From Environment to Enamel: A Narrative Review of Social Determinants, Oral-Systemic Health Disparities, and the Interprofessional Clinical Pathway
Abstract
Background: Oral health disparities are not merely dental problems but manifestations of deeply entrenched social, economic, and environmental inequities. The social determinants of health (SDOH)—particularly poverty, food insecurity, and low health literacy—create a syndemic that fuels both poor oral health and adverse systemic outcomes, perpetuating cycles of disadvantage. Aim: This narrative review aims to synthesize evidence on the pathway through which SDOH generate oral-systemic health disparities and to examine the roles of an interprofessional team in screening for, diagnosing, and intervening upon these social and biological sequelae within clinical settings. Methods: A comprehensive literature search was conducted in PubMed, CINAHL, PsycINFO, SocINDEX, and Scopus (2010-2024). Results: The review delineates a causal pathway from structural inequities to biological risk (e.g., diet-driven malnutrition and inflammation) to clinical disease (caries, periodontitis, diabetes, CVD). It identifies critical gaps in clinical practice, including inadequate SDOH screening in dental and medical settings and a lack of integrated care models. The review proposes a framework for embedding systematic SDOH assessment (by nursing/social work), point-of-care nutritional and inflammatory biomarker testing (laboratory), behavioral counseling (psychology), and resource navigation (social work) into primary care and dental workflows. Conclusion: Addressing oral-systemic health disparities requires a fundamental reorientation of clinical practice from a biomedical to a biosocial model. Effective intervention necessitates co-located, interprofessional teams equipped to identify social risks and activate medical, dental, and community resources simultaneously, thereby treating the social roots of disease alongside its symptoms.
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Authors
Copyright (c) 2024 Eman Jabri Alanazi, Fatima Awad Jazaa Alenazi, Hanan Jubri Alanazi, Mohammed Shaya Alshammari, Laila Hassan Alsalman, Wed Madder Taid Algezani, Ahmed Mohammed Hussain Alzahrani, Mohammad Bani Zaid, Menwer Abdullah Alotaibi, Mohammed Mubarak Mohammed Aldawsari, Badr Mohammed Rabia Alanazi, Ali Murdi Alqarni, Abdullah Qabl Almutairi
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