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Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, Listl S, Celeste RK, Guarnizo-Herreño CC, Kearns C, Benzian H, Allison P, Watt RG. Oral diseases: a global public health challenge. Lancet 2019; 394:249-260. [PMID: 31327369 DOI: 10.1016/s0140-6736(19)31146-8] [Citation(s) in RCA: 1484] [Impact Index Per Article: 296.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/12/2019] [Accepted: 04/26/2019] [Indexed: 02/08/2023]
Abstract
Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.
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Affiliation(s)
- Marco A Peres
- Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Gold Coast, QLD, Australia
| | - Lorna M D Macpherson
- Department of Dental Public Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Robert J Weyant
- Department of Dental Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Blánaid Daly
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Renato Venturelli
- WHO Collaborating Centre in Oral Health Inequalities and Public Health, Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Stefan Listl
- Quality and Safety of Oral Healthcare, Department of Dentistry, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands; Section for Translational Health Economics, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Carol C Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Cristin Kearns
- Department of Preventive and Restorative Dental Sciences and Philip R Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Habib Benzian
- WHO Collaborating Centre for Quality-Improvement, Evidence-Based Dentistry, Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA; New York University College of Global Public Health, New York, NY, USA
| | - Paul Allison
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Richard G Watt
- WHO Collaborating Centre in Oral Health Inequalities and Public Health, Department of Epidemiology and Public Health, University College London, London, UK.
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52
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Understanding and tackling oral health inequalities in vulnerable adult populations: from the margins to the mainstream. Br Dent J 2019; 227:49-54. [DOI: 10.1038/s41415-019-0472-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Duijster D, Oude Groeniger J, van der Heijden GJMG, van Lenthe FJ. Material, behavioural, cultural and psychosocial factors in the explanation of socioeconomic inequalities in oral health. Eur J Public Health 2019; 28:590-597. [PMID: 29272383 PMCID: PMC6051465 DOI: 10.1093/eurpub/ckx209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background This study aimed to assess the contribution of material, behavioural, cultural and psychosocial factors in the explanation of socioeconomic inequalities (education and income) in oral health of Dutch adults. Methods Cross-sectional data from participants (25-75 years of age) of the fifth wave of the GLOBE cohort were used (n = 2812). Questionnaires were used to obtain data on material factors (e.g. financial difficulties), behavioural factors (e.g. smoking), cultural factors (e.g. cultural activities) and psychosocial factors (e.g. psychological distress). Oral health outcomes were self-reported number of teeth and self-rated oral health (SROH). Mediation analysis, using multivariable negative binomial regression and logistic regression, was performed. Results Education level and income showed a graded positive relationship with both oral health outcomes. Adding material, behavioural, cultural and psychosocial factors substantially reduced the rate ratio for the number of teeth of the lowest education group from 0.79 (95% confidence interval (CI): 0.75-0.83) to 0.92 (95% CI: 0.87-0.97) and of the lowest income group from 0.80 (95% CI: 0.73-0.88) to 1.04 (95% CI: 0.96-1.14). Inclusion of all factors also substantially reduced the odds ratio for poor SROH of the lowest education group from 1.61 (95% CI: 1.28-2.03) to 1.12 (95% CI: 0.85-1.48) and of the lowest income groups from 3.18 (95% CI: 2.13-4.74) to 1.48 (95% CI: 0.90-2.45). Conclusion In general, behavioural factors contributed most to the explanation of socioeconomic inequalities in adult oral health, followed by material factors. The contribution of cultural and psychosocial factors was relatively moderate.
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Affiliation(s)
- Denise Duijster
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Geert J M G van der Heijden
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
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54
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Knight ET, Murray Thomson W. A public health perspective on personalized periodontics. Periodontol 2000 2019; 78:195-200. [PMID: 30198135 DOI: 10.1111/prd.12228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk-assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio-economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach.
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Affiliation(s)
- Ellie T Knight
- Sir John Walsh Research Institute, Department of Oral Sciences, School of Dentistry, The University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Sir John Walsh Research Institute, Department of Oral Sciences, School of Dentistry, The University of Otago, Dunedin, New Zealand
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55
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Lutfiyya MN, Gross AJ, Soffe B, Lipsky MS. Dental care utilization: examining the associations between health services deficits and not having a dental visit in past 12 months. BMC Public Health 2019; 19:265. [PMID: 30836954 PMCID: PMC6402128 DOI: 10.1186/s12889-019-6590-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/25/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A growing literature supports the contention that closing the divide between dental and medical care can improve access to and coordination of patient care. Health service deficits (HSDs) entail: no routine medical exam, no personal healthcare provider (HCP), no health insurance, and/or delaying medical care because of cost all within the last 12 months. Examining the associations between HSDs and dental care utilization could inform strategies and interventions aimed at narrowing the gap between the medical and dental professions. This study explored whether HSDs are associated with not having a dental care visit within the last 12 months. In addition, the study sought to provide an updated analysis of the characteristics and factors associated with dental care utilization. METHODS Two thousand sixteen Behavioral Risk Factor Surveillance System survey data were analyzed using bivariate and multivariable techniques. The outcome variable for this study was: last dental visit was longer than 12 months ago. RESULTS US adults without healthcare insurance, without a personal HCP, who had delayed medical care because of cost, and who had their last routine medical visit longer than 12 months ago had greater odds of not having a dental visit within the last 12 months. Further, this study identified disparities in dental care utilization among males, rural residents, those earning less than $50,000 per year, Non-Hispanic Blacks and Non-Hispanic other races. Individuals with six or more and/or all of their permanent teeth removed and current smokers also had greater odds of not having had a dental care visit in the past 12 months. CONCLUSIONS Findings suggest that a stronger integration of medical and dental care might increase dental care utilization. In addition, persistent disparities in dental care utilization remain for several demographic groups. Targeted interventions offer the promise of helping achieve HP 2020 goals for improved oral health.
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Affiliation(s)
- M. Nawal Lutfiyya
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Minneapolis, MN USA
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
| | - Andrew J. Gross
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
| | - Burke Soffe
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
| | - Martin S. Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
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Tiwari T, Palatta AM. An Adapted Framework for Incorporating the Social Determinants of Health into Predoctoral Dental Curricula. J Dent Educ 2019; 83:127-136. [DOI: 10.21815/jde.019.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Tamanna Tiwari
- Department of Community Dentistry and Population Health
- Center for Oral Disease Prevention and Population Health Research; School of Dental Medicine; University of Colorado Anschutz Medical Campus
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57
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Weber-Gasparoni K. Examination, Diagnosis, and Treatment Planning of the Infant and Toddler. Pediatr Dent 2019. [DOI: 10.1016/b978-0-323-60826-8.00014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Agler CS, Shungin D, Ferreira Zandoná AG, Schmadeke P, Basta PV, Luo J, Cantrell J, Pahel TD, Meyer BD, Shaffer JR, Schaefer AS, North KE, Divaris K. Protocols, Methods, and Tools for Genome-Wide Association Studies (GWAS) of Dental Traits. Methods Mol Biol 2019; 1922:493-509. [PMID: 30838596 PMCID: PMC6613560 DOI: 10.1007/978-1-4939-9012-2_38] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Oral health and disease are known to be influenced by complex interactions between environmental (e.g., social and behavioral) factors and innate susceptibility. Although the exact contribution of genomics and other layers of "omics" to oral health is an area of active research, it is well established that the susceptibility to dental caries, periodontal disease, and other oral and craniofacial traits is substantially influenced by the human genome. A comprehensive understanding of these genomic factors is necessary for the realization of precision medicine in the oral health domain. To aid in this direction, the advent and increasing affordability of high-throughput genotyping has enabled the simultaneous interrogation of millions of genetic polymorphisms for association with oral and craniofacial traits. Specifically, genome-wide association studies (GWAS) of dental caries and periodontal disease have provided initial insights into novel loci and biological processes plausibly implicated in these two common, complex, biofilm-mediated diseases. This paper presents a summary of protocols, methods, tools, and pipelines for the conduct of GWAS of dental caries, periodontal disease, and related traits. The protocol begins with the consideration of different traits for both diseases and outlines procedures for genotyping, quality control, adjustment for population stratification, heritability and association analyses, annotation, reporting, and interpretation. Methods and tools available for GWAS are being constantly updated and improved; with this in mind, the presented approaches have been successfully applied in numerous GWAS and meta-analyses among tens of thousands of individuals, including dental traits such as dental caries and periodontal disease. As such, they can serve as a guide or template for future genomic investigations of these and other traits.
