Oral Health Over the Life Course

Dental Caries and Preventive Dental Visits Among Children in the U.S.: The Impact of Race/Ethnicity and Immigration

Introduction

National data on dental caries and dental service use among immigrant children in U.S. are limited. It is not known whether race/ethnicity would interact with immigration status to increase these disparities. Using a nationally representative sample, this study assessed the interaction effects of immigrant generation status and race/ethnicity on dental caries and dental visits among children in the U.S.

Methods

Data were from the 2020 and 2021 National Survey of Children's Health. All data were self-reported by parents/guardians. The 2 outcomes were (1) dental caries (yes/no) in the past 12 months and (2) preventive dental visits (yes/no) in the past 12 months. Racial/ethnic groups included non-Hispanic White, Black, Hispanics, and Asian Americans. The analytical sample included 66,167 children aged 2-17 years, including 1,243 first-generation immigrant children; 11,017 second-generation immigrant children; and 53,907 nonimmigrant children. Study authors ran separate multiple logistic regression models for the 2 outcome variables. All analyses accounted for the survey design of National Survey of Children's Health.

Results

First-generation immigrant children were more likely to have dental caries than nonimmigrant children (AOR=1.44). The interaction of race/ethnicity and immigrant generation status was significant (p=0.04) in the preventive dental visits model, indicating increased challenges in getting dental visits among minority immigrant children in comparison with that among non-Hispanic White immigrant children, especially among first-generation immigrant children of Asian Americans (AOR=0.41) and non-Hispanic Black immigrant children (AOR=0.37).

Conclusions

First-generation immigrant children were less likely to see a dentist and more likely to have dental caries than nonimmigrants. Moreover, first-generation immigrant children from minority racial/ethnic groups were the least likely to seek dental services. To further reduce disparities in oral health and dental use among children in the U.S., culturally sensitive health promotion is warranted to improve oral health literacy and reduce barriers to dental care for immigrants, especially immigrant children of the minority groups.

Census tract geospatial analysis comparing social determinants of health with tooth loss in California seniors: An ecologic study

OBJECTIVES

Individual-level social determinant of health (SDOH) measures alone may insufficiently explain disparities in edentulism among seniors. Therefore, the authors examined the correlation of census tract-level SDOH and residential racial segregation measures with edentulism in Californian adults aged ≥65 years old.

METHODS

Explanatory variables were obtained from Healthy Places Index (HPI), the National Cancer Institute and diversitydatakids.org. The edentulism outcome variable was obtained from CDC's PLACES small area estimates from the 2018 Behavioral Risk Factor Surveillance System data. Pearson and Spearman rank correlations were estimated. Multiple linear regression and multi-collinearity evaluations were performed. The Global Moran's I statistic assessed partial autocorrelation within census tracts.

RESULTS

Pearson and Spearman correlations were similar, supporting robustness. HPI, an area measure of advantage, strongly negatively correlated with edentulism prevalence [correlation coefficient: -0.87; 95% confidence interval (CI): -0.87, -0.86]. A change of 1.0 in HPI corresponded to an estimated decrease in edentulism prevalence of 5.9% (linear model adjusted R2 = 0.78). Racially segregated census tracts with Hispanics or Blacks alone were positively correlated with edentulism prevalence [0.60, 95% CI: 0.58, 0.62; and 0.33, 95% CI: 0.31, 0.35, respectively]. The converse was seen in census tracts with non-Hispanic Whites alone [-0.57, 95% CI: -0.58, -0.55]. Global Moran's I statistic for edentulism (0.13) and HPI scores (0.19) were significant (both p < .001) indicating geospatial autocorrelation.

CONCLUSIONS

Higher disadvantage and minority racial segregation within census tracts were positively correlated with edentulism prevalence. Future research and policy should consider possible interventions improving SDOH to reduce oral health inequities.

The contract between NHS dentistry and communities and how this varies by neighbourhood types

Introduction There is a growing concern that the NHS's ability to deliver dental care is not keeping pace with population growth. Also, existing capacity may not be evenly distributed, potentially creating dental deserts in some neighbourhoods.Aims This study aims to explore recent trends in NHS general practice dental capacity in England and analyse if these trends vary depending on neighbourhood context.Design This research employs a descriptive analysis of time trends.Materials and methods The study uses data on NHS-contracted capacity in England, measured in units of dental activity (UDAs). These UDAs are geo-located to neighbourhood types using practice postcodes. Changes in the populations of these neighbourhoods provide context for the capacity trends.Results Some trends remain stable over time, albeit at insufficient levels. Rural areas continue to have the lowest capacity for NHS dental treatments. Additionally, areas with previously generous provision are experiencing significant percentage decreases in capacity.Discussion To prevent the formation of dental deserts, two critical issues require attention: firstly, the accessibility of NHS treatment and how it varies across urban/suburban and rural neighbourhoods; secondly, balancing supply and demand by matching the supply of dental care with the demand, conditioned by socio-economic and socio-demographic factors within different neighbourhoods.

A Qualitative Study of Preschool Children's Perspectives on an Oral Health Promotion Program in New South Wales, Australia

In Australia, dental caries are observed in almost half of children starting school. Oral health promotion programs are being implemented in early childhood education and care (ECEC) settings to promote oral health. This study examined children's perceptions of one such program, the Bright Smiles Bright Futures (BSBF) program in ECEC settings in New South Wales, Australia. Data were collected using focus group discussions from 15 children aged 3-5 years, transcribed verbatim, and analysed through inductive thematic analysis. Three themes were identified as follows: (i) oral health knowledge of children, (ii) oral hygiene practices routine and skills development, and (iii) evaluation of the oral health promotion kit and opportunities for improvement. Children's perspectives highlight the BSBF program's success in communicating key messages to promote oral health. The integration of family-centric approaches, acknowledgement of children's preferences, and the use of interactive tools collectively enhance the overall effectiveness of the oral health promotion program.

