JMIR Publications

ABSTRACT

Background:

Social disparities in oral health are a persistent global challenge, disproportionately affecting Indigenous populations.

Objective:

To compare oral health status, access to dental treatment, and social determinants of health between Mapuche and non-Mapuche older adults in the La Araucanía Region of Chile, within the context of a mobile digital healthcare model. In addition, it examines whether ethnicity serves as a predictor of oral health outcomes and dental treatment access, guided by the Commission on Social Determinants of Health (CSDH) framework

Methods:

A cross-sectional analytic study of 480 adults ≥ 60 years attended through a hybrid teledentistry and mobile clinic model (TEGO) in four municipalities; participants with incomplete data were excluded. Outcomes included non-functional dentition, edentulism, caries, periodontitis fixed prosthetic rehabilitation, and unmet denture need. Determinants were classified as structural (sex, age, education, rurality, ethnicity) or intermediate (behavioral, biological, psychosocial and health system access). Bivariate analyses compared Mapuche and non-Mapuche participants, followed by multivariable logistic regression, adjusted for number of teeth present, to evaluate predictors of oral health outcomes and dental treatment access.

Results:

A total of 471 older adults (mean age 72.8 years, SD 7.7) were included. Overall, 76.9% had non-functional dentition, 18% were edentulous, 25.6% had caries, 46% had periodontitis. In bivariate analysis Mapuche older adults showed lower educational attainment, higher rural residence, and poorer oral health than non-Indigenous peers, with more risk factors (infrequent toothbrushing, higher sugar intake), greater restorative needs, and reduced access to complex dental care. In the multivariate analysis structural determinants exerted stronger effects on oral health outcomes than intermediary ones, however associations varied depending on the outcome assessed. Female sex increased edentulism risk but was protective for periodontitis; lower education predicted non-functional dentition ((OR 4.28, 95% CI 2.34-7.88, P<.001) and edentulism (OR 3.04, 95% CI 1.52-6.09, P=.002), and ethnicity was the most consistent predictor for cavitated caries (OR 2.40, 95% CI 1.25-4.63, P=.009) or periodontitis, with Mapuche participants showing over twice the odds of periodontitis compared to non-Mapuche (OR 2.43, 95% CI 1.21-4.88, P=.01). Current restorative and prosthetic needs were associated with sugar consumption and tobacco use, respectively. Access to dental care was associated with behavioral factors (brushing, interproximal hygiene, sugar intake) and structural determinants (age, sex, rurality, ethnicity).

Conclusions:

Social determinants of Mapuche older adults differ from their non-indigenous counterparts. Nevertheless, Structural determinants, particularly low education, sex, age, were key predictors of oral health outcomes and care access, while sugar consumption and tobacco use were linked to treatment needs. Prioritizing these determinants, systematically monitoring them, and integrating digital innovations could help promote more equitable and accessible oral health care.