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Affiliation(s)
- Cary S Agler
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Dmitry Shungin
- Department of Odontology, Umeå University, Umeå, Sweden
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Andrea G Ferreira Zandoná
- Department of Comprehensive Dentistry, Tufts University School of Dental Medicine, Tufts University, Boston, MA, USA
| | - Paige Schmadeke
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Biospecimen Core Processing Facility, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Patricia V Basta
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Biospecimen Core Processing Facility, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Jason Luo
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Mammalian Genotyping Core, University of North Carolina, Chapel Hill, NC, USA
| | - John Cantrell
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Thomas D Pahel
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Beau D Meyer
- Department of Pediatric Dentistry, UNC School of Dentistry, CB#7450, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - John R Shaffer
- Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arne S Schaefer
- Department of Periodontology, Institute of Dental, Oral and Maxillary Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | - Kari E North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Carolina Center for Genome Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Kimon Divaris
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
- Department of Pediatric Dentistry, UNC School of Dentistry, CB#7450, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
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Fontana M, Eckert G, Keels M, Jackson R, Katz B, Kemper A, Levy B, Levy S, Yanca E, Kelly S, Daly J, Patterson B, McKnight P. Predicting Caries in Medical Settings: Risk Factors in Diverse Infant Groups. J Dent Res 2019; 98:68-76. [PMID: 30205016 PMCID: PMC6304713 DOI: 10.1177/0022034518799080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Expanded partnership with the medical community is a promising strategy for reducing disparities in dental caries among young children. However, no validated caries risk instrument exists for use in primary health care settings. To help resolve this gap, a 52-item caries risk questionnaire was developed and targeted to primary caregivers (PCGs) to test in a 3-y prospective study. To begin to understand the validity of the questionnaire items, the purpose of this study was to compare responses to the questionnaire based on key demographic characteristics known to be associated with disparities in caries experience (e.g., race/ethnicity and insurance status). A total of 1,323 one-year-old children were recruited primarily through 3 medical research networks. Baseline questionnaire responses were analyzed via logistic regression. The sample was 49% female. Its racial/ethnic makeup was as follows: 13% Hispanic, 37% White, 37% Black, and 13% other or multiracial. Sixty-one percent were enrolled in Medicaid, and 95% resided in urban communities. Mothers represented 94% of PCGs. There were significant differences ( P < 0.05) in baseline responses based on Medicaid status and race/ethnicity. As compared with those not enrolled in Medicaid, children in the Medicaid group were significantly more likely (after adjusting for race/ethnicity) to 1) go to sleep while nursing or drinking something other than water, 2) eat sugary snacks between meals, 3) consume sugary drinks between meals, 4) receive topical fluoride from a health professional, 5) visit the dentist, and 6) not have an employed adult in the household. PCGs of children enrolled in Medicaid were significantly more likely to be the mother, have bleeding gums, eat sugary snacks between meals, consume sugary drinks between meals, eat or drink something other than water before going to bed, and not get regular dental checkups. In conclusion, there are significant differences in caries risk questionnaire responses based on Medicaid status and race/ethnicity that provide construct and criterion validity to the developed caries risk tool (ClinicalTrials.gov NCT01707797).
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Affiliation(s)
- M. Fontana
- University of Michigan, Ann Arbor, MI,
USA
| | | | | | - R. Jackson
- Indiana University, Indianapolis, IN,
USA
| | - B.P. Katz
- Indiana University, Indianapolis, IN,
USA
| | - A.R. Kemper
- Division of Ambulatory Pediatrics,
Nationwide Children’s Hospital, Columbus, OH, USA
| | - B.T. Levy
- University of Iowa, Iowa City, IA,
USA
| | - S.M. Levy
- University of Iowa, Iowa City, IA,
USA
| | - E. Yanca
- University of Michigan, Ann Arbor, MI,
USA
| | - S. Kelly
- Indiana University, Indianapolis, IN,
USA
| | - J.M. Daly
- University of Iowa, Iowa City, IA,
USA
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Dye BA, Weatherspoon DJ, Lopez Mitnik G. Tooth loss among older adults according to poverty status in the United States from 1999 through 2004 and 2009 through 2014. J Am Dent Assoc 2019; 150:9-23.e3. [PMID: 30503018 PMCID: PMC6394416 DOI: 10.1016/j.adaj.2018.09.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND As tooth loss decreases in an aging United States, retaining enough natural teeth for function is important for quality of life. METHODS The authors used data from the 1999 through 2004 and the 2009 through 2014 National Health and Nutrition Examination Surveys to assess changes in tooth loss in adults 50 years or older. The authors evaluated changes in edentulism, retaining all teeth, and having a functional dentition (21 or more natural teeth) according to poverty status. RESULTS Edentulism was lower in 2009 through 2014 than in 1999 through 2004 (11% versus 17%) for adults 50 years or older, but this decrease was not significant among the poor (people at < 100% of the federal poverty guideline; P > .05). Complete tooth retention improved from 14% to 21% between 1999 through 2004 and 2009 through 2014 for people 50 years or older (P < .05). Gains were attributable mostly to adults who were nonpoor (≥ 200% federal poverty guideline). More older adults had a functional dentition in 2009 through 2014 than in 1999 through 2004 (67% versus 55%; P < .05), although the increases generally were significant only for those not living in poverty. CONCLUSIONS Complete tooth loss has decreased by more than 75% for those aged 65 through 74 years over the past 5 decades in the United States. Improvements in tooth loss measures, such as edentulism and complete tooth retention, have been most significant among the nonpoor, whereas those who are poor have experienced fewer improvements. PRACTICE IMPLICATIONS An aging population is experiencing less edentulism and greater tooth retention, so older adults may need more regular oral health care and prevention services to address concerns such as root caries and periodontal disease.
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61
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MORAES RB, MARQUES BB, COCCO DMP, KNORST JK, TOMAZONI F, ARDENGHI TM. Effect of environmental and socioeconomic factors on the use of dental floss among children: a hierarchical approach. Braz Oral Res 2019; 33:e096. [DOI: 10.1590/1807-3107bor-2019.vol33.0096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/01/2019] [Indexed: 11/22/2022] Open
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Stormon N, Kazantzis N, Ford PJ, Lalloo R. Children's oral health in Australia: The past decade's research agenda. Community Dent Oral Epidemiol 2018; 47:153-161. [DOI: 10.1111/cdoe.12438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/19/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Nicole Stormon
- UQ Oral Health Centre; School of Dentistry; The University of Queensland; Brisbane Queensland Australia
| | - Nicholas Kazantzis
- UQ Oral Health Centre; School of Dentistry; The University of Queensland; Brisbane Queensland Australia
| | - Pauline J. Ford
- UQ Oral Health Centre; School of Dentistry; The University of Queensland; Brisbane Queensland Australia
| | - Ratilal Lalloo
- UQ Oral Health Centre; School of Dentistry; The University of Queensland; Brisbane Queensland Australia
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63
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Henshaw M, Borrelli B, Gregorich S, Heaton B, Tooley E, Santo W, Cheng N, Rasmussen M, Helman S, Shain S, Garcia R. Randomized Trial of Motivational Interviewing to Prevent Early Childhood Caries in Public Housing. JDR Clin Trans Res 2018; 3:353-365. [PMID: 30238060 PMCID: PMC6139579 DOI: 10.1177/2380084418794377] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Caries experience among preschool-age children has remained relatively unchanged for the past 2 decades, despite recently documented decreases in untreated decay. OBJECTIVES In a community-based cluster-randomized controlled trial, a motivational interviewing (MI) intervention administered to primary caregivers was hypothesized to reduce caries increment over 2 y as compared with controls, among children aged 0 to 5 y at baseline living in public housing. METHODS Public housing residents, who served as interventionists, were trained in MI with a focus on early childhood caries prevention. All 26 eligible public housing developments were randomized to either control (quarterly clinical examinations, fluoride varnish applications, toothbrush/toothpaste, and educational brochures) or intervention (same procedures as control plus MI counseling). Quarterly MI sessions were delivered in English or Spanish over 2 y, audio recorded, and assessed for treatment fidelity. The primary outcome was the increment in dmfs (decayed, missing, and filled tooth surfaces) as assessed by clinical examination at baseline, 12 mo, and 24 mo. Secondary outcomes included caregiver oral health knowledge and child oral health behaviors (child toothbrushing and sugar-sweetened beverage intake). Baseline characteristics were compared between groups and adjusted for housing-site clusters. Longitudinal outcomes were analyzed with mixed models. RESULTS A total of 1,065 children (49% female, 55% non-White, 61% Hispanic, 89% below poverty level, n = 686 control) and their caregivers were enrolled. During 2 y of follow-up, the mean dmfs increment increased in both groups; however, there were no statistically significant group differences at 24 mo or group × time interactions. The mean increase in intervention caregivers' knowledge was significantly greater than that of control, F(2, 1,593) = 3.48, P = 0.0310, but there were no significant intervention effects on caregiver-reported child sugar-sweetened beverage intake or child toothbrushing. CONCLUSION MI counseling plus intensive caries prevention activities resulted in knowledge increases but did not improve oral health behaviors or caries increment (ClinicalTrials.gov NCT01205971). KNOWLEDGE TRANSFER STATEMENT When viewed in light of the findings from the companion Pine Ridge study and other recent MI studies, the results of this study suggest that when the complex disease of early childhood caries is addressed in high-risk populations, MI is not effective, and alternative approaches are warranted.