Associations between school-based fluoride mouth-rinse program, medical-dental expense subsidy policy, and children's oral health in Japan: an ecological study

BACKGROUND

Dental caries are a common non-communicable disease among children. As a public health measure at the prefectural level, school-based fluoride mouth-rinse (S-FMR) program, medical/dental expense subsidy policies, and other factors may reduce the incidence of dental caries and tooth loss. Prefectures focusing on promoting oral health policies may promote both, but the interaction effect of implementing both subsidy policies and S-FMR at the prefectural level on caries prevention has not yet been examined.

METHODS

We conducted an ecological study using two-wave panel data, prefecture-level aggregated data in Japan for 2016 and 2018. Coefficient and 95% confidence intervals (CI) were calculated for the dependent variables for oral health using mixed-effects linear regression analysis adjusted for possible confounders. Two dependent variables were used; the standardized claim ratio (SCR) of deciduous tooth extraction and 12-year-olds' decayed, missing, or filled permanent teeth (DMFT). Four independent variables were S-FMR, the SCR of dental sealants, prefectural income per person, and subsidy policy in three models: co-payment until children enter elementary school (n = 23), no co-payment until children enter elementary school (n = 7), and co-payment continuing beyond elementary school (n = 17). The effects of six interaction terms, each representing a unique pairing from the four independent variables, were individually calculated.

RESULTS

S-FMR was negatively associated with the SCR of deciduous tooth extractions and DMFT (coefficient = -0.11, 95% CI -0.20; -0.01 and coefficient = -0.003, 95% CI -0.005; -0.001, respectively). No co-payment until children enter elementary school was positively associated with the SCR of deciduous tooth extraction compared to co-payment until children enter elementary school(coefficient = 11.42, 95% CI 3.29; 19.55). SCR of dental sealants was positively associated with the SCR of deciduous tooth extractions (coefficient = 0.12, 95% CI 0.06; 0.19) but negatively associated with DMFT (coefficient = -0.001, 95% CI -0.003; -0.0001). Per capita prefectural income was positively associated with the SCR of deciduous tooth extractions(coefficient = 0.01, 95% CI 0.001; 0.02). No interaction was found between S-FMR and the subsidy policy at both outcomes.

CONCLUSION

High S-FMR utilization and no co-payment until children enter elementary school were associated with fewer deciduous tooth extractions. Also, S-FMR and dental sealant were associated with decreased DMFT.

Impact of dental visiting patterns on oral health: A systematic review of longitudinal studies

AIM

To systematically review longitudinal studies investigating the impact of dental visiting patterns on oral health across the life course.

METHODS

Five databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL) were searched up to March 2023. Results were screened based on eligibility criteria in a two-stage process: title and abstract, and full-text review. A backward search of reference lists and a forward search of citations of the included papers was also conducted. The quality of the included papers was assessed using the Newcastle-Ottawa Scale. Key study information was extracted and a narrative synthesis of the findings was performed.

RESULTS

Eleven papers from five longitudinal studies in five countries (Australia, Brazil, China, New Zealand, Sweden) met the inclusion criteria. Studies of moderate to high quality consistently reported that regular dental attendance was associated with having less dental caries experience, fewer missing teeth and better oral health-related quality of life. Inconsistent findings were observed for decayed teeth, and no association was found for periodontal condition.

CONCLUSIONS

This review highlights an association between regular dental visiting pattern and improved oral health, notably less dental caries experience and better oral health-related quality of life. Dental attendance emerges as an important predictor of oral health across the life course, underscoring the importance of routine dental care.

REGISTRATION INFORMATION

The PROSPERO registration number is CRD42023396380.

The relationship of children's dental clinical status with school performance and school attendance in the Kingdom of Bahrain: A life-course approach

OBJECTIVES

To examine the association between dental clinical status and school performance and school attendance in the Kingdom of Bahrain (KoB) using a life-course framework.

METHODS

This time-ordered cross-sectional study included 466 school children in Grade 2 (aged 7-8 years) and their parents in the KoB. Data were collected through parents' self-administered questionnaires, children's face-to-face interviews and dental clinical examinations. Data on children's school performance and school attendance were gathered from parents and school records. Structural equation modelling (SEM) examined the direct and indirect pathways between variables.

RESULTS

Children born in families with high socio-economic status (SES) were less likely to have dental caries and more likely to have better school performance at 7-8 years of age. Dentine caries was directly linked with poor school performance. Treated teeth directly predicted high school performance. The presence of dentine caries mediated the relationship of SES with school performance.

CONCLUSIONS

Birth and current socio-economic factors were significant predictors of dental clinical conditions and school performance. Dental caries and fewer treated teeth directly predicted poor school performance.

Exposure to household dysfunction at childhood and later number of teeth among older Japanese adults: A life course study from the Japan Gerontological Evaluation Study

OBJECTIVES

The aim of this retrospective cohort study was to investigate the life course association between exposure to two household dysfunctions (father violence against mother and parental divorce) at childhood (≤18 years) with later number of remaining teeth (≥65 years) in functionally independent older Japanese population. This was the first study to investigate this research question in the Asian context.

METHODS

The Japan Gerontological Evaluation study (JAGES) self-reported retrospective data gathered in 2013 was used (n = 21,604). Each household dysfunction was binary variable (Yes/No), while the five categories of the number of remaining teeth were ≥20, 10-19, 5-9, 1-4, and no teeth. Sex-stratified ordered logistic regression models were used to calculate the odds ratios (OR) of having fewer teeth. The models were adjusted for age, economic adversity in childhood, educational attainment, comorbidities, and smoking status.

RESULTS

Overall, 46.4% were men and a total of 1149 participants (5.3%) experienced household dysfunction at childhood [men = 642 (6.4%), women = 507 (4.4%)]. The regression models showed higher OR of having fewer teeth among men who experienced a household dysfunction [OR = 1.16; 95% Confidence interval (CI) = 1.00-1.36] than men who did not. This association was not observed among women [OR = 0.94; 95% CI = 0.79-1.13]. Similar magnitude and direction of the association was observed among men but not among women when the two components of household dysfunction were used separately and aggregately as exposure variables.

