Oral health in prison: an integrative review

• DOI: https://doi.org/10.1108/IJPH-08-2021-0081
• Published date: 18 March 2022
• Date: 18 March 2022
• Pages: 251-269
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Kjersti Berge Evensen,Vibeke Hervik Bull

Oral health in prison: an integrative review

Kjersti Berge Evensen and Vibeke Hervik Bull

Abstract

Purpose –Prisoners’ oral health is an often overseen, yet important aspect of the general health of

prisoners. To develop effective measures to improve the situation, it is important to get an overview

of existing research.The purpose of this study is to examine and analyse existingresearch on oral health

of prisonersand provide a thorough understandingof prisoners’ oral health and relatedfactors.

Design/methodology/approach –Due to relatively few scientific papers on prisoners’ oral health, an

integrative review was chosen. Integrative reviews allow for the inclusion of diverse methodologies. A

literature search was conducted, followed by an assessment of the quality of the studies by using the

Mixed MethodsAppraisal Tool. Thematic analysis wasused to analyse the studies.

Findings –The few studies addressing European prisoners’ oral health in the last 21years differ in

design and methodology. The results from this review indicate that prisoners’ oral health is a complex

phenomenon and should be understood from both individual and organisational perspectives. More

researchis needed to bridge the gap in the literature on prisoners’oral health.

Originality/value –To the best of the authors’ knowledge,this is the first literature review on European

prisoners’oral health.

Keywords Prison, Prisoner, Oral health, Dental health, Literature review, Integrative review

Paper type Research paper

Introduction

Oral health has improved, and the prevalence of dental caries has decreased in m ost Western

countries, but not for everyone. A recent Lancet Series article postulates that “extreme oral

health inequalities exist for the most marginalised and socially excluded groups in societies,

such as homeless people [and] prisoners” (Peres et al.,2019, p. 252) and the gap between

these groups and the general population is increasing (Freeman and Richards, 2019).

Prisoners generally come from socially disadvantaged communities and compared to the

general population, reflect higher rates of physical and mental diseases an d tobacco, alcohol

and illegal drug use (Heidari et al.,2007;Heidari et al.,2008;Priwe and Carlsson, 2018;

Vainionpa

¨a

¨et al.,2018;Arora et al. ,2020). Prisoners’ oral health is also inferior to that of the

general population [World Health Organization (WHO), 2 014]. Oral health includes physical,

emotional and social functions important to general health, self- esteem and dignity (Peres

et al., 2019;Slade, 1997;Treadwell et al.,2016). Poor oral health is associated with impaired

social and work opportunities and adverse health consequences , such as poor nutrition, pain,

increased medication, endocarditis, mouth cancer and diabetes (L ocker et al.,2000;Lockhart

et al., 2009;Ng and Leung, 2006;Slade, 1997). For prisoners, good ora l health may also be

related to successful reintegration intosociety (Janssen et al., 2017).

The WHO emphasises the importance of universal access to health-care services that are

provided in a way that meets individual preferences and needs (Cinar, 2016). Accordingly,

prisoners’ dental services should be adapted to the prison setting and their specific needs

(Cinar, 2016).

The objective of this review was to examine existing research on oral health of prisoners

from a broad perspective and provide a comprehensive understanding of prisoners’ oral

Kjersti Berge Evensen and

Vibeke Hervik Bull are both

based at Oral Health

Centre of Expertise-

Rogaland, Stavanger,

Norway.

Received 16 August 2021

Revised 20 December 2021

24 January 2022

11 February 2022

Accepted 11 February 2022

DOI 10.1108/IJPH-08-2021-0081 VOL. 19 NO. 2 2023,pp. 251-269, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 251

health and related factors.In line with the recommendations for integrative reviews,a further

aim was to develop a conceptual framework to understand all aspects of prisoners’ oral

health, including risk factorsand consequences for oral health and access and utilisation of

dental services in prison.

Method

An integrative review approach was chosen to look broadly into the phenomenon of oral

health of prisoners. An integrative approach allows for the inclusion of diverse

methodologies and study designs, as well as synthesising research from different sources,

capturing all aspects of prisoners’ oral health and offering a holistic understanding of the

phenomenon (Broome, 1993). Toronto and Remington’s (2020) guidelines for integrative

reviews were used for the problem formulation, literature search and data analyses.Much of

the literature on prisoners’ oral health comes from the USA (Heidari et al., 2014b). Although

the US and European prison populations are quite similar (Heidariet al., 2014a), their prison

and health-care systems are not, making a comparison of the two difficult (Heidari et al.,

2014d;Lunn et al., 2003). While dental health-care services in prisons across Europe differ

significantly as well (WHO, 2014), most European countries have pledged to follow the

WHO Health in Prison Project guidelines, which address oral health and dental services in

prison (Bose and Jenner, 2007).

Following Toronto and Remington’s (2020) guidelines, a preliminary literature search was

conducted using Google Scholar and EBSCO Discovery Services with the followingkeywords:

䊏“oral health” and “prison” or “jail” or “incarceration” or “imprisonment” or “correctional

facilities”;

䊏“dental health” and “prison” or “jail” or “incarceration” or “imprisonment” or

“correctional facilities”;

䊏“oral health” and “prisoner”; and

䊏“dental health” and “prisoner”. Integrative review guidelines recommend using more

than one search strategy (Toronto and Remington, 2020).

Therefore, a second literature search was conducted following Webster and Watson’s

(2002) recommendations: the references cited in the papers identified in the initial search

were examined, producing additional articles for review. Both authors independently

performed the literature searches and examination of articles. Inclusion and exclusion

criteria are presented in Table 1.

Both qualitative and quantitative studies were included, which is recommended in

integrative reviews to get a complete overview of the research on a field (Cooper, 1998).

Table 1 Inclusion and exclusion criteria

Inclusion criteria Exclusion criteria

Study published between January 2000 and October 2021 Studies published before between January 2000 and October 2021

Data collected from a prison setting in a European country Conducted on prisoners outside prison or outside Europe

English or Scandinavian language

Qualitative or quantitative peer-reviewed, scientific articles Reports, guides, evaluations of projects, theoretical papers, unpublished

manuscripts, conference papers

Passing both screening questions in MMAT Not meeting one or both of the screening questions in MMAT

Description of objectives, research question, sampling

strategy, data collection, respondents and analysis

Lack of description of either one or several of the following: study

objectives, research question, sampling strategy, data collection,

respondents and analysis

Conducted in a prison setting

Studies exploring all aspects of prisoners’ oral health Studies exploring prisoners’ health in general

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