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Affiliation(s)
- M.M. Henshaw
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - B. Borrelli
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - S.E. Gregorich
- University of California, San Francisco, San Francisco, CA, USA
| | - B. Heaton
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | | | - W. Santo
- University of California, San Francisco, San Francisco, CA, USA
| | - N.F. Cheng
- University of California, San Francisco, San Francisco, CA, USA
| | - M. Rasmussen
- University of California, San Francisco, San Francisco, CA, USA
| | - S. Helman
- University of California, San Francisco, San Francisco, CA, USA
| | - S. Shain
- University of California, San Francisco, San Francisco, CA, USA
| | - R.I. Garcia
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
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Watt RG, Mathur MR, Aida J, Bönecker M, Venturelli R, Gansky SA. Oral Health Disparities in Children: A Canary in the Coalmine? Pediatr Clin North Am 2018; 65:965-979. [PMID: 30213357 DOI: 10.1016/j.pcl.2018.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite being largely preventable, oral diseases are still a major public health problem in child populations in many parts of the world. Increasingly, however, oral diseases disproportionately affect socially disadvantaged groups in society. It is unjust and unfair that children and families from disadvantaged backgrounds experience high levels of oral diseases. This article analyzes oral diseases through a health disparities lens. Action to combat oral health disparities requires a radical multifaceted strategy that addresses the shared underlying root causes of oral diseases, the social determinants of health inequality.
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Affiliation(s)
- Richard G Watt
- Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
| | - Manu Raj Mathur
- Department of Dental Public Health, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Gurgaon, Haryana 122002, India
| | - Jun Aida
- Department of International Health, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Marcelo Bönecker
- Dental Faculty, Av. Prof Lineu Prestes 2227 - University of Sao Paulo, Sao Paulo 05508-900, Brazil
| | - Renato Venturelli
- Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Stuart A Gansky
- Division of Oral Epidemiology and Dental Public Health, Center to Address Disparities in Children's Oral Health (Known As CAN DO), Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, Box #1361, San Francisco, CA 94143, USA
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Early childhood caries, salivary and microbiological aspects among 3- to 4-year-old children in Cali, Colombia. Eur Arch Paediatr Dent 2018; 19:347-352. [DOI: 10.1007/s40368-018-0365-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
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Costa SM, Martins CC, Pinto MQC, Vasconcelos M, Abreu MHNG. Socioeconomic Factors and Caries in People between 19 and 60 Years of Age: An Update of a Systematic Review and Meta-Analysis of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1775. [PMID: 30126170 PMCID: PMC6121598 DOI: 10.3390/ijerph15081775] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/11/2018] [Accepted: 08/15/2018] [Indexed: 12/14/2022]
Abstract
This study is aimed to perform an update of a systematic review and meta-regression to evaluate the effect modification of the socioeconomic indicators on caries in adults. We included studies that associated social determinants with caries, with no restriction of year and language. The Newcastle-Ottawa Scale was used to evaluate the risk of bias. With regard to the meta-analysis, statistical heterogeneity was evaluated by I², and the random effect model was used when it was high. A subgroup analysis was conducted for socioeconomic indicators, and a meta-regression was performed. Publication bias was assessed through Egger's test. Sixty-one studies were included in the systematic review and 25 were included in the meta-analysis. All of the studies were published between 1975 and 2016. The most frequent socioeconomic indicators were schooling, income, and socioeconomic status (SES). In the quantitative analysis, the DMFT (decayed, missing, filled teeth) variation was attributed to the studies' heterogeneity. The increase of 10.35 units in the proportion of people with lower SES was associated with an increase of one unit in DMFT, p = 0.050. The findings provide evidence that populations with the highest proportions of people with low SES are associated with a greater severity of caries. The results suggest the need for actions to reduce the inequalities in oral health (PROSPERO [CRD42017074434]).
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Affiliation(s)
- Simone M Costa
- Department of Dentistry, Universidade Estadual de Montes Claros, Montes Claros, Minas Gerais 39401-089, Brazil.
| | - Carolina C Martins
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil.
| | - Mânia Q C Pinto
- Department of Dentistry, Universidade Estadual de Montes Claros, Montes Claros, Minas Gerais 39401-089, Brazil.
| | - Mara Vasconcelos
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil.
| | - Mauro H N G Abreu
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil.
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Poor oral health affects survival in head and neck cancer. Oral Oncol 2018; 73:111-117. [PMID: 28939062 DOI: 10.1016/j.oraloncology.2017.08.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/18/2017] [Accepted: 08/14/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Poor oral health has emerged as a risk factor for squamous cell carcinoma of the head and neck (HNSCC) but its impact on survival has not been examined. We sought to estimate the impact of oral health indicators on survival in a population-based HNSCC cohort. MATERIALS AND METHODS Cases (n=1381) and age-, sex- and race-matched controls (n=1396) were participants in the Carolina Head and Neck Cancer Epidemiologic Study (CHANCE). Vital status was determined via linkage with the National Death Index. Survival was considered at 5years post-diagnosis or study-enrollment for controls. Oral health was assessed using self-reported indicators including frequency of routine dental exams and tooth brushing. We used Kaplan-Meyer analyses and Cox regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Routine dental visits during the preceding 10years were associated with decreased mortality risk (>10 visits: HR=0.6, 95% CI=0.4-0.8) after adjusting for confounders. This effect was most pronounced for oral cavity cancer-(e.g., >10 visits: HR=0.4, 95% CI=0.2-0.9). Dental visits were also positively associated with survival among controls. No other routine health screening (e.g., eye exams) was associated with survival. CONCLUSION We found significant associations between markers of oral health and survival among both HNSCC cases and controls. This association was most pronounced for sites closer to the dentition. Oral health may have a direct effect on tumor biology due to the associated immune or inflammatory response. It may also represent a proxy for wellness or unmeasured social determinants of health.
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68
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Filipponi T, Richards W, Coll AM. Oral health knowledge, perceptions and practices among parents, guardians and teachers in South Wales, UK: A qualitative study. Br Dent J 2018; 224:517-522. [PMID: 29576611 DOI: 10.1038/sj.bdj.2018.223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 11/09/2022]
Affiliation(s)
- T Filipponi
- University of South Wales, Life Sciences and Education, University of South Wales, Pontypridd, CF37 1DL
| | - W Richards
- University of South Wales, Life Sciences and Education, University of South Wales, Pontypridd, CF37 1DL
| | - A-M Coll
- University of South Wales, Life Sciences and Education, University of South Wales, Pontypridd, CF37 1DL
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Ballantine JL, Carlson JC, Ferreira Zandoná AG, Agler C, Zeldin LP, Rozier RG, Roberts MW, Basta PV, Luo J, Antonio‐Obese ME, McNeil DW, Weyant RJ, Crout RJ, Slayton RL, Levy SM, Shaffer JR, Marazita ML, North KE, Divaris K. Exploring the genomic basis of early childhood caries: a pilot study. Int J Paediatr Dent 2018; 28:217-225. [PMID: 29057527 PMCID: PMC5811369 DOI: 10.1111/ipd.12344] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE A genetic component in early childhood caries (ECC) is theorized, but no genome-wide investigations of ECC have been conducted. This pilot study is part of a long-term research program aimed to: (1) determine the proportion of ECC variance attributable to the human genome and (2) identify ECC-associated genetic loci. METHODS The study's community-based sample comprised 212 children (mean age=39 months; range = 30-52 months; males = 55%; Hispanic/Latino = 35%, African-American = 32%; American Academy of Pediatric Dentistry definition of ECC prevalence = 38%). Approximately 2.4 million single nucleotide polymorphisms (SNPs) were genotyped using DNA purified from saliva. A P < 5 × 10-8 criterion was used for genome-wide significance. SNPs with P < 5 × 10-5 were followed-up in three independent cohorts of 921 preschool-age children with similar ECC prevalence. RESULTS SNPs with minor allele frequency ≥5% explained 52% (standard error = 54%) of ECC variance (one-sided P = 0.03). Unsurprisingly, given the pilot's small sample size, no genome-wide significant associations were found. An intergenic locus on 4q32 (rs4690994) displayed the strongest association with ECC [P = 2.3 × 10-6 ; odds ratio (OR) = 3.5; 95% confidence interval (CI) = 2.1-5.9]. Thirteen loci with suggestive associations were followed-up - none showed evidence of association in the replication samples. CONCLUSION This study's findings support a heritable component of ECC and demonstrate the feasibility of conducting genomics studies among preschool-age children.
