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Alfaisal Y, Idris G, Peters OA, Peters CI, Zafar S. Factors influencing treatment decisions in permanent mature teeth with irreversible pulpitis: a questionnaire-based study. Aust Dent J 2024. [PMID: 38850075 DOI: 10.1111/adj.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Decision-making in dentistry is a complex process, and this study evaluated factors that influence dentists' approaches in permanent mature teeth with irreversible pulpitis. METHODS An online questionnaire was distributed to a group of dental practitioners. The questionnaire surveyed dentists' opinions about the management of vital permanent teeth with irreversible pulpitis including a case scenario. RESULTS Data from 262 respondents were analysed. Barriers to perform vital pulp therapy (VPT) included presuming it an inappropriate long-term treatment (29.7%), lack of knowledge, insufficient access to materials, inadequate training and lack of confidence. Patient's preference (79.44%) and tooth restorability (91%) were the most frequently reported factors influencing treatment decisions. Dentists aged 25-35 years and who have 1-5 years of experience ranked extraction as a more successful treatment (P = 0.008; P = 0.003, respectively). Non-Australian graduates ranked pulpotomy to be a more successful procedure (P = 0.007), and public sector/hospital practitioners favoured extraction more than practitioners from other sectors (P = 0.003). Postgraduates/specialists preferred pulpotomy (P = 0.012) more than general dentists. Participants' clinical approaches for the management of symptomatic irreversible pulpitis: root canal treatment (45.0%), indirect pulp capping (22.9%), direct pulp capping (15.8%), pulpotomy (17.1%) and extraction (6.3%). CONCLUSIONS Female, more experienced, overseas-educated dentists and endodontists preferred VPT for irreversible pulpitis in permanent mature teeth more than other participants. © 2024 Australian Dental Association.
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Affiliation(s)
- Y Alfaisal
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - G Idris
- Metro North Hospital and Health Services, Queensland Health, Brisbane, QLD, Australia
| | - O A Peters
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - C I Peters
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - S Zafar
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
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Karam SA, Schuch HS, Demarco FF, Horta BL, Borrell LN, Celeste RK, Correa MB. Differential effect of social mobility on tooth loss by race in adulthood: 1982 Pelotas Birth Cohort Study. Community Dent Oral Epidemiol 2024. [PMID: 38778564 DOI: 10.1111/cdoe.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/20/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To examine the association between social mobility and tooth loss in adults from the 1982 Pelotas Birth Cohort Study and whether race modifies this association. METHODS The Oral Health Study used data from 541 individuals who were followed up to 31 years of age. Social mobility, composed of the participants' socioeconomic position (SEP) at birth and at age 30, was categorized as never poor, upwardly mobile, downwardly mobile and always poor. The outcome was the prevalence of at least one tooth lost due to dental caries when the participants were examined at 31 years of age. The effect modifier was race (Black/Brown versus white people). Log-binomial regression models were used to estimate crude and sex-adjusted prevalence ratios (PR) and to determine whether the association varied with race. Statistical interactions were tested using an additive scale. RESULTS The prevalence of any tooth loss was 50.8% (n = 274). In social mobility groups, the prevalence of at least one tooth lost in the never-poor group was about 31% points higher for Black/Brown (68.2%) than for white people (37.4%). Antagonistic findings were found for the interaction between race and social mobility (Sinergy Index = 0.48; 95% CI 0.24, 0.99; and relative excess of risk due to the interaction = -1.38; 95% CI -2.34, -0.42), suggesting that the observed joint effect of race and social mobility on tooth loss was lower than the expected sum of these factors. The estimates for Black/Brown people were smaller for those who were always poor during their lives, relative to their white counterparts. CONCLUSIONS The findings suggest a higher prevalence of at least one tooth lost among people in the downward mobile SEP group and Black/Brown people. Greater racial inequity was found among Black/Brown people who had never experienced episodes of poverty, with Black/Brown people having a greater prevalence of at least one tooth lost than their white counterparts.
