiopia. The harmful and painful procedure is based on the erroneous belief that these buds are the cause of diarrhea and fever during teething. Outreach and education are encouraged in these communities to prevent continued oral mutilation.

While much can and should be done to address cultural differences in order to improve oral health for children in ethnic communities, the NIH researchers offer five initial suggestions for medical providers:

  1. Ask about diet, bottle use, and dental care history
  2. Examine and assess for lesions and decay
  3. Apply fluoride varnish where possible
  4. Advise families on the value of daily hygiene practices
  5. Refer to dental providers in their community with adequate urgency

Making a Difference

Although the refugee crisis continues to grow worldwide, humanitarian efforts work to keep pace. The FDI World Dental Federation represents more than a million dentists and dental associations around the globe, working with the United Nations to contribute oral healthcare for refugees everywhere.

The Anera organization has provided assistance since 1968 and has launched a project focusing on the dental health of Syrian refugees in Lebanon and surrounding settlements. Unclean drinking water has exacerbated the lack of dental care there as well as poverty.

In the United States, recent efforts include several Oklahoma City organizations offering free dental services to local Afghan refugees, and 16 Philadelphia dental students treating more than 60 patients – also Afghan – at a pop-up clinic.

Many Ukrainians surged into Poland when the Russian conflict began, and the Polish dental community responded by launching a database of dentists offering free urgent care to the refugees.

Dentists have long understood the importance of good oral health as it can improve quality of life, overall health, and even the economy as people maintain the ability to learn and work. This awareness must extend to the refugee and asylum-seeking community in order to mitigate the growing global crisis.

If readers would like to learn how they can help, here are a few organizations and resources available:


Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan’s career includes award-winning feature writing, as well as creating content with context for a wide variety of industries.

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