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Affiliation(s)
- Jami L. Ballantine
- Department of Pediatric DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Jenna C. Carlson
- Center for Craniofacial and Dental GeneticsSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of BiostatisticsGraduate School of Public HealthUniversity of PittsburghPittsburghPAUSA,Department of Human GeneticsGraduate School of Public HealthUniversity of PittsburghPittsburghPA USA
| | - Andrea G. Ferreira Zandoná
- Department of Operative DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Cary Agler
- Oral and Craniofacial Health SciencesSchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Leslie P. Zeldin
- Oral and Craniofacial Health SciencesSchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Richard Gary Rozier
- Department of Health Policy and ManagementGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Michael W. Roberts
- Department of Pediatric DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Patricia V. Basta
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA,Biospecimen Processing Facility coreUniversity of North CarolinaChapel HillNCUSA
| | - Jason Luo
- Lineberger Comprehensive Cancer CenterSchool of MedicineUniversity of North CarolinaChapel HillNCUSA,Mammalian Genotyping coreUniversity of North CarolinaChapel HillNCUSA
| | - Mikafui E. Antonio‐Obese
- Oral and Craniofacial Health SciencesSchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Daniel W. McNeil
- Departments of Dental Practice & Rural Health and PsychologyWest Virginia UniversityMorgantownWVUSA
| | - Robert J. Weyant
- Department of Dental Public Health and Information ManagementSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA
| | - Richard J. Crout
- Department of PeriodonticsSchool of DentistryWest Virginia UniversityMorgantownWVUSA
| | - Rebecca L. Slayton
- Department of Pediatric DentistrySchool of DentistryUniversity of WashingtonSeattleWAUSA
| | - Steven M. Levy
- Department of Preventive and Community DentistryUniversity of Iowa College of DentistryIowa CityIAUSA,Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIAUSA
| | - John R. Shaffer
- Center for Craniofacial and Dental GeneticsSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of Human GeneticsGraduate School of Public HealthUniversity of PittsburghPittsburghPA USA,Department of Oral BiologySchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA
| | - Mary L. Marazita
- Center for Craniofacial and Dental GeneticsSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of Human GeneticsGraduate School of Public HealthUniversity of PittsburghPittsburghPA USA,Department of Oral BiologySchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of PsychiatrySchool of MedicineUniversity of PittsburghPittsburghPAUSA,Clinical and Translational Science InstituteSchool of MedicineUniversity of PittsburghPittsburghPAUSA
| | - Kari E. North
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Kimon Divaris
- Department of Pediatric DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA,Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA
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Sabato E, Owens J, Mauro AM, Findley P, Lamba S, Fenesy K. Integrating Social Determinants of Health into Dental Curricula: An Interprofessional Approach. J Dent Educ 2018; 82:237-245. [DOI: 10.21815/jde.018.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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71
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Bono LK, Rogo EJ, Hodges K, Frantz AC. Post-Graduation Effects of an Advocacy Engagement Project on Alumni of a Dental Hygiene Program. J Dent Educ 2018; 82:118-129. [PMID: 29437843 DOI: 10.21815/jde.018.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/28/2017] [Indexed: 11/20/2022]
Abstract
The aim of this study was to investigate advocacy actions of dental hygiene program alumni who had completed a Legislative Advocacy Project (LAP) when they were students in the undergraduate or graduate program. Five variables were assessed: participation, frequency, perceived barriers, engagement, and mentorship. Alumni of the undergraduate and graduate programs were compared regarding frequency of and barriers encountered to legislative advocacy actions. A descriptive-comparative research design was used with quantitative and qualitative analysis. A convenience sample of 157 alumni who had completed a seven-week LAP at Idaho State University between 2008 and 2013 were invited to complete a 52-item author-designed online questionnaire in 2015. The response rate was 41.4%. The results showed a significant difference for participation prior to and after the LAP (df=12, X2=28.28, p=0.005). Most respondents, however, did not participate in legislative actions. There was a significant difference between the two groups for two frequency items: subscribing to online listservs (p=0.001) and contacting political representatives or staff (p=0.003). The three greatest barriers were time, financial resources, and testifying. The analysis found a significant difference between the two groups for the barrier of interest in advocating (p=0.05). In the qualitative analysis, themes emerged about engagement factors (collective efforts and advocacy commitment) and mentorship (mentoring experiences). Advocacy actions after graduation improved, but implementation of actions was challenging due to competing barriers. The results of this study may be useful in identifying key components of advocacy education that should be part of training programs.
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Affiliation(s)
- Leciel K Bono
- Prof. Bono is Assistant Professor, Dental Hygiene Department, Idaho State University; Dr. Rogo is Professor, Dental Hygiene Department, Idaho State University; Prof. Hodges is Professor Emerita, Dental Hygiene Department, Idaho State University; and Dr. Frantz is Professor Emeritus, College of Education, Idaho State University.
| | - Ellen J Rogo
- Prof. Bono is Assistant Professor, Dental Hygiene Department, Idaho State University; Dr. Rogo is Professor, Dental Hygiene Department, Idaho State University; Prof. Hodges is Professor Emerita, Dental Hygiene Department, Idaho State University; and Dr. Frantz is Professor Emeritus, College of Education, Idaho State University
| | - Kathleen Hodges
- Prof. Bono is Assistant Professor, Dental Hygiene Department, Idaho State University; Dr. Rogo is Professor, Dental Hygiene Department, Idaho State University; Prof. Hodges is Professor Emerita, Dental Hygiene Department, Idaho State University; and Dr. Frantz is Professor Emeritus, College of Education, Idaho State University
| | - Alan C Frantz
- Prof. Bono is Assistant Professor, Dental Hygiene Department, Idaho State University; Dr. Rogo is Professor, Dental Hygiene Department, Idaho State University; Prof. Hodges is Professor Emerita, Dental Hygiene Department, Idaho State University; and Dr. Frantz is Professor Emeritus, College of Education, Idaho State University
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72
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Do L, Ha D, Roberts-Thomson K, Jamieson L, Peres M, Spencer A. Race- and Income-Related Inequalities in Oral Health in Australian Children by Fluoridation Status. JDR Clin Trans Res 2018; 3:170-179. [DOI: 10.1177/2380084417751350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- L.G. Do
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - D.H. Ha
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - K.F. Roberts-Thomson
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - L. Jamieson
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - M.A. Peres
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - A.J. Spencer
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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73
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Oropesa RS, Landale NS, Hillemeier MM. How does legal status matter for oral health care among Mexican-origin children in California? SSM Popul Health 2017; 3:730-739. [PMID: 28944283 PMCID: PMC5607870 DOI: 10.1016/j.ssmph.2017.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This research examines the relationship between legal status and oral health care among Mexican-origin children. Using the 2001–2014 California Health Interview Surveys, the objectives are: (1) to demonstrate population-level changes in the legal statuses of parents, the legal statuses of children, and the likelihood of receiving dental care; (2) to reveal how the roles of legal status boundaries in dental care are changing; and (3) to determine whether the salience of these boundaries is attributable to legal status per se. The results reveal increases in the native-born share and dental care utilization for the total Mexican-origin population. Although dental care was primarily linked to parental citizenship early in this period, parental legal statuses are no longer a unique source of variation in utilization (despite the greater likelihood of insurance among citizens). These results imply that future gains in utilization among Mexican-origin children will mainly come from overcoming barriers to care among the native born. Speculation exists on the importance of documentation status for dental care. Parental documentation has not been uniquely important for dental care. Parental citizenship predicted differences in child dental care in the early 2000s. These differences subsequently decreased by 2014 when dental care rose for all children. Increases were especially prominent among categories of non-citizens. Declines in immigration imply that increasing attention to the native born is needed.
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Affiliation(s)
- R S Oropesa
- Department of Sociology, The Pennsylvania State University, University Park, PA 16802, phone: (814) 865-1577, fax: (814) 863-7216
| | - Nancy S Landale
- Department of Sociology, The Pennsylvania State University, University Park, PA 16802
| | - Marianne M Hillemeier
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA 16802
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Tiwari T, Baker S, Albino J. Editorial: Reducing Oral Health Disparities: Social, Environmental and Cultural Factors. Front Public Health 2017; 5:298. [PMID: 29181375 PMCID: PMC5693850 DOI: 10.3389/fpubh.2017.00298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/27/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tamanna Tiwari
- Department of Community Dentistry and Population Health, University of Colorado Hospital, Aurora, CO, United States
| | - Sarah Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Judith Albino
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
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75
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Chen YA, Quiñonez C. Basic income guarantee: a review of implications for oral health. J Public Health Dent 2017; 78:56-62. [PMID: 28771733 DOI: 10.1111/jphd.12239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 06/16/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To: a) Familiarize readers with the concept of a basic income guarantee (BIG) and its different forms; b) Consider how BIG could improve oral health and decrease oral health disparities; c) Motivate readers to advocate for the evaluation of oral health outcomes in BIG experiments. METHODS Published articles and book chapters that have analyzed and reviewed data from past BIG pilot projects were examined for their findings on health and socioeconomic outcomes. RESULTS Our findings suggest various areas and mechanisms whereby BIG can influence oral health-related outcomes, whether through impacts on work, illness and injury, education, a social multiplier effect, expenditure behavior, and/or mental illness and other health outcomes. CONCLUSION Our findings illustrate the importance of assessing oral health-related outcomes in future BIG pilot projects.