CONCLUSION

An exposure to a household dysfunction at childhood was associated with having fewer teeth in later life among men but not among women.

Oral and craniofacial research in the Generation R study: an executive summary

OBJECTIVES

Oral conditions are of high prevalence and chronic character within the general population. Identifying the risk factors and determinants of oral disease is important, not only to reduce the burden of oral diseases, but also to improve (equal access to) oral health care systems, and to develop effective oral health promotion programs. Longitudinal population-based (birth-)cohort studies are very suitable to study risk factors on common oral diseases and have the potential to emphasize the importance of a healthy start for oral health. In this paper, we provide an overview of the comprehensive oral and craniofacial dataset that has been collected in the Generation R study: a population-based prospective birth cohort in the Netherlands that was designed to identify causes of health from fetal life until adulthood.

METHODS

Within the multidisciplinary context of the Generation R study, oral and craniofacial data has been collected from the age of 3 years onwards, and continued at the age of six, nine, and thirteen. Data collection is continuing in 17-year-old participants.

RESEARCH OUTCOMES

In total, the cohort population comprised 9749 children at birth, and 7405 eligible participants at the age of seventeen. Based on questionnaires, the dataset contains information on oral hygiene, dental visits, oral habits, oral health-related quality of life, orthodontic treatment, and obstructive sleep apnea. Based on direct measurements, the dataset contains information on dental caries, developmental defects of enamel, objective orthodontic treatment need, dental development, craniofacial characteristics, mandibular cortical thickness, and 3D facial measurements.

CONCLUSIONS

Several research lines have been set up using the oral and craniofacial data linked with the extensive data collection that exists within the Generation R study.

CLINICAL RELEVANCE

Being embedded in a multidisciplinary and longitudinal birth cohort study allows researchers to study several determinants of oral and craniofacial health, and to provide answers and insight into unknown etiologies and oral health problems in the general population.

Assessing association of dental caries with child oral impact on daily performance; a cross-sectional study of adolescents in Copperbelt province, Zambia

BACKGROUND

Dental caries and child oral impact on daily performance (C-OIDP) have been linked in several studies. However, the studies used caries indices, which limit the ability to examine how C-OIDP prevalence varies across various stages of the dental caries process. Furthermore, cross-cultural differences between Zambia and other African countries where the C-OIDP instrument has been widely used necessitate testing its pychometric properties. This study's primary aim was to evaluate the association between dental caries and C-OIDP. Secondarily, the study reports the psychometric properties of the C-OIDP index among Zambian adolescents.

METHODS

A cross-sectional study was conducted between February and June 2021 among grade 8-9 adolescents in Copperbelt province, Zambia. A multistage cluster sampling method was used to select participants. Using a pretested self-administered questionnaire, socio-demographics, oral health behaviors, self-reported oral health, and C-OIDP were evaluated. The test-retest and internal consistency reliability of the C-OIDP were evaluated. The Caries Assessment and Treatment Spectrum (CAST) was used to evaluate dental caries. Adjusted odd ratios and 95% confidence intervals were used to evaluate the association between dental caries and C-OIDP after adjusting for confounders identified by a directed acyclic graph.

RESULTS

Among 1,794 participants, 54.0% were females, while 56.0% were aged 11-14 years. About a quarter (24.6%) had one or more teeth at the pre-morbidity stage, 15.2% at the morbidity, 6.4% at the severe morbidity and 2.7 at the mortality stage. The internal consistency reliability of the C-OIDP Cohen's Kappa was 0.940, while the Kappa coefficients of the C-OIDP items ranged from 0.960 to 1.00. Participants with severe caries had a high prevalence of C-OIDP, with rates for morbidity, severe morbidity, and mortality stages being 49.3%, 65.3%, and 49.3%, respectively. Oral impacts were 2.6 times (AOR 2.6, 95% CI 2.1-3.4) more likely to be reported by participants with dental caries than those without caries.

CONCLUSIONS

Dental caries was associated with high reporting of C-OIDP, and C-OIDP prevalence was high among participants in the severe stages of the caries process. The English version of the C-OIDP demonstrated adequate psychometric characteristics for assessing OHRQoL among Zambian adolescents.

Adverse Childhood Experiences and Oral Health Conditions Among Middle-aged and Older Chinese Adults: Exploring the Moderating Roles of Education and Gender

This study aims to examine whether adverse childhood experiences (ACEs) are associated with oral health conditions (denture use, difficulty in chewing, and edentulism) among middle-aged and older adults in China and if gender and adulthood education moderate the associations. Data were obtained from the 2014 and 2018 surveys from the China Health and Retirement Longitudinal Study (N = 17,091) and logistic regressions were carried out. Results show that childhood hunger (OR = 1.12), loneliness (OR = 1.10) and family relations (OR = 1.07) were significantly associated with higher odds of denture use and there were significant associations between hunger (OR = 1.16) and difficulty in chewing. For the female subsample, education significantly moderated the adverse effect of childhood hunger on denture use and difficulty in chewing. Findings suggest that ACEs have long-lasting impacts on oral health conditions in later life and adulthood education might offer critical resources for females, helping them buffer the detrimental health impacts of ACEs.

Health insurance is associated with dental care use among university students in Washington State

BACKGROUND

The goal of this study was to examine the association of health insurance and preventive dental care use among university students.

METHODS

This secondary analysis of cross-sectional data focused on students at University of Washington in Washington state (WA) who completed a health insurance survey in 2017 (n = 3768). The exposure was health insurance (private insurance in WA [reference group], not insured, Medicaid or Medicare [public insurance], university insurance, private insurance not in WA, other) and the outcome was receiving a dental cleaning in the past 6 months. Logistic regression was used to generate odds ratios and 95% confidence intervals (CI) adjusted for confounders.

RESULTS

About 5% of university students did not have health insurance and 37% did not have a dental cleaning in the past 6 months. Compared to students with private health insurance based in WA, the odds of not receiving a dental cleaning were 3.90 times greater for university students with no health insurance (95% CI 2.74, 5.55; p < .001) and 3.08 times greater for publicly-insured university students (95% CI 2.52, 3.76; p < .001).

