Medical-Dental Integration for Vulnerable Populations: Addressing Social Determinants and Complex Care Needs – A Narrative Review
Abstract
Background: Vulnerable populations, including those experiencing homelessness, refugees, and the elderly in long-term care (LTC), suffer disproportionately from poor oral health and its systemic sequelae, exacerbated by fractured care systems and profound social determinants of health (SDOH). The historical schism between medical and dental care creates insurmountable barriers for these groups, leading to preventable suffering, dignity loss, and costly emergency department (ED) utilization for untreated dental pain and infection. Aim: This narrative review synthesizes evidence from 2010-2024 on integrated medical-dental care models for vulnerable populations, analyzing the roles of sociology, nursing, dental laboratories, health assistants, pharmacy, and health security in delivering equitable, person-centered care. Methods: A comprehensive search of PubMed, Scopus, CINAHL, and sociology databases was conducted. Thematic analysis integrated literature from public health, nursing, dental science, social sciences, and health services research. Results: Effective models—such as co-located clinics, embedded dental services in shelters/LTC, and mobile units—demonstrate improved access, better management of chronic diseases (e.g., diabetes), and reduced acute care visits. Success is contingent on addressing sociological barriers (stigma, trust), utilizing health assistants as navigators, incorporating oral health into nursing assessments, providing affordable prosthetics, and ensuring pharmaceutical coordination. Conclusion: Medical-dental integration is not merely a clinical convenience but an ethical imperative for health equity. Its realization requires a deliberate, team-based approach that dismantles professional siloes, actively counters structural stigma, and embeds oral health within a holistic framework of social care and crisis preparedness.
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Authors
Copyright (c) 2024 Masoud Ayed Aldossry, Tagred Abdullah Alhaeyty, Mansour Nidaa Aldhafeeri, Nasser Abdullah Aldhafeeri, Ahmed Bandar Qaynan Alotaibi, Omar Omair Mohammed Alharbi, Mohmmed Owaidh Almutairi, Salem Mohammed Ahmed Bajunayd, Mashael Abdullah Saif Al Mutawa, Ali Mahdi Abkar Mubarak, Saad Nasser Mohammed Alelyani, Jamal Nidaa Aldhafeeri
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