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Affiliation(s)
- Yi-An Chen
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Carlos Quiñonez
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
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76
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Lo YTC, Wahlqvist ML, Chang YH, Lee MS. Combined Effects of Chewing Ability and Dietary Diversity on Medical Service Use and Expenditures. J Am Geriatr Soc 2017; 64:1187-94. [PMID: 27321597 DOI: 10.1111/jgs.14150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To examine whether chewing ability affects healthcare use and expenditure and whether improving dietary quality alleviates any such effects. DESIGN Prospective cohort. SETTING The Elderly Nutrition and Health Survey in Taiwan (1999-2000), a nationwide community-based survey of people aged 65 and older. PARTICIPANTS Individuals aged 65 and older (N = 1,793; 903 men, 890 women). MEASUREMENTS Chewing ability (satisfactory or unsatisfactory) was assessed using a questionnaire, and dietary quality was assessed using a 24-hour dietary recall as a dietary diversity score. Data on annual medical use and expenditures from the interview date until December 31, 2006, were collected from National Health Insurance claims. Generalized linear models were used to assess the associations between chewing ability, dietary quality, and annual medical usage or expenditure. RESULTS After 8 years of follow-up, older adults with unsatisfactory chewing ability had considerably higher emergency, hospitalization, and total medical expenditures. Older adults with unsatisfactory chewing ability and a poor diet used fewer annual preventive care and dental services than those with satisfactory chewing ability but had longer hospital stays and higher expenditures. After adjusting for covariates, unsatisfactory chewing ability resulted in significantly longer hospital stays in participants with a poor diet (β = 2.34, 95% confidence interval = 2.02-2.71, P < .001). CONCLUSION Unsatisfactory chewing ability and a less-diverse diet together are associated with longer hospital stays and higher medical expenditures.
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Affiliation(s)
- Yuan-Ting C Lo
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Mark L Wahlqvist
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.,Monash Asia Institute, Monash University, Caulfield East, Melbourne, Victoria, Australia
| | - Yu-Hung Chang
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Monash Asia Institute, Monash University, Caulfield East, Melbourne, Victoria, Australia
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Abstract
Pediatric oral health is determined by the interaction of environmental factors and genetic influences. This is the case for early childhood caries, the most common disease of childhood. The complexity of exogenous-environmental factors interacting with innate biological predispositions results in a continuum of normal variation, as well as oral health and disease outcomes. Optimal oral health and care or precision dentistry warrants comprehensive understanding of these influences and tools enabling intervention on modifiable factors. This article reviews the current knowledge of the genomic basis of pediatric oral health and highlights known and postulated mechanistic pathways of action relevant to early childhood caries.
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Affiliation(s)
- Kimon Divaris
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina at Chapel Hill, 228 Brauer Hall, CB#7450, Chapel Hill, NC 27599, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA.
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Naidoo S, Dimba E, Yengopal V, Folayan MO, Akpata ES. Strategies for Oral Health Research in Africa and the Middle Eastern Region. Adv Dent Res 2017; 27:43-9. [PMID: 26101339 DOI: 10.1177/0022034515575539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The highest burden of diseases worldwide is in low- and middle-income countries, but due to lack of capacity and inadequate infrastructure, research output from these countries is unable to address existing and emerging challenges in health care. Oral health research has particularly been hampered by low prioritization, resulting in insufficient development of this sector. There is an urgent need for research correlating oral health to upstream social and environmental determinants and promoting the common risk factor approach for prevention of noncommunicable diseases. Population-wide preventive measures for oral health care are more effective than purely curative approaches, especially for vulnerable groups who have limited access to information and appropriate health care. This article identifies priorities and proposes strategies for researchers, stakeholders, and policy makers for the initiation and sustenance of appropriate oral health care research. The proposed interventions are intended to promote collaboration, capacity building, and health advocacy. Local ownership in multinational research projects in low- and middle-income countries, complemented by skills transfer from high-income countries, is encouraged to ensure that regional health needs are addressed. Emphasis is placed on a shift toward translational research that has a direct impact on oral health care systems.
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Affiliation(s)
- S Naidoo
- Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | - E Dimba
- School of Dental Science, University of Nairobi, Nairobi, Kenya
| | - V Yengopal
- School of Oral Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - M O Folayan
- Faculty of Dentistry, Obafemi Awolowa University, Ile-Ife, Nigeria
| | - E S Akpata
- College of Medicine, Lagos State University, Lagos, Nigeria
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Ogunbodede EO, Kida IA, Madjapa HS, Amedari M, Ehizele A, Mutave R, Sodipo B, Temilola S, Okoye L. Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region. Adv Dent Res 2017; 27:18-25. [PMID: 26101336 DOI: 10.1177/0022034515575538] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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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Affiliation(s)
- E O Ogunbodede
- Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - I A Kida
- School of Dentistry, Muhimbili University Health and Allied Sciences, Dar es Salaam, Tanzania
| | - H S Madjapa
- School of Dentistry, Muhimbili University Health and Allied Sciences, Dar es Salaam, Tanzania
| | - M Amedari
- Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - A Ehizele
- School of Dentistry, University of Benin, Benin City, Nigeria
| | - R Mutave
- Dental School, University of Nairobi, Nairobi, Kenya
| | - B Sodipo
- Federal Medical Centre, Katsina, Nigeria
| | - S Temilola
- Dental Hospital, Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria
| | - L Okoye
- Faculty of Dentistry, University of Nigeria-Enugu Campus, Enugu, Nigeria
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Affiliation(s)
- B A Dye
- 1 National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
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81
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Gomez A, Nelson KE. The Oral Microbiome of Children: Development, Disease, and Implications Beyond Oral Health. MICROBIAL ECOLOGY 2017; 73:492-503. [PMID: 27628595 PMCID: PMC5274568 DOI: 10.1007/s00248-016-0854-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/01/2016] [Indexed: 05/05/2023]
Abstract
In the era of applied meta-omics and personalized medicine, the oral microbiome is a valuable asset. From biomarker discovery to being a powerful source of therapeutic targets and to presenting an opportunity for developing non-invasive approaches to health care, it has become clear that oral microbes may hold the answer for understanding disease, even beyond the oral cavity. Although our understanding of oral microbiome diversity has come a long way in the past 50 years, there are still many areas that need to be fine-tuned for better risk assessment and diagnosis, especially in early developmental stages of human life. Here, we discuss the factors that impact development of the oral microbiome and explore oral markers of disease, with a focus on the early oral cavity. Our ultimate goal is to put different experimental and methodological views into perspective for better assessment of early oral and systemic disease at an early age and discuss how oral microbiomes-at the community level-could provide improved assessment in individuals and populations at risk.
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Affiliation(s)
- Andres Gomez
- Departments of Human Biology and Genomic Medicine, J. Craig Venter Institute, La Jolla, 92037, CA, USA.
| | - Karen E Nelson
- Departments of Human Biology and Genomic Medicine, J. Craig Venter Institute, La Jolla, 92037, CA, USA
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82
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Rodríguez N, Moral J. Validation of the Oral Hygiene Habits Scale: Relationships with sociodemographic variables in the general and clinical population of Monterrey, Mexico. JOURNAL OF ORAL RESEARCH 2016. [DOI: 10.17126/joralres.2016.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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83
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Lee J, Watt R, Williams D, Giannobile W. A New Definition for Oral Health: Implications for Clinical Practice, Policy, and Research. J Dent Res 2016; 96:125-127. [DOI: 10.1177/0022034516682718] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- J.Y. Lee
- Department of Pediatric Dentistry, School of Dentistry, and Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - R.G. Watt
- Department of Epidemiology and Public Health, University College London, Gower Street, London, UK
| | - D.M. Williams
- Bart’s and The London School of Medicine and Dentistry, London, UK
| | - W.V. Giannobile
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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84
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Collins CC, Villa-Torres L, Sams LD, Zeldin LP, Divaris K. Framing Young Childrens Oral Health: A Participatory Action Research Project. PLoS One 2016; 11:e0161728. [PMID: 27548714 PMCID: PMC4993516 DOI: 10.1371/journal.pone.0161728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/10/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the widespread acknowledgement of the importance of childhood oral health, little progress has been made in preventing early childhood caries. Limited information exists regarding specific daily-life and community-related factors that impede optimal oral hygiene, diet, care, and ultimately oral health for children. We sought to understand what parents of young children consider important and potentially modifiable factors and resources influencing their children's oral health, within the contexts of the family and the community. METHODS This qualitative study employed Photovoice among 10 English-speaking parents of infants and toddlers who were clients of an urban WIC clinic in North Carolina. The primary research question was: "What do you consider as important behaviors, as well as family and community resources to prevent cavities among young children?" Five group sessions were conducted and they were recorded, transcribed verbatim and analyzed using qualitative research methodology. Inductive analyses were based on analytical summaries, double-coding, and summary matrices and were done using Atlas.ti.7.5.9 software. FINDINGS Good oral health was associated with avoidance of problems or restorations for the participants. Financial constraints affected healthy food and beverage choices, as well as access to oral health care. Time constraints and occasional frustration related to children's oral hygiene emerged as additional barriers. Establishment of rules/routines and commitment to them was a successful strategy to promote their children's oral health, as well as modeling of older siblings, cooperation among caregivers and peer support. Community programs and organizations, social hubs including playgrounds, grocery stores and social media emerged as promising avenues for gaining support and sharing resources. CONCLUSIONS Low-income parents of young children are faced with daily life struggles that interfere with oral health and care. Financial constraints are pervasive, but parents identified several strategies involving home care and community agents that can be helpful. Future interventions aimed to improve children's oral health must take into consideration the role of families and the communities in which they live.