CONCLUSIONS

University students are at risk for poor oral health behaviors. Those without health insurance and those with public insurance face barriers to preventive dental care. Efforts should be made to connect uninsured university students with insurance, dental services, and other oral health promotion activities.

Oral Health and Mortality Among Older Adults: A Doubly Robust Survival Analysis

INTRODUCTION

Evidence on the association between oral health and mortality is inconclusive, and few studies have accounted for the nonrandom selection bias in estimating their relationship. This study aims to investigate the link between oral health and mortality in community-dwelling older adults by adjusting for confounding factors with a doubly robust survival estimation.

METHODS

Data came from the third National Health and Nutrition Examination Survey (1988-1994) and were linked to the National Death Index mortality data through December 2015. The analytic sample consisted of 4,880 adults aged ≥60 years. Oral health measures included objective clinical indicators (edentulism, periodontitis, and untreated dental caries) and self-rated oral health. Cox proportional hazards regression models and inverse probability weighting with regression adjustment for observational survival-time estimation were utilized to assess the relationship between oral health and mortality. Analyses were conducted in 2021.

RESULTS

Edentulism (average treatment effect= -26.13, 95% CI= -48.69, -3.57) was associated with a reduction in survival time. Periodontal conditions and dental caries were related to all-cause mortality in Cox models but became nonsignificant when inverse probability weighting with regression adjustment survival estimation was applied. Good self-rated oral health was significantly related to an increase in survival time (average treatment effect=21.50; 95% CI= 4.92, 38.07).

CONCLUSIONS

Both objective and subjective oral health are risk factors for mortality among older adults. Improving access to dental screening and treatment among community-dwelling older adults has the potential to reduce oral health‒related risks of mortality.

Evaluating the ecological hypothesis: early life salivary microbiome assembly predicts dental caries in a longitudinal case-control study

BACKGROUND

Early childhood caries (ECC)-dental caries (cavities) occurring in primary teeth up to age 6 years-is a prevalent childhood oral disease with a microbial etiology. Streptococcus mutans was previously considered a primary cause, but recent research promotes the ecologic hypothesis, in which a dysbiosis in the oral microbial community leads to caries. In this incident, density sampled case-control study of 189 children followed from 2 months to 5 years, we use the salivary bacteriome to (1) prospectively test the ecological hypothesis of ECC in salivary bacteriome communities and (2) identify co-occurring salivary bacterial communities predicting future ECC.

RESULTS

Supervised classification of future ECC case status using salivary samples from age 12 months using bacteriome-wide data (AUC-ROC 0.78 95% CI (0.71-0.85)) predicts future ECC status before S. mutans can be detected. Dirichlet multinomial community state typing and co-occurrence network analysis identified similar robust and replicable groups of co-occurring taxa. Mean relative abundance of a Haemophilus parainfluenzae/Neisseria/Fusobacterium periodonticum group was lower in future ECC cases (0.14) than controls (0.23, P value < 0.001) in pre-incident visits, positively correlated with saliva pH (Pearson rho = 0.33, P value < 0.001) and reduced in individuals who had acquired S. mutans by the next study visit (0.13) versus those who did not (0.20, P value < 0.01). In a subset of whole genome shotgun sequenced samples (n = 30), case plaque had higher abundances of antibiotic production and resistance gene orthologs, including a major facilitator superfamily multidrug resistance transporter (MFS DHA2 family PBH value = 1.9 × 10-28), lantibiotic transport system permease protein (PBH value = 6.0 × 10-6) and bacitracin synthase I (PBH value = 5.6 × 10-6). The oxidative phosphorylation KEGG pathway was enriched in case plaque (PBH value = 1.2 × 10-8), while the ABC transporter pathway was depleted (PBH value = 3.6 × 10-3).

CONCLUSIONS

Early-life bacterial interactions predisposed children to ECC, supporting a time-dependent interpretation of the ecological hypothesis. Bacterial communities which assemble before 12 months of age can promote or inhibit an ecological succession to S. mutans dominance and cariogenesis. Intragenera competitions and intergenera cooperation between oral taxa may shape the emergence of these communities, providing points for preventive interventions. Video Abstract.

Sustainable development goals and ending ECC as a public health crisis

Early Childhood Caries (ECC) remains a global issue despite numerous advancements in research and interventional approaches. Nearly, 530 million children suffer from untreated dental caries of primary teeth. The consequences of such untreated dental caries not only limit the child's chewing and eating abilities but also, significantly impact the child's overall growth. Research has demonstrated that ECC is associated with nearly 123 risk factors. ECC has also been associated with local pain, infections, abscesses, and sleep pattern. Furthermore, it can affect the child's emotional status and decrease their ability to learn or perform their usual activities. In high-income countries, dental care continues to endorse a "current treatment-based approach" that involves high-technology, interventionist, and specialized approaches. While such approaches provide immediate benefit at an individual level, it fails to intercept the underlying causes of the disease at large. In low-income and middle-income countries (LMICs), the "current treatment approach" often remains limited, unaffordable, and unsuitable for the majority of the population. Rather, dentistry needs to focus on "sustainable goals" and integrate dental care with the mainstream healthcare system and primary care services. Dental care systems should promote "early first dental visits," when the child is 1 year of age or when the first tooth arrives. The serious shortages of appropriately trained oral healthcare personnel in certain regions of the world, lack of appropriate technologies and isolation of oral health services from the health system, and limited adoption of prevention and oral health promotion can pose as critical barriers. The oral health care systems must focus on three major keystones to combat the burden of ECC-1. Essential oral health services are integrated into healthcare in every country ensuring the availability of appropriate healthcare accessible and available globally, 2. Integrating oral and general healthcare to effectively prevent and manage oral disease and improve oral health, 3. Collaborating with a wide range of health workers to deliver sustainable oral health care tailored to cater to the oral health care needs of local communities.