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Affiliation(s)
- Sarah Arangurem Karam
- Graduate Program in Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
- Professional Master's in Health in the Life Cycle, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York, USA
| | - Roger Keller Celeste
- Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Alfaisal Y, Idris G, Peters OA, Zafar S, Nagendrababu V, Peters CI. Vital pulp therapy-Factors influencing decision-making for permanent mature teeth with irreversible pulpitis: A systematic review. Int Endod J 2024; 57:505-519. [PMID: 38326290 DOI: 10.1111/iej.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND There is an increased tendency towards adopting minimally invasive interventions in dentistry, supported by advancement in materials and techniques. However, the decision-making process in choosing conservative or invasive treatments is influenced by several factors, particularly in permanent teeth with irreversible pulpitis. OBJECTIVES The objective of the study was to systematically review the literature regarding factors that influence decision-making for vital pulp therapy (VPT) as definitive treatment option in permanent mature teeth diagnosed with irreversible pulpitis. METHODS Two independent reviewers searched five electronic databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library). Grey literature was searched through Google Scholar and contact with experts. Defined search keys were applied, and all peer-reviewed literature published with no language nor publication date limits were included. The All studies investigating the factors influencing treatment decision-making in mature permanent teeth with irreversible pulpitis were included. The quality of included studies was assessed by two independent reviewers using the Joanna Briggs Institute quality assessment tool. RESULTS Six articles were included in the review. All included studies used questionnaires to characterize clinician preferences and attitudes in choosing treatment options for mature permanent teeth with irreversible pulpitis. The available evidence suggests that dentist-related factors have a significant influence on the chosen treatment in teeth with irreversible pulpitis, with speciality training and years of experience influencing the choice of VPT over other treatment options. COVID-19 reportedly swayed the dentists' decision to favour VPT. Only one article studied the influence of patient-related factors, such as age and presence of spontaneous pain on decision-making. Of note, a history of cardiovascular disease moved dentists towards prescribing VPT. DISCUSSION Collectively, the included studies demonstrated an overriding influence of dentist-related factors on choosing among treatment options for painful teeth diagnosed with irreversible pulpitis. Patient-related factors were acknowledged but there are also potential factors such as socio-economic constraints that were not included in the component studies. CONCLUSION In teeth with irreversible pulpitis clinicians educational background influence the decision towards a specific treatment option. Further data, preferably derived from clinical records, is necessary in future investigations to explore the effect of other important factors related to both dentists and patients. REGISTRATION PROSPERO database (CRD42022339653).
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Affiliation(s)
- Yasmen Alfaisal
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Ghassan Idris
- Metro North Hospital and Health Services, Queensland Health, Brisbane, Queensland, Australia
| | - Ove A Peters
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Sobia Zafar
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Christine I Peters
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
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Pires ALC, Costa FDS, D'Ávila OP, Carvalho RVD, Conde MCM, Correa MB, Demarco FF, Chisini LA. Contextual inequalities in specialized dental public health care in Brazil. Braz Oral Res 2024; 38:e023. [PMID: 38597543 DOI: 10.1590/1807-3107bor-2024.vol38.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 06/15/2023] [Indexed: 04/11/2024] Open
Abstract
The present study aimed to investigate the contextual inequalities of specialized public dental care (SPDC) in Brazil. The outcome was the trajectory of dental specialized production in municipalities with SPDC (from 2015 to 2017) obtained by group-based trajectory modeling. A Poisson regression model was used to analyze the factors associated with the high trajectory of SPDC production. The inequality indicators for SPDC production were the slope index and the concentration index according to contextual factors. The study included 954 SPDC units distributed across 893 municipalities. Among the municipalities evaluated, 62.9% had a low trajectory of SPDC. Large-sized municipalities had the highest production (IRR = 2.84, 95%CI: 1.94-4.14) and the southern region had the lowest production (IRR = 0.73, 95%CI: 0.58-0.92). Municipalities presenting a very high human development index (HDI) showed the greatest SPDC production (IRR = 3.34, 95%CI: 1.09-10.24), as well as municipalities with the highest tertile of schooling rate (IRR = 1.23, 95%CI: 1.00-1.50). The absolute inequality was 52.1 percentage points for the average monthly wage (p < 0.001), 61.0 percentage points for the HDI (p < 0.001), -22.1 for infant mortality rate (p <0.001), and 14.8 for the schooling rate (p = 0.012). Thus, there are contextual inequalities in the Brazilian SPDC. Higher scores for social indicators were associated with better SPDC performance.
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Affiliation(s)
- Ana Luiza Cardoso Pires
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Department of Restorative Dentistry, Pelotas, RS, Brazil
| | | | - Otávio Pereira D'Ávila
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Department of Social Dentistry, Pelotas, RS, Brazil
| | | | - Marcus Cristian Muniz Conde
- Universidade do Vale do Taquari-Univates, Center for Biological Sciences and Health, Department of Restorative Dentistry, Lajeado, RS, Brazil
| | - Marcos Britto Correa
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Department of Restorative Dentistry, Pelotas, RS, Brazil
| | - Flávio Fernando Demarco
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Department of Restorative Dentistry, Pelotas, RS, Brazil
| | - Luiz Alexandre Chisini
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Department of Restorative Dentistry, Pelotas, RS, Brazil
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Fleming E, Taylor GW, Neighbors HW. Systemic racism and racial inequities in periodontal health: The long journey from upstream determinants to downstream treatment. Periodontol 2000 2024. [PMID: 38501675 DOI: 10.1111/prd.12559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/11/2024] [Indexed: 03/20/2024]
Abstract
Racial disparities in the prevalence of periodontal disease are consistent and persistent. The epidemiology of periodontal disease demonstrates racial inequities: non-Hispanic Black (14.7%), Mexican American (13.4%), and other Hispanic adults (7.8%) experience a higher prevalence of severe periodontal disease than non-Hispanic White adults (5.9%). Epidemiologic and clinical research on periodontal health suffers from the same problem that has plagued the health equity movement, an over emphasis on describing racial inequities coupled with few interventions that reduce racial health inequity. Over the decades that racial inequities in periodontal disease have been observed, many have argued that systemic racism is the fundamental driver of racial health inequity. This paper interrogates the roles of systemic racism, dental education, clinical treatment, and patient behavior in periodontal disease. We describe how, together, these mechanisms contribute to racial disparities in periodontal outcomes. However, it is insufficient for oral health equity scientists to only describe and discuss the negative effects of systemic racism. The imperative is to create antiracist strategies designed to eliminate systemic racism. Health equity scientists must also specify how dental systems operate in a racist manner and create effective clinical strategies designed to reduce racial disparities in periodontal disease.