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Affiliation(s)
- Chimere C. Collins
- Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Laura Villa-Torres
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Lattice D. Sams
- Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Leslie P. Zeldin
- Oral and Craniofacial Health Sciences, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Kimon Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
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85
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Matsuyama Y, Aida J, Taura K, Kimoto K, Ando Y, Aoyama H, Morita M, Ito K, Koyama S, Hase A, Tsuboya T, Osaka K. School-Based Fluoride Mouth-Rinse Program Dissemination Associated With Decreasing Dental Caries Inequalities Between Japanese Prefectures: An Ecological Study. J Epidemiol 2016; 26:563-571. [PMID: 27108752 PMCID: PMC5083319 DOI: 10.2188/jea.je20150255] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Dental caries inequalities still severely burden individuals’ and society’s health, even in countries where fluoride toothpastes are widely used and the incidence of dental caries has been decreasing. School-based fluoride mouth-rinse (S-FMR) programs, a population strategy for dental caries prevention, might decrease dental caries inequalities. This study investigated the association between S-FMR and decreasing dental caries prevalence and caries-related inequalities in 12-year-olds by Japanese prefecture. Methods We conducted an ecological study using multi-year prefecture-level aggregated data of children born between 1994 and 2000 in all 47 Japanese prefectures. Using two-level linear regression analyses (birth year nested within prefecture), the association between S-FMR utilization in each prefecture and 12-year-olds’ decayed, missing, or filled permanent teeth (DMFT), which indicates dental caries experience in their permanent teeth, were examined. Variables that could explain DMFT inequalities between prefectures, such as dental caries experience at age 3 years, dentist density, and prefectural socioeconomic circumstances, were also considered. Results High S-FMR utilization was significantly associated with low DMFT at age 12 (coefficient −0.011; 95% confidence interval, −0.018 to −0.005). S-FMR utilization explained 25.2% of the DMFT variance between prefectures after considering other variables. Interaction between S-FMR and dental caries experience at age 3 years showed that S-FMR was significantly more effective in prefectures where the 3-year-olds had high levels of dental caries experience. Conclusions S-FMR, administered to children of all socioeconomic statuses, was associated with lower DMFT. Utilization of S-FMR reduced dental caries inequalities via proportionate universalism.
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Affiliation(s)
- Yusuke Matsuyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry
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86
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Born CD, Divaris K, Zeldin LP, Rozier RG. Influences on preschool children's oral health-related quality of life as reported by English and Spanish-speaking parents and caregivers. J Public Health Dent 2016; 76:276-286. [PMID: 26990804 DOI: 10.1111/jphd.12152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/20/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study examined young, preschool children's oral health-related quality of life (OHRQoL) among a community-based cohort of English and Spanish-speaking parent-child dyads in North Carolina, and sought to quantify the association of parent/caregiver characteristics, including spoken language, with OHRQoL impacts. METHODS Data from structured interviews with 1,111 parents of children aged 6-23 months enrolled in the Zero-Out Early Childhood Caries study in 2010-2012 were used. OHRQoL was measured using the overall score (range: 0-52) of the Early Childhood Oral Health Impact Scale (ECOHIS). We examined associations with parents' sociodemographic characteristics, spoken language, self-reported oral and general health, oral health knowledge, children's dental attendance, and dental care needs. Analyses included descriptive, bivariate, and multivariate methods based upon zero-inflated negative binomial regression. To determine differences between English and Spanish speakers, language-stratified model estimates were contrasted using homogeneity χ2 tests. RESULTS The mean overall ECOHIS score was 3.9 [95% confidence interval (CI) = 3.6-4.2]; 4.7 among English-speakers and 1.5 among Spanish speakers. In multivariate analyses, caregivers' education showed a positive association with OHRQoL impacts among Spanish speakers [prevalence ratio (PR) = 1.12 (95% CI = 1.03-1.22), for every added year of schooling], whereas caregivers' fair/poor oral health showed a positive association among English speakers (PR = 1.20; 95% CI = 1.02-1.41). CONCLUSIONS The overall severity of ECOHIS impacts was low among this population-based sample of young, preschool children, and substantially lower among Spanish versus English speakers. Further studies are warranted to identify sources of these differences in - actual or reported - OHRQoL impacts.
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Affiliation(s)
- Catherine D Born
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Kimon Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Leslie P Zeldin
- Department of Oral and Craniofacial Health Sciences, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - R Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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87
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Social-Biological Interactions in Oral Disease: A 'Cells to Society' View. PLoS One 2016; 11:e0146218. [PMID: 26751953 PMCID: PMC4709106 DOI: 10.1371/journal.pone.0146218] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 11/09/2015] [Indexed: 11/01/2022] Open
Abstract
Oral diseases constitute a major worldwide public health problem, with their burden concentrating in socially disadvantaged and less affluent groups of the population, resulting in significant oral health inequalities. Biomedical and behavioural approaches have proven relatively ineffective in reducing these inequalities, and have potentially increased the health gap between social groups. Some suggest this stems from a lack of understanding of how the social and psychosocial contexts in which behavioural and biological changes occur influence oral disease. To unravel the pathways through which social factors affect oral health outcomes, a better understanding is thus needed of how the social 'gets under the skin,' or becomes embodied, to alter the biological. In this paper, we present the current knowledge on the interplay between social and biological factors in oral disease. We first provide an overview of the process of embodiment in chronic disease and then evaluate the evidence on embodiment in oral disease by reviewing published studies in this area. Results show that, in periodontal disease, income, education and perceived stress are correlated with elevated levels of stress hormones, disrupted immune biomarkers and increased allostatic load. Similarly, socioeconomic position and increased financial stress are related to increased stress hormones and cariogenic bacterial counts in dental caries. Based on these results, we propose a dynamic model depicting social-biological interactions that illustrates potential interdependencies between social and biological factors that lead to poor oral health. This work and the proposed model may aid in developing a better understanding of the causes of oral health inequalities and implicate the importance of addressing the social determinants of oral health in innovating public health interventions.
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88
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Affiliation(s)
- R G Watt
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - A Heilmann
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - S Listl
- Translational Health Economics Group, Department of Conservative Dentistry, Heidelberg University, Heidelberg, Germany Munich Center for the Economics of Aging, Max Planck Institute for Social Law and Social Policy, Munich, Germany
| | - M A Peres
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
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89
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Abstract
In recent years, unprecedented gains in the understanding of the biology and mechanisms underlying human health and disease have been made. In the domain of oral health, although much remains to be learned, the complex interactions between different systems in play have begun to unravel: host genome, oral microbiome with its transcriptome, proteome and metabolome, and more distal influences, including relevant behaviors and environmental exposures. A reasonable expectation is that this emerging body of knowledge can help improve the oral health and optimize care for individuals and populations. These goals are articulated by the National Institutes of Health as "precision medicine" and the elimination of health disparities. Key processes in these efforts are the discovery of causal factors or mechanistic pathways and the identification of individuals or population segments that are most likely to develop (any or severe forms of) oral disease. This article critically reviews the fundamental concepts of risk assessment and outcome prediction, as they relate to early childhood caries (ECC)-a common complex disease with significant negative impacts on children, their families, and the health system. The article highlights recent work and advances in methods available to estimate caries risk and derive person-level caries propensities. It further discusses the reasons for their limited utility in predicting individual ECC outcomes and informing clinical decision making. Critical issues identified include the misconception of defining dental caries as a tooth or surface-level condition versus a person-level disease; the fallacy of applying population-level parameters to individuals, termed privatization of risk; and the inadequacy of using frequentist versus Bayesian modeling approaches to derive individual disease propensity estimates. The article concludes with the notion that accurate caries risk assessment at the population level and "precision dentistry" at the person level are both desirable and achievable but must be based on high-quality longitudinal data and rigorous methodology.
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Affiliation(s)
- K Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina-Chapel Hill, NC, USA Department of Epidemiology, Gillings School of Global Health, University of North Carolina-Chapel Hill, NC, USA
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90
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Burgette JM, Lee JY, Baker AD, Vann WF. Is Dental Utilization Associated with Oral Health Literacy? J Dent Res 2015; 95:160-6. [PMID: 26567035 DOI: 10.1177/0022034515617457] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objectives of this study were to examine the pattern of association between dental utilization and oral health literacy (OHL). As part of the Carolina Oral Health Literacy Project, clients in the Women, Infants, and Children's Special Supplemental Nutrition Program completed a structured 30-min in-person interview conducted by 2 trained interviewers at 9 sites in 7 counties in North Carolina. Data were collected on clients' OHL, sociodemographics, dental utilization, self-efficacy, and dental knowledge. The outcome, OHL, was measured with a dental word recognition test (30-item Rapid Estimate of Adult Literacy in Dentistry). Descriptive and multiple linear regression methods were used to examine the distribution of OHL and its association with covariates. After adjusting for age, education, race, marital status, self-efficacy, and dental knowledge, multiple linear regression showed that dental utilization was not a significant predictor of OHL (P > 0.05). Under the conditions of this study, dental utilization was not a significant predictor of OHL.