Factors influencing oral health behaviours, access and delivery of dental care for autistic children and adolescents: A mixed-methods systematic review

Background

Autistic children and young people (CYP) experience oral health (OH) inequalities. They are at high risk of dental disease and show significant levels of unmet need in relation to OH and access to dental care.

Aim

This study aimed to gather evidence on the factors that influence OH behaviours, access to and delivery of dental care for autistic CYP.

Design

This was a mixed‐methods narrative systematic review.

Data Sources

Embase, Web of Science, Dentistry & Oral Sciences Source, MEDLINE, Psychinfo, Scopus, CINAHL, SocINDEX and grey literature were the data sources for this study.

Review Methods

A systematic search was conducted for qualitative, quantitative and mixed‐methods research studies from countries with a High Development Index that related to OH behaviours, access to and delivery of dental care for autistic CYP. Results were analysed using narrative synthesis.

Results

From 59 eligible studies, 9 themes were generated: (1) affordability and accessibility; (2) autism‐related factors and cognitive or motor skill differences; (3) the dental environment; (4) managing CYP's behaviour; (5) responding and adapting to the needs of the autistic CYP and their parent/carer; (6) attitude of dental health professionals (DHPs) towards autistic CYP and their parents/carers; (7) knowledge of how to care for and support CYP's OH; (8) empowerment of parents/carers and collaboration with DHPs; and (9) communication and building rapport.

Conclusion

The adoption of healthy OH behaviours and access to dental care by autistic CYP is impacted by a range of factors including those intrinsically related to a diagnosis of autism, for example, communication and those often associated with autism, for example, sensory sensitivities. Access to better OH and dental care can be facilitated by responding to the individual needs of autistic CYP through accommodation, education and adaptation. This necessitates greater awareness and knowledge of autism amongst DHPs and the provision of appropriate services. More methodologically robust intervention studies are needed to identify effective ways to support autistic CYP in achieving good OH and access to dental care.

Patient and Public Contribution

The review protocol was developed with members of the project patient and public involvement group who provided the autistic voice, contributing to the interpretation of the review findings and writing of the manuscript.

Oral Health, Health Service Utilization, and Age at Arrival to the U.S. among Safety Net Patients

Background: Immigrants’ oral health disparities have not been adequately investigated using a lifecourse approach, which investigates the cumulative effects of risk and protective exposures among other considerations. Methods: We examined self-reported oral health outcomes and health care appointment outcomes among a sample of patients enrolled at a federally qualified health center in Richmond Virginia (N = 327) who were categorized into three groups by approximate age at arrival to the U.S. Results: Study participants who arrived to the U.S. prior to age 18 had better retention of natural dentition, better oral health related quality of life, and a lower proportion of dental appointments to address pain than those who arrived after age 18 or were born in the U.S. Conclusions: Im/migrants’ differentiated oral health outcomes by age at arrival to the U.S. suggest the relevance of lifecourse factors, for example the cumulative effects of risk and protective exposures, and confirm the merits of lifecourse studies of im/migrants’ oral health.

Motivators and barriers to oral hygiene self-care among adolescents in Malaysia: A qualitative study

OBJECTIVE

Having good oral hygiene self-care, especially a regular toothbrushing habit will promote lifelong oral health. Therefore, understanding the factors that influence an adolescent's oral hygiene behaviour is important in developing effective oral health programmes for this age group. This study aimed to explore the motivators and barriers to adolescents' oral hygiene self-care by exploring the perspectives of secondary school students from three government schools in the state of Selangor, Malaysia.

METHODS

Focus group discussions (FGD) were conducted with Form 2 (14-years-old) and Form 4 (16-years-old) students from selected secondary schools in Selangor using a semi-structured topic guide until data saturation was reached. Data were transcribed verbatim and analysed using framework method analysis.

RESULTS

A total of 10 FGDs were conducted involving 77 adolescents. The motivators for good oral hygiene self-care were appearance, fear of oral disease, consequences of oral disease and past toothache experience. The barriers for oral hygiene self-care were poor attitude towards oral care, lack of confidence in toothbrushing skills, snacking habit and the taste of toothpaste.

CONCLUSION

Understanding the motivators and barriers to adolescents' oral hygiene self-care is the first step in designing effective oral health education messages. The findings from this study can be used as a guide for oral health education programmes and development of materials that fulfil the needs of the adolescent population.

Early-Life Patterns of Sugar Consumption and Dental Caries in the Permanent Teeth: A Birth Cohort Study

Early-life family conditions may presage caries development in childhood. The aim of this study was to evaluate associations between patterns of sugar consumption in early childhood and permanent dentition caries at age 6 years. A cohort enrolled women accessing prenatal care at public health clinics in Porto Alegre, Brazil. Sociodemographic, anthropometric, and dietary data were collected during pregnancy and 6-month, 12-month, and 3-year follow-ups. Calibrated dental examinations occurred at ages 3 and 6 years. Multivariable logistic regression analysis was performed in series to quantify associations between early-life variables and permanent dentition caries. At age 6 years, 7.9% of children (21/266) had ≥1 caries lesion on permanent teeth (first molars). In unadjusted models, gestational weight gain, sweet food introduction (age 6 months), household sugar purchases (age 3 years), and caries (age 3 years) were positively associated with permanent dentition caries (age 6 years). In multivariable models, each 1-kg increase in gestational weight gain (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.01, 1.16) and each 1-item increase in sweet food consumption at age 6 months (OR: 1.27; 95% CI: 1.02, 1.59) remained statistically significantly associated with permanent molar caries. Findings from this cohort study suggest family and child factors that long predate the permanent dentition, including sugar-related behaviors, predict future dental status, and may inform prevention strategies.

Oral health: Epidemiology and concordance in Australian children and parents

INTRODUCTION

Studying parent-child pair health provides the opportunity to identify risk factors and opportunities for oral health prevention and intervention focusing on the family context. The aim of this study was to describe the oral health of children aged 11-12 years and their parents in a national sample of parent-child dyads in Australia.

