**1. Introduction**

The literature has reported that a migration background can affect the oral health status of individuals [1,2], and, since the number of international migrants has continued to grow over the past five decades, this issue is salient.

According to the World Migration Report 2022, it is estimated that 218 million people now in a country other than their country of birth, and it was observed that the number of migrants is three times higher than in 1970 [3]. The International Migration Report

**Citation:** Lauritano, D.; Moreo, G.; Martinelli, M.; Campanella, V.; Arcuri, C.; Carinci, F. Oral Health in Migrants: An Observational Study on the Oral Health Status of a Migrant Cohort Coming from Middle- and Low-Income Countries. *Appl. Sci.* **2022**, *12*, 5774. https://doi.org/ 10.3390/app12125774

Academic Editor: Bruno Chrcanovic

Received: 14 May 2022 Accepted: 5 June 2022 Published: 7 June 2022

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**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

by the United Nations [4] highlighted that in 2017 more than 50% of the total number of international migrants settled in developed countries.

It has been reported that 1.9 million persons migrated to the European Union (EU) from non-EU countries in 2020, and, in 2021, 5.3% of the entire population living in the EU were migrants [5].

It has been largely demonstrated that poor oral health can have a negative effect on general health, consistently impacting daily activities [6–10], so much so that oral health was defined as a Leading Health Indicator 2020 [11].

Many developing countries, such as Bangladesh, Sri Lanka, Pakistan, and India, presented a very low oral health literacy [12], which the World Health Organization defined as "the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health" [13]. Furthermore, the healthcare system in these countries is often less qualified, not well organized, and without specific regulations [1].

Migrants move from their countries for many reasons, such as conflicts, persecution, and poverty [14,15], and they face many barriers once they reach the host country: social and economic inequalities, language and legal status problems, different cultural habits, and difficulties in accessing healthcare facilities [16,17]. Therefore, the phenomenon of migration, which includes economic, social, and emotional disruption, may negatively affect the quality of life of migrants and, consequently, their general health and oral health [18].

Several authors have demonstrated that people who migrated from middle- and lowincome countries to high-income countries presented a lower oral health status, a condition due to cultural habits, religiosity, and social behaviours of their native nations [19–21].

Pabbla et al. [22] recorded in his systematic review a significantly higher prevalence of dental caries and gingival bleeding among migrant children coming from Asian and African countries compared to the population of the host countries (European countries). The same study highlighted a general poor knowledge of oral health among migrants and a lack of monitoring by migrant parents of the oral health of their children.

Serna et al. [23] investigated the dental care utilization among Hispanic migrant farmworkers in South Florida, showing that most of them did not have a past year dental visit, and they presented poor oral conditions, having difficulties in accessing healthcare services.

The article by Svensson et al. [24] assessed poor oral hygiene in half of the analysed migrant children coming from Somalia to Sweden, underlining that 78–82% of them had never visited a dental department in their native nation, and that, in most cases, parents did not assist their youngest children during tooth cleaning.

There are different risk factors, which prevent migrant children from maintaining good oral health, and Reza et al. [25] grouped them into 3 levels: (1) the child level, due to the different oral hygiene habits, (2) the family level, including economic barriers, parents' inadequate knowledge of oral health practices, and scant attention to the oral health condition of their children and (3) the community level, that is, lack of medical insurance.

Considering these, interventions aimed at reducing disparities in access to dental treatment are necessary [26–28].

This observational study aimed to assess the periodontal health status and the prevalence of dental caries and lesions of the oral mucosa of a migrant cohort coming from middle- and low-income countries to Italy. Furthermore, we investigated the association between dental caries, periodontal status, and educational level of the included migrants.

## **2. Materials and Methods**

A cross-sectional design was used to realize this observational study, recording the prevalence of dental caries, oral mucosa lesions, and gingival health status in a migrant population coming from middle- and low-income countries and resident in Italy. Our research included 200 migrant subjects, aged between 3 and 37, who visited the dental department of the Policlinico Tor Vergata (Rome, Italy) in the period from 1 September

2021 to 31 March 2022. This study was approved by the Fondazione Policlinico Tor Vergata (Rome, Italy) ethical committee (approval number N. 0001919/2020 del 29/01/2020).

Inclusion criteria were as follows: (a) subjects under the age of 40 years; (b) patients identified as migrants; (c) persons whose country of origin was identified as middle- or low-income country; (d) participants aged 18 years and older had to be born in middleor low-income countries; (e) parents of patients under the age of 18 had to be born in middle- or low-income countries; (f) migrants resident in Italy. Persons aged 40 years and older, migrants identified as asylum seekers or refugees, non-migrant subjects, or migrants coming from high-income countries were excluded from our study.

The selected sample included 110 female and 90 male subjects aged between 3 and 37 (median age 9.39 years old ± 6.49). This research selected 188 children, of whom 30 were born in middle- and low-income countries, and 158 were born in Italy but had both parents whose country of birth was a middle- or low-income country. The subjects selected for our study came from (Table 1):


**Table 1.** Country of origin of included patients.

Africa (*n* = 62): Egypt (*n* = 42), Morocco (*n* = 10), Tunisia (*n* = 4), Senegal (*n* = 3), Algeria (*n* = 1), Cameroon (*n* = 1), and Mauritius (*n* = 1);

Central and South America (*n* = 58): Peru (*n* = 36), Ecuador (*n* = 13), El Salvador (*n* = 7), Venezuela (*n* = 1), and Bolivia (*n* = 1);

Europe (*n* = 45): Romania (*n* = 13), Albania (*n* = 13), Ukraine (*n* = 6), Moldavia (*n* = 5), Kosovo (*n* = 2), Montenegro (*n* = 3), Bosnia and Herzegovina (*n* = 1), and Turkey (*n* = 2);

Asia (*n* = 35): China (*n* = 6), India (*n* = 3), the Philippines (*n* = 12), Pakistan (*n* = 1), Sri Lanka (*n* = 6), Bangladesh (*n* = 5), Nepal (*n* = 1), and Saudi Arabia (*n* = 1).