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Affiliation(s)
- J M Burgette
- Department of Pediatric Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Y Lee
- Department of Pediatric Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A D Baker
- Department of Pediatric Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - W F Vann
- Department of Pediatric Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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91
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Cunha MAGDM, Lino PA, Santos TRD, Vasconcelos M, Lucas SD, Abreu MHNGD. A 15-Year Time-series Study of Tooth Extraction in Brazil. Medicine (Baltimore) 2015; 94:e1924. [PMID: 26632688 PMCID: PMC5058957 DOI: 10.1097/md.0000000000001924] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tooth loss is considered to be a public health problem. Time-series studies that assess the influence of social conditions and access to health services on tooth loss are scarce.This study aimed to examine the time-series of permanent tooth extraction in Brazil between 1998 and 2012 and to compare these series in municipalities with different Human Development Index (HDI) scores and with different access to distinct primary and secondary care.The time-series study was performed between 1998 and 2012, using data from the Brazilian National Health Information System. Time-series study was performed between 1998 and 2012. Two annual rates of tooth extraction were calculated and evaluated separately according to 3 parameters: the HDI, the presence of a Dental Specialty Center, and coverage by Oral Health Teams. The time-series was analyzed using a linear regression model.An overall decrease in the tooth-loss tendencies during this period was observed, particularly in the tooth-extraction rate during primary care procedures. In the municipalities with an HDI that was lower than the median, the average tooth-loss rates were higher than in the municipalities with a higher HDI. The municipalities with lower rates of Oral Health Team coverage also showed lower extraction rates than the municipalities with higher coverage rates.In general, Brazil has shown a decrease in the trend to extract permanent teeth during these 15 years. Increased human development and access to dental services have influenced tooth-extraction rates.
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Affiliation(s)
- Maria Aparecida Goncalves de Melo Cunha
- From the Centro Universitário Newton Paiva, Av. Silva Lobo, 1718, Belo Horizonte, Minas Gerais, Brazil (MAGMC); and Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Belo Horizonte, Minas Gerais, Brazil (PAL, TRS, MV, SDL, MHNGA)
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92
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Nelson S, Riedy C, Albert JM, Lee W, Slusar MB, Curtan S, Ferretti G, Cunha-Cruz J, Milgrom P. Family Access to a Dentist Study (FADS): A multi-center randomized controlled trial. Contemp Clin Trials 2015; 45:177-183. [PMID: 26500170 DOI: 10.1016/j.cct.2015.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/14/2015] [Accepted: 10/17/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Many low-income parent/caregivers do not understand the importance of cavity-free primary (baby) teeth and the chronic nature of dental caries (tooth decay). As a consequence, dental preventive and treatment utilization is low even when children are screened in schools and referred for care. This study aims to test a referral letter and Dental Information Guide (DIG) designed using the Common-Sense Model of Self-Regulation (CSM) framework to improve caregivers' illness perception of dental caries and increase utilization of care by children with restorative dental needs. METHODS A multi-site randomized controlled trial with caregivers of Kindergarten to 4th grade children in urban Ohio and rural Washington State will compare five arms: (1) CSM referral letter alone; (2) CSM referral letter+DIG; (3) reduced CSM referral letter alone; (4) reduced CSM referral letter+DIG; and (5) standard (control) referral. At baseline, children will be screened at school to determine restorative dental needs. If in need of treatment, caregivers will be randomized to study arms and an intervention packet will be sent home. The primary outcome will be dental care based on a change in oral health status by clinical examination 7 months post-screening (ICDAS sealant codes 1 and 2; restoration codes 3-8; extraction). Enrollment commenced summer 2015 with results in summer 2016. CONCLUSION This study uses the CSM framework to develop and test behavioral interventions to increase dental utilization among low-income caregivers. If effective this simple intervention has broad applicability in clinical and community-based settings.
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Affiliation(s)
- Suchitra Nelson
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, USA.
| | - Christine Riedy
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Jeffrey M Albert
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, USA
| | - Wonik Lee
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, USA
| | - Mary Beth Slusar
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, USA
| | - Shelley Curtan
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, USA
| | - Gerald Ferretti
- Department of Pediatric Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, USA
| | - Joana Cunha-Cruz
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, USA
| | - Peter Milgrom
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, USA
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93
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Matsuo G, Rozier RG, Kranz AM. Dental Caries: Racial and Ethnic Disparities Among North Carolina Kindergarten Students. Am J Public Health 2015; 105:2503-9. [PMID: 26469649 DOI: 10.2105/ajph.2015.302884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We examined racial/ethnic disparities in dental caries among kindergarten students in North Carolina and the cross-level effects between students' race/ethnicity and school poverty status. METHODS We adjusted the analysis of oral health surveillance information (2009-2010) for individual-, school-, and county-level variables. We included a cross-level interaction of student's race/ethnicity (White, Black, Hispanic) and school National School Lunch Program (NSLP) participation (< 75% vs ≥ 75% of students), which we used as a compositional school-level variable measuring poverty among families of enrolled students. RESULTS Among 70,089 students in 1067 schools in 95 counties, the prevalence of dental caries was 30.4% for White, 39.0% for Black, and 51.7% for Hispanic students. The adjusted difference in caries experience between Black and White students was significantly greater in schools with NSLP participation of less than 75%. CONCLUSIONS Racial/ethnic oral health disparities exist among kindergarten students in North Carolina as a whole and regardless of school's poverty status. Furthermore, disparities between White and Black students are larger in nonpoor schools than in poor schools. Further studies are needed to explore causal pathways that might lead to these disparities.
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Affiliation(s)
- Go Matsuo
- At the time of the study, Go Matsuo was with the Oral Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. R. Gary Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Ashley M. Kranz is with the School of Dentistry, University of North Carolina, Chapel Hill
| | - R Gary Rozier
- At the time of the study, Go Matsuo was with the Oral Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. R. Gary Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Ashley M. Kranz is with the School of Dentistry, University of North Carolina, Chapel Hill
| | - Ashley M Kranz
- At the time of the study, Go Matsuo was with the Oral Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. R. Gary Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Ashley M. Kranz is with the School of Dentistry, University of North Carolina, Chapel Hill
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94
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Abstract
The etiology of dental caries reflects a complex interplay of biochemical, microbial, genetic, social and physical environmental, and health-influencing behavioral factors. This review updates the literature on the efficacy of behavioral approaches to caries prevention for children up to 18 y of age. Included were studies of behavioral interventions implemented at individual, family, and community levels that assessed results in terms of reductions in caries increments. Only those reports published since 2011 were considered. Outcomes were variable, although motivational interviewing, which involves individuals in decisions about oral health within the context of their respective life circumstances, proved effective in 3 of 4 reported studies, and more definitive trials are underway. Recommendations for future research include examinations of the cost-effectiveness of interventions, as well as work focused on understanding the mechanisms underlying oral health behavior change and variables that may mediate or moderate responses to interventions.
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Affiliation(s)
- J Albino
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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95
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Delgado-Angulo EK, Bernabé E, Marcenes W. Ethnic inequalities in dental caries among adults in East London. J Public Health (Oxf) 2015; 38:e55-62. [DOI: 10.1093/pubmed/fdv097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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96
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Abstract
Recent research has emphasized the relationships between environmental and individual factors that may influence population oral health and lead to health inequalities. However, little is known about the effect of interactions between environmental and individual factors on inequalities in clinical (e.g., decayed teeth) and subjective oral health outcomes (e.g., oral health–related quality of life [OHQoL]). This cohort study aimed to explore the direct and mediated longitudinal interrelationships between key environmental and individual factors on clinical and subjective oral health outcomes in adults. Self-reported measures of OHQoL and individual (sense of coherence [SOC], social support, stress, oral health beliefs, dental behaviors, and subjective socioeconomic status [SES]) and environmental factors (SES and social network) were collected at baseline and 3-mo follow-up, together with a baseline clinical examination of 495 adult employees of an automobile parts manufacturer in India. Lagged structural equation modeling was guided by the adapted Wilson and Cleary/Brunner and Marmot model linking clinical, individual, and environmental variables to quality of life. The study provides tentative evidence that SES may influence levels of resources such as social support and SOC, which mediate stress and in turn may influence subjective oral health outcomes. Accordingly, the present findings and the adapted Wilson and Cleary/Brunner and Marmot model on which they are predicted provide support for the psychosocial pathway being key in the SES–oral health relationship. The pathways through which environmental factors interact with individual factors to impact subjective oral health outcomes identified here may bring opportunities for more targeted oral health promotion strategies.