METHODS

The Child Health CheckPoint is a study of 11 to 12-year-old children and one parent nested within the Longitudinal Study of Australian Children, a nationally representative cohort study. In 2015-16, the study collected two-dimensional photographic intra-oral images and was scored using visual assessments of the teeth, oral hygiene and malocclusion.

RESULTS

Of the 1874 CheckPoint families, 1396 biological parent-child pairs had at least one oral health measure recorded. Over two-thirds of children had moderate to severe gingival inflammation (69.7%, 95%CI 64.7-74.9). Parents had a lower proportion of poor oral hygiene (2.1%, 95% CI 1.4-3.0) than children (13.0%, 95% CI 11.3-14.9). High concordance was seen in the Modified Gingival Index correlation coefficient 0.49 (95%CI 0.44-0.53).

CONCLUSION

The high concordance in gingival health between child-parent pairs supports the familial and behavioural links established in previous studies. Children had poorer oral hygiene but fewer visible dental caries lesions than their parents. As dental caries is a chronic and cumulative disease, preventive interventions targeting children's oral hygiene are needed.

Oral health and depressive symptoms: findings from the English Longitudinal Study of Ageing

Aim We assessed the cross-sectional association between depressive symptoms and oral health using a nationally representative sample of older adults aged 50 years and older living in England.Methods Data came from wave 7 (2014-2015) of the English Longitudinal Study of Ageing. Multiple logistic regression analyses were conducted to assess the association between depressive symptoms, measured through the eight-item Centre for Epidemiologic Studies Depression Scale and three oral health outcomes, namely self-rated oral health, edentulousness and oral impacts.Results The analytical sample comprised 3,617 individuals. The proportion of participants that reported poor self-rated oral health, being edentate and having at least one oral health impact in the last six months was 19.8%, 7.7% and 8.9%, respectively. Around a tenth of the participants reported having depressive symptoms (10%). All unadjusted associations between depressive symptoms and the oral health measures were statistically significant. However, after accounting for potential confounders, only the relationship between depressive symptoms and self-rated oral health remained significant (OR = 1.38; 95% CI 1.01-1.89). Socioeconomic and general health-related variables appeared to influence the associations between depressive symptoms and oral health, particularly edentulousness and oral impacts.Conclusion Depressive symptoms were associated with poor self-rated oral health in older English adults.

How effective and cost-effective is water fluoridation for adults? Protocol for a 10-year retrospective cohort study

BACKGROUND

Tooth decay can cause pain, sleepless nights and loss of productive workdays. Fluoridation of drinking water was identified in the 1940s as a cost-effective method of prevention. In the mid-1970s, fluoride toothpastes became widely available. Since then, in high-income countries the prevalence of tooth decay in children has reduced whilst natural tooth retention in older age groups has increased. Most water fluoridation research was carried out before these dramatic changes in fluoride availability and oral health. Furthermore, there is a paucity of evidence in adults. The aim of this study is to assess the clinical and cost-effectiveness of water fluoridation in preventing invasive dental treatment in adults and adolescents aged over 12.

METHODS/DESIGN

Retrospective cohort study using 10 years of routinely available dental treatment data. Individuals exposed to water fluoridation will be identified by sampled water fluoride concentration linked to place of residence. Outcomes will be based on the number of invasive dental treatments received per participant (fillings, extractions, root canal treatments). A generalised linear model with clustering by local authority area will be used for analysis. The model will include area level propensity scores and individual-level covariates. The economic evaluation will focus on (1) cost-effectiveness as assessed by the water fluoridation mean cost per invasive treatment avoided and (2) a return on investment from the public sector perspective, capturing the change in cost of dental service utilisation resulting from investment in water fluoridation.

DISCUSSIONS

There is a well-recognised need for contemporary evidence regarding the effectiveness and cost-effectiveness of water fluoridation, particularly for adults. The absence of such evidence for all age groups may lead to an underestimation of the potential benefits of a population-wide, rather than targeted, fluoride delivery programme. This study will utilise a pragmatic design to address the information needs of policy makers in a timely manner.

Poor parenting behaviours and dental caries experience in 6- To 7-year-old children

OBJECTIVES

The association between poor parenting and dental caries in children remains unclear. We investigated the association of poor parenting with dental caries and oral health behaviour among children aged 6-7 years in Japan.

METHODS

Two waves of repeated cross-sectional surveys on children and their caregivers in Adachi City, Tokyo, were analysed. Questionnaires on parenting behaviour and the child's oral health behaviour were distributed through schools and completed by 8499 caregivers (response rate = 80.8%). The number of decayed or filled primary teeth (dft) at school dental health check-ups was linked to the survey data (N for complete case analysis = 6309). Factor analysis was performed to identify types of poor parenting: poor involvement, child abuse and lack of supervision of a child's health behaviours. The association between factor scores (z-score), the number of dft and oral health behaviour (not brushing teeth twice a day, not controlling snack eating habits and drinking juice every day) was evaluated by Poisson's regressions adjusted for covariates, including caregiver's socioeconomic status.

RESULTS

Poor involvement and lack of supervision of a child's health behaviours were positively associated with dft (mean ratio, MR [95% confidence interval, CI] =1.05 [1.03, 1.07] and 1.18 [1.16, 1.21], respectively) and unhealthy oral health behaviours. Child abuse was not associated with dft (MR = 0.99 [0.96, 1.01]) but was associated with all three unhealthy oral health behaviours (prevalence ratio, PR [95% CI] were 1.11 [1.06, 1.16], 1.11 [1.06, 1.16] and 1.06 [1.00, 1.11] for not brushing teeth, not controlling snack eating and drinking juice, respectively).

CONCLUSIONS

Poor involvement and lack of supervision of a child's health behaviours were associated with dental caries, and any type of poor parenting was associated with poor oral health behaviour among children.

