Therapeutic approaches for difficult-to-treat rheumatoid arthritis: a systematic literature review of current evidence.

Oral health remains an integral component of overall health and well-being, yet the prevalence of common oral diseases remains a significant global health issue. Oral diseases have been reported to affect approximately 3.5 billion people, which represents 45% of the global population. This global burden remains challenging, especially in low-and middle-income countries and has been known to have a strong association with affecting the poor and socially disadvantaged members of society. This is further exemplified by factors that extend beyond financial capacity, such as geographic location, health literacy and systemic healthcare limitations. The local landscape does not deviate far from the global trend. Data from several cycles of National Health and Morbidity Surveys consistently demonstrate a higher prevalence of oral disease among the rural population. National Oral Health Survey of Adults 2020, a survey conducted in Malaysia to understand the oral health status of adults and their treatment needs, also documented that 85.1% of adults in Malaysia had dental caries and 94.5% had periodontal conditions. Although the public sector provides a comprehensive network of dental care facilities such as health clinics, hospitals, Urban Transformation Centres, and Rural Transformation Centres, in addition to the large number of private dental care facilities, the utilisation of oral healthcare services remains low among those residing in rural areas, those of low socio-economic status, the elderly and toddlers or preschoolers. Gaps are still prevalent as the targets set by the programme’s National Oral Health Plan on the oral health status of the elderly and primary school children have not been met. This was further exacerbated by the findings from a national survey that highlighted the decline in the utilisation rate of oral health care services from 27.8% in 2015 to 23.7% in 2019. These findings warrant remedial measures to be undertaken to address the oral health status of the population. The World Health Organization has been advocating for oral healthcare systems to be restructured to adopt approaches that prioritise vulnerable communities and innovative workforce solutions, such as the utilisation of non-dental health professionals to increase oral health literacy. This would require a strategic shift away from static facility-based care to address issues of limited accessibility, affordability and human resource constraints. Community health outreach programmes have been touted as an effective strategy to reach vulnerable populations to identify health needs, empower communities for awareness and lifestyle change, and provide screening services. The models adopted to deliver these services globally include collaborating with community-based organisations, forming partnerships with community centres or clinics, and engaging with community health workers.