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Affiliation(s)
- E. Gupta
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - P.G. Robinson
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - C.M. Marya
- Sudha Rastogi Dental College, Faridabad, India
| | - S.R. Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Masoe AV, Blinkhorn AS, Taylor J, Blinkhorn FA. Factors that influence the preventive care offered to adolescents accessing Public Oral Health Services, NSW, Australia. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2015; 6:101-13. [PMID: 26124689 PMCID: PMC4476312 DOI: 10.2147/ahmt.s84332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Many adolescents are at risk of dental caries and periodontal disease, which may be controlled through health education and clinical preventive interventions provided by oral health and dental therapists (therapists). Senior clinicians (SCs) can influence the focus of dental care in the New South Wales (NSW) Public Oral Health Services as their role is to provide clinical support and advice to therapists, advocate for their communities, and inform Local Health District (LHD) managers of areas for clinical quality improvement. The objective of this study was to record facilitating factors and strategies that are used by SCs to encourage therapists to provide preventive care and advice to adolescent patients. METHODS In-depth, semistructured interviews were undertaken with 16 SCs from all of the 15 NSW LHDs (nine rural and six metropolitan). A framework matrix was used to systematically code data and enable key themes to be identified for analysis. RESULTS All SCs from the 15 NSW Health LHDs participated in the study. Factors influencing SCs' ability to integrate preventive care into clinical practice were: 1) clinical leadership and administrative support, 2) professional support network, 3) clinical and educational resources, 4) the clinician's patient management aptitude, and 5) clinical governance processes. Clinical quality improvement and continuing professional development strategies equipped clinicians to manage and enhance adolescents' confidence toward self-care. CONCLUSION This study shows that SCs have a clear understanding of strategies to enhance the therapist's offer of scientific-based preventive care to adolescents. The problem they face is that currently, success is measured in terms of relief of pain activities, restorations placed, and extraction of teeth, which is an outdated concept. However, to improve clinical models of care will require the overarching administrative authority, NSW Health, to accept that the scientific evidence relating to dental care has changed and that management monitoring information should be incorporated into NSW Health reforms.
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Affiliation(s)
- Angela V Masoe
- School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia
| | - Anthony S Blinkhorn
- Department of Population Oral Health, Faculty of Dentistry, University of Sydney, Westmead, NSW, Australia
| | - Jane Taylor
- School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia
| | - Fiona A Blinkhorn
- School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia
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Logan HL, Guo Y, Emanuel AS, Shepperd JA, Dodd VJ, Marks JG, Muller KE, Riley JL. Determinants of First-Time Cancer Examinations in a Rural Community: A Mechanism for Behavior Change. Am J Public Health 2015; 105:1424-31. [PMID: 25973820 DOI: 10.2105/ajph.2014.302516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES After conducting a media campaign focusing on the importance of oral and pharyngeal cancer (OPC) examinations, we assessed mechanisms of behavior change among individuals receiving an OPC examination for the first time. METHODS We used data from 2 waves of telephone surveys of individuals residing in 36 rural census tracts in northern Florida (n = 806). The second survey occurred after our media intervention. We developed media messages and modes of message delivery with community members via focus groups and intercept interviews. We performed a mediation analysis to examine behavior change mechanisms. RESULTS Greater exposure to media messages corresponded with heightened concern about OPC. Heightened concern, in turn, predicted receipt of a first-time OPC examination, but only among men. CONCLUSIONS We extended earlier studies by measuring an outcome behavior (receipt of an OPC examination) and demonstrating that the putative mechanism of action (concern about the disease) explained the link between a media intervention and engaging in the target behavior. Improving the quality of media campaigns by engaging community stakeholders in selecting messages and delivery methods is an effective strategy in building public health interventions aimed at changing behaviors.
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Affiliation(s)
- Henrietta L Logan
- At the time of the study, Henrietta L. Logan, Amber S. Emanuel, Virginia J. Dodd, John G. Marks, and Joseph L. Riley III were with the Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville. Yi Guo and Keith E. Muller were with the Department of Health Outcomes and Policy, College of Medicine, University of Florida. James A. Shepperd was with the Department of Psychology, College of Liberal Arts and Science, University of Florida
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99
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Masoe AV, Blinkhorn AS, Taylor J, Blinkhorn FA. Preventive management plans recorded by dental therapists and oral health therapists using clinical vignettes for adolescents accessing public oral health services in New South Wales, Australia. Aust Dent J 2015; 61:21-28. [PMID: 25912297 DOI: 10.1111/adj.12336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to investigate factors that influence dental therapists and oral health therapists (therapists) plan preventive oral health care for adolescents attending New South Wales public oral health services. METHODS A cross-sectional postal survey using two clinical vignettes was used to record the preventive care treatment plans offered by therapists working across 15 New South Wales local health districts. Data were tabulated and chi-square statistics used in the analysis. RESULTS One hundred and seventeen therapists returned questionnaires, giving a 64.6% response rate. The participants highlighted the importance of offering oral hygiene instruction (97.0%), dietary advice (95.0%) and topical fluoride applications (74.0%). Recommended home use products included fluoride toothpaste 5000 ppmF (59.0%) and casein phosphopeptide-amorphous calcium phosphate plus fluoride (CPP-ACPF) paste (57.7%). Over 50% used fissure sealants. More respondents (88%) would utilize motivational interviewing strategies for a patient with dental caries concerns; however, only 63% would use this technique for a patient in pain (p < 0.001). CONCLUSIONS Considerable variations were noted in therapists' recommendations for stabilizing and managing dental disease, suggesting a need for clinical directors to consider providing more advice to therapists on the scientific basis of preventing dental caries.
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Affiliation(s)
- A V Masoe
- School of Health Sciences, Faculty of Health and Medicine, Oral Health Discipline, The University of Newcastle, Ourimbah, New South Wales, Australia
| | - A S Blinkhorn
- Population Oral Health Unit, Faculty of Dentistry, The University of Sydney, Westmead, New South Wales, Australia
| | - J Taylor
- School of Health Sciences, Faculty of Health and Medicine, Oral Health Discipline, The University of Newcastle, Ourimbah, New South Wales, Australia
| | - F A Blinkhorn
- School of Health Sciences, Faculty of Health and Medicine, Oral Health Discipline, The University of Newcastle, Ourimbah, New South Wales, Australia
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100
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Lynch DJ, Villhauer AL, Warren JJ, Marshall TA, Dawson DV, Blanchette DR, Phipps KR, Starr DE, Drake DR. Genotypic characterization of initial acquisition of Streptococcus mutans in American Indian children. J Oral Microbiol 2015; 7:27182. [PMID: 25840611 PMCID: PMC4385128 DOI: 10.3402/jom.v7.27182] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 11/24/2022] Open
Abstract
Background Severe-early childhood caries (S-ECC) is one of the most common infectious diseases in children and is prevalent in lower socio-economic populations. American Indian children suffer from the highest levels of S-ECC in the United States. Members of the mutans streptococci, Streptococcus mutans, in particular, are key etiologic agents in the development of caries. Children typically acquire S. mutans from their mothers and early acquisition is often associated with higher levels of tooth decay. Methods We have conducted a 5-year birth cohort study with a Northern Plains Tribe to determine the temporality and fidelity of S. mutans transmission from mother to child in addition to the genotypic diversity of S. mutans in this community. Plaque samples were collected from 239 mother/child dyads at regular intervals from birth to 36 months and S. mutans were isolated and genotyped by arbitrarily primed-polymerase chain reaction (AP-PCR). Results Here we present preliminary findings from a subset of the cohort. The focus for this paper is on initial acquisition events in the children. We identified 17 unique genotypes in 711 S. mutans isolates in our subset of 40 children, 40 mothers and 14 primary caregivers. Twelve of these genotypes were identified in more than one individual. S. mutans colonization occurred by 16 months in 57.5% of the children and early colonization was associated with higher decayed, missing and filled surface (DMFS) scores (p=0.0007). Children colonized by S. mutans shared a common genotype with their mothers 47.8% of the time. While multiple genotypes were common in adults, only 10% of children harbored multiple genotypes. Conclusion These children acquire S. mutans at an earlier age than the originally described ‘window of infectivity’ and often, but not exclusively, from their mothers. Early acquisition is associated with both the caries status of the children and the mothers.
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Affiliation(s)
- David J Lynch
- Dows Institute for Dental Research, University of Iowa, College of Dentistry, Iowa City, IA, USA
| | - Alissa L Villhauer
- Dows Institute for Dental Research, University of Iowa, College of Dentistry, Iowa City, IA, USA
| | - John J Warren
- Preventive and Community Dentistry, University of Iowa, College of Dentistry, Iowa City, IA, USA
| | - Teresa A Marshall
- Preventive and Community Dentistry, University of Iowa, College of Dentistry, Iowa City, IA, USA
| | - Deborah V Dawson
- Dows Institute for Dental Research, University of Iowa, College of Dentistry, Iowa City, IA, USA
| | - Derek R Blanchette
- Dows Institute for Dental Research, University of Iowa, College of Dentistry, Iowa City, IA, USA
| | | | - Delores E Starr
- Area Regional Dental Prevention/Research Director, Pine Ridge, SD, USA
| | - David R Drake
- Dows Institute for Dental Research, University of Iowa, College of Dentistry, Iowa City, IA, USA;
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