Prevention and management of periodontal diseases and dental caries in the older adults

As a result of aging populations, in the future, dental practitioners will be caring for more older adults than ever before. These older adults, especially in developed countries, will demand a greater number of dental services, driven by increased tooth retention and an expectation of excellent oral healthcare throughout the life course. Further, the global rise in the prevalence and incidence of chronic diseases will increase the risk and/or severity of oral diseases and add a layer of complexity to the management of oral diseases in older adults. More older adults will be at a higher risk of periodontal disease and root caries as a result of reduced tooth loss and edentulism. This article reviews information on periodontitis and root caries, oral diseases which reflect the cumulative risk of the individual, and which are best addressed through prevention. Oral healthcare providers must embrace the concept of lifelong emphasis on prevention, as well as participation as active members of a healthcare team which provides healthcare for older adults in various settings (eg, hospital/clinic-based care, community-based settings, and long-term care facilities). National guidelines that address oral health are being considered by some countries, and if these are implemented they will increase the accessibility to oral health for older adults. In parallel to this, revisions of existing older adult insurance schemes (eg, the inclusion of routine oral healthcare in the US Medicare program) would promote the maintenance of a functional dentition that is pain-free and conducive to general health. The opportunity exists to implement a holistic approach to oral health that will align oral health with general health and emphasize that true health can only be achieved with the inclusion of oral health.

Availability of public dental care service and dental caries increment in children: a cohort study

OBJECTIVE

Evaluate the impact of the availability of public dental care service on the increment of dental caries in children.

METHODS

This is a 2-year cohort study that followed preschool children from southern Brazil. Dental caries was measured at baseline and follow-up evaluation, considering the number of surfaces with untreated dental caries. Demographic and socioeconomic characteristics as well as the use and availability of dental services were assessed. Multilevel Poisson regression analysis through a hierarchical approach and considering a random effect for repeated measures was used to explore the influence of exploratory variables in the increase in the outcome.

RESULTS

A total of 419 cases were evaluated at follow-up (91.3% cohort retention rate). The increase in the untreated dental caries was associated with living in places where there is no regular presence of dentists in the public health system. In addition, the increment of dental caries was influenced by age, household income, and dental attendance.

CONCLUSION

The results suggest that the availability of dentists in the public health system have an impact the increment of dental caries among children. The integration of the dentist in the primary healthcare can contribute to decrease the barriers that lead to children's oral health.

Behavioral Sciences in the Promotion of Oral Health

The importance and value of behavioral sciences in dentistry have long been recognized, and their contribution to dental education, research, clinical practice, and oral health policy has been significant over the past half century. Over time behavioral sciences have expanded our understanding of oral health beyond "disease" to a broader biopsychosocial concept of oral health. This in turn has led dentistry away from a focus of "treatment" to oral health "care," notably in the new millennium. Key oral health behaviors have been identified for more than half a century: the importance of diet, oral hygiene, dental services, and other factors. Various behavioral models and theories have been proposed, particularly since the 1970s, providing useful frameworks with sound psychological basis to help understand the paths of oral health behaviors. These models draw on theories of self-efficacy, motivation, counseling, and "behavior change." Since the 1980s, there has been a greater understanding that these behaviors often share a common pathway with the etiology of other diseases (common risk factors). Furthermore, the relationship between individual factors and the broader environmental factors has been increasingly emphasized since the 1990s, leading to a united call for action in addressing oral health inequalities. Within the past decade, there are useful examples of models, frameworks, and techniques of behavior change with respect to oral health, involving planning, prompting, encouraging, goal setting, and/or motivating. In particular, there is a growing interest and use of motivational interviewing. Likewise, behavioral therapies, such as cognitive behavioral therapy, are increasingly being employed in dental practice in the management of dental anxiety, pain, and psychosomatic dental and oral problems, with promising results. Recommendations are outlined for future directions for behavioral sciences in the promotion of oral health.

Recording of diagnoses in public primary oral health care in a retrospective longitudinal observational study in a Finnish town: Underrepresentation of periodontitis diagnoses

OBJECTIVES

This study investigates which oral diagnoses public primary dental care dentists record.

METHODS

An observational register-based retrospective follow-up study was performed in the public primary oral health care of a Finnish town after the dentists were advised to mark the diagnoses in their practices. The rate of recorded diagnoses resulting from visits to the public primary care dentists was studied. The assessed diagnoses were recorded with the 10th revision of the International Classification of Diseases. The distribution of diagnoses was recorded during a 2-year follow-up period.

RESULTS

The most frequent diagnosis groups were dental caries (K02, 38.6%), other diseases of dental hard tissues (K03, 14.9%), diseases of pulp and periapical tissues (K04, 11.4%), periodontal diseases (K05, 9.7%), and different types of bone fractures (S02, 8.1%). Periodontitis was underrepresented.

CONCLUSIONS

In public primary oral health care, there may be difficulties in adequate recording of certain chronic diseases.

100% Fruit Juice and Dental Health: A Systematic Review of the Literature

Background: The objective of this systematic review was to assess the scope and breadth of publicly available prospective cohort and randomized controlled trial (RCT) literature on 100% fruit juice and dental caries or tooth erosion in humans.

Methods: We performed a systematic search in MEDLINE/PubMed, EMBASE, and Web of Science for studies published from inception through May 2018, and the Cochrane Library databases for reports published through January 2018. Prospective cohort studies or RCTs conducted on dental health and 100% fruit juice, and published in English were selected. No restrictions were set for age, sex, geographic location, or socioeconomic status.

Results: Eight publications representing five independent prospective cohort studies and nine publications on nine RCTs were included. All prospective cohort studies were in children or adolescents, and all RCTs were in adults. Prospective cohort studies on tooth erosion found no association between juice intake and tooth erosion, while those on dental caries incidence reported either no association or an inverse association between 100% fruit juice intakes and dental caries incidence. RCTs on tooth erosion showed decreased microhardness, increased surface enamel loss, increased erosion depth, greater enamel softening, and/or increased pellicle layer with 100% fruit juice, and those on dental caries showed increased demineralization of enamel slabs with 100% fruit juice.

Conclusions: The existing evidence on 100% fruit juice intake and caries and tooth erosion are not conclusive. Overall, prospective cohort studies in children and adolescents found no association between 100% fruit juice intake and tooth erosion or dental caries, but, RCT data in adults suggests that 100% fruit juice could contribute to tooth erosion and dental caries. The RCT data, however, were from small, short-term studies that utilized intra-oral devices generally devoid of normal plaque or saliva action, and generally employed conditions that are not reflective of normal juice consumption.

