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      University-based initiatives towards better access to oral health care for rural and remote populations: A scoping review

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          Abstract

          This scoping review maps a wide array of literature to identify academic programs that have been developed to enhance oral health care for rural and remote populations and to provide an overview of their outcomes. Arksey and O’Malley’s 5-stage scoping review framework has steered this review. We conducted a literature search with defined eligibility criteria through electronic databases, websites of academic records, professional and rural oral health care organizations as well as grey literature spanning the time interval from the late 1960s to May 2017. The charted data was classified, analyzed and reported using a thematic approach. A total of 72 citations (67 publications and seven websites) were selected for the final review. The review identified 62 universities with program initiatives towards improving access to oral health care in rural and remote communities. These initiatives were classified into three categories: training and education of dental and allied health students and professionals, education and training of rural and remote community members and oral health care services. The programs were successful in terms of dental students’ positive perception about rural practice and their enhanced competencies, students’ increased adoption of rural practices, non-dental health care providers’ improved oral health knowledge and self-efficacy, rural oral health and oral health services’ improvement, as well as cost-effectiveness compared to other strategies. The results of our review suggest that these innovative programs were effective in improving access to oral health care in rural and remote regions and may serve as models for other academic institutions that have not yet implemented such programs.

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          Using teledentistry to improve access to dental care for the underserved.

          Teledentistry is an exciting new area of dentistry that fuses electronic health records, telecommunications technology, digital imaging, and the Internet to link health providers in rural or remote communities. For the patient located in underserved or remote areas, teledentistry improves ready access to preventive dental care and teleconsultation with specialists. It allows the dentist in the nearby community to provide easier access to preventive care to a patient who, otherwise, probably will not seek care. It enables the specialist located many miles away to make a diagnosis and recommend treatment options and/or referral.
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            Conceptual recommendations for selecting the most appropriate knowledge synthesis method to answer research questions related to complex evidence.

            To compare and contrast different knowledge synthesis methods and map their specific steps through a scoping review to gain a better understanding of how to select the most appropriate knowledge synthesis method to answer research questions of complex evidence.
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              Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region.

              Although there have been major improvements in oral health, with remarkable advances in the prevention and management of oral diseases, globally, inequalities persist between urban and rural communities. These inequalities exist in the distribution of oral health services, accessibility, utilization, treatment outcomes, oral health knowledge and practices, health insurance coverage, oral health-related quality of life, and prevalence of oral diseases, among others. People living in rural areas are likely to be poorer, be less health literate, have more caries, have fewer teeth, have no health insurance coverage, and have less money to spend on dental care than persons living in urban areas. Rural areas are often associated with lower education levels, which in turn have been found to be related to lower levels of health literacy and poor use of health care services. These factors have an impact on oral health care, service delivery, and research. Hence, unmet dental care remains one of the most urgent health care needs in these communities. We highlight some of the conceptual issues relating to urban-rural inequalities in oral health, especially in the African and Middle East Region (AMER). Actions to reduce oral health inequalities and ameliorate rural-urban disparity are necessary both within the health sector and the wider policy environment. Recommended actions include population-specific oral health promotion programs, measures aimed at increasing access to oral health services in rural areas, integration of oral health into existing primary health care services, and support for research aimed at informing policy on the social determinants of health. Concerted efforts must be made by all stakeholders (governments, health care workforce, organizations, and communities) to reduce disparities and improve oral health outcomes in underserved populations.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                31 May 2019
                2019
                : 14
                : 5
                : e0217658
                Affiliations
                [1 ] Faculty of Dentistry, Université de Montréal, Montreal, Quebec, Canada
                [2 ] Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
                University of Queensland, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors also contributed equally to this work.

                Author information
                http://orcid.org/0000-0002-8370-4147
                http://orcid.org/0000-0002-7730-4139
                Article
                PONE-D-19-10981
                10.1371/journal.pone.0217658
                6544292
                31150463
                b3f23e9e-b1ff-430f-9893-ff82d3935906
                © 2019 Shrivastava et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 April 2019
                : 13 May 2019
                Page count
                Figures: 1, Tables: 6, Pages: 23
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Oral Medicine
                Oral Health
                Medicine and Health Sciences
                Health Care
                Health Services Research
                Research and Analysis Methods
                Research Design
                Survey Research
                Medicine and Health Sciences
                Oral Medicine
                Dentistry
                Social Sciences
                Sociology
                Social Research
                Medicine and Health Sciences
                Health Care
                Health Care Policy
                Health Systems Strengthening
                Social Sciences
                Sociology
                Education
                Schools
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                Custom metadata
                All relevant data are within the paper.

                Uncategorized
                Uncategorized

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