Is tooth loss important when evaluating perceived general health? Findings from a nationally representative study of Costa Rican adults

OBJECTIVES

Although previous studies have shown that oral diseases can impact certain systemic conditions, dental care has been historically separated from medical healthcare organizations in middle-income countries. There is a lack of research approaches which test the independent relationship between oral health and multidimensional measures of general health. This study analyses the influence of tooth loss on self-rated health (SRH), hypothesizing that, relatively to certain morbidity conditions, tooth loss is a health condition associated with SRH. This study analyses the influence of tooth loss on self-rated health (SRH), hypothesizing that, relative to certain morbidity conditions, tooth loss is a health condition associated with SRH.

METHODS

Data were obtained from the Costa Rican Longevity and Healthy Aging Study 1945-1955 Retirement Cohort, a national representative longitudinal survey including residents born between 1945 and 1955. The association between severe tooth loss and SRH was analysed cross-sectionally using the first wave of the study conducted in 2010. A multivariable logistic regression, adjusted for potential confounders, was performed on 2797 participants. A counterfactual analysis was additionally performed to illustrate the theoretical change on SRH prevalence-if all the participants were not to have had severe tooth loss.

RESULTS

Severe tooth loss was associated with poor SRH, after adjustment for smoking, morbidity, biomarkers and performance-based physical measures. The counterfactual analysis showed that severe tooth loss was the fifth most important morbidity condition in determining poor SRH. Declaring a poor SRH would have been decreased by 2.0 percentage points if those participants having severe tooth loss had shared the same risk pattern of those who had not lost the majority of their teeth.

CONCLUSION

Individuals consider their oral health status to a similar extent as other morbidity conditions when evaluating their general health. A stronger focus on oral health, and its impact on general health, could lead to better planning of national resources, thereby improving accessibility to health care and modifying prevailing conceptions of health care in low- and middle-income countries.

Material, behavioural, cultural and psychosocial factors in the explanation of socioeconomic inequalities in oral health

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.

Impact of Dental Diseases on Quality-Adjusted Life Expectancy in US Adults

Comparing the burden of dental conditions to other health outcomes provides useful insight for public policy. We aimed to estimate quality-adjusted life expectancy (QALE) loss due to dental conditions in the US adult population. Social inequalities in QALE loss by dental conditions were also examined. Data from 3 cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES waves 2001 to 2002, 2003 to 2004, and 2011 to 2012) were pooled and analyzed. The average age of study participants ( n = 9,445) was 48.4 y. Disutility scores were derived from self-rated health and the numbers of physically unhealthy days, mentally unhealthy days, and days with activity limitation, employing a previously published algorithm. The associations between the disutility scores and the numbers of decayed teeth, missing teeth, and periodontitis were examined by multiple linear regression stratified by age groups (20–39, 40–59, and ≥60 y), adjusted for other covariates (age, sex, wave fixed effect, educational attainment, smoking, and diabetes). The QALE loss due to dental conditions at the age of 20 was estimated using life tables. Decayed and missing teeth, but not periodontitis, were associated with a larger disutility score. The coefficient for decayed teeth was larger among the older population, whereas that of missing teeth was smaller among them. The estimated QALE loss was 0.43 y (95% confidence interval [CI], 0.28–0.59), which reached 5.3% of QALE loss (8.15 y; 95% CI, 8.03–8.27) due to overall morbidity. There were clear social gradients in QALE loss by dental conditions across the life course, and people with high school or less education had 0.32 y larger QALE loss in total compared with people with college or more education. This study suggests that improvements in people’s dental health may yield substantial gains in population health and well-being. The necessity of more comprehensive public health strategies is highlighted.

Socio-demographic determinants as predictors of oral hygiene status and gingivitis in schoolchildren aged 7-12 years old: A cross-sectional study

OBJECTIVE

Gingivitis and poor oral hygiene status are the most prevalent oral diseases among primary school students. Poor oral hygiene status, gingivitis and socio-demographic determinants have been shown to be associated with periodontal diseases. There is limited information on the gingivitis and oral hygiene status among Iranian children. In the present study, the status of gingivitis, oral hygiene status, and their association with socio-demographic determinants among schoolchildren aged 7-12 years old in Hamadan were investigated.

METHODS

In this cross-sectional study, 988 primary school students aged 7-12 years old were selected. The oral hygiene status was measured through Simplified Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI) was used to evaluate gingival bleeding and calculus. CPI was measured using a standardized protocol to investigate gum bleeding and calculus. The oral hygiene was classified as good, fair or poor based on calculus and debris measurements. Age, gender, educational level, occupation and residence district of parents, dental pain experience in the last year and whether parents supervised their children while brushing were assessed by the questionnaires. The collected data were analyzed using descriptive statistics and logistic regression analysis.

RESULTS

The oral hygiene status was good in 644 students (65.20%), fair in 341 (34.50%) and poor in three (0.30%). Moreover, the results of CPI depicted that 639 students (64.07%) had healthy periodontium, 320 (32.40%) had periodontal bleeding and 29 (2.9%) were with calculus. Higher percentage of the boys in the age group of 12 years old had periodontal bleeding and fewer good oral hygiene. The results of CPI and OHI-S scores depicted that more than half of the primary school students had healthy gums and periodontium (64.1%) and good oral hygiene status (65.2%). There were significant statistical associations between age and residence district with calculus measured by the CPI, also between gender, age, residence district, and mother's occupation with the gingival bleeding measured by the CPI. Furthermore, age and mother's occupation were significantly associated with OHI-S index.

CONCLUSIONS

In general, the periodontal health status is poorer in students attending suburban schools compared to those in urban schools in Hamadan. Since there are significant associations between gender, school districts and mother's occupation with oral hygiene index among schoolchildren in primary schools, considering them in schools' oral health program design might be useful.