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Affiliation(s)
- Eleanor Fleming
- Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - George W Taylor
- Department of Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, University of California San Francisco School of Dentistry, San Francisco, California, USA
| | - Harold Woody Neighbors
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Celeste RK, Boing AF, Peres KG, Peres MA. Life course social mobility, race and tooth loss in adulthood: The role of dental health services. Oral Dis 2024. [PMID: 38438701 DOI: 10.1111/odi.14918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 12/12/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVES To evaluate the extent to which dental care factors in adulthood modify and, at the same time, mediate the association between race/ethnicity and social mobility from childhood to adulthood with two oral health outcomes in adults. METHODS In 2012, 1222 individuals 20-59 years old participated in the second wave of the Epi-Floripa Study in Florianopolis, Brazil. Exposures included social mobility based on adulthood and childhood events, dental care in previous years, type of dental care coverage, reason for dental visits and race. The number of missing and decayed teeth were dichotomised as MT >0 and DT >0. RESULTS The prevalence of missing and decayed teeth was 61.9% and 23.0%, respectively. Age-sex adjusted inequalities in decayed and missing teeth among Black and White individuals were 41.2 percentage points (pp) (95% CI: 3.9-78.7) and 53.1 pp (19.5:86.7), respectively. Inequalities between those persistently higher and lower in socioeconomic position were 42.6 pp (14.6-70.7) and 90.0 pp (62.1-100). The Relative Excess of Risk due to Interaction (RERI) was not statistically significant (p < 0.05). Oaxaca-Blinder decomposition analyses showed that dental care variables accounted for a small proportion of inequalities. CONCLUSIONS This result implies that dental care is unlikely to significantly reduce or increase oral health inequalities in this particular population.
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Affiliation(s)
- Roger Keller Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Antonio Fernando Boing
- Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Karen Glazer Peres
- National Dental Centre Singapore, National Dental Research Institute Singapore, Singapore, Singapore
- Oral Health Academic Clinical Programme, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Marco Aurelio Peres
- National Dental Centre Singapore, National Dental Research Institute Singapore, Singapore, Singapore
- Oral Health Academic Clinical Programme, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
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Santos MPAD, Bastos JL. Antiracist ethos and the collective oral health as a pathway for life. CIENCIA & SAUDE COLETIVA 2024; 29:e06732023. [PMID: 38451647 DOI: 10.1590/1413-81232024293.06732023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/15/2023] [Indexed: 03/08/2024] Open
Abstract
This article proposes a reflection on the imperative of antiracism in collective oral health, which, as a science, field, core, and praxis, contributes significantly to the reconstruction of an ethos that considers equity and enables citizenship and democracy. As a paradigm, we assumed the concept of "Buccality" and the guidelines of the National Comprehensive Health Policy for the Black Population, emphasizing the defense of the right to health as a prerogative of the right to life and the combat against racism and all forms of discrimination systematically. As a critical exercise, we discussed the status quo of collective oral health. We pointed to adopting a racial pro-equity perspective as an intentional, political choice socially agreed upon with all of society for social justice. Finally, we propose recommendations for dismantling systemic racism in collective oral health.
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Affiliation(s)
- Marcia Pereira Alves Dos Santos
- Faculdade de Odontologia, Universidade Federal do Rio de Janeiro. R. Prof. Rodolpho Paulo Rocco 325, Ilha da Cidade Universitária. 21941-913 Rio de Janeiro RJ Brasil.
| | - João Luiz Bastos
- Faculty of Health Sciences, Simon Fraser University. Burnaby BC Canada
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Mendes VLDDC, Risso PA, Santos MPAD. Dental caries in the permanent dentition and health-related quality of life among children and adolescents with sickle cell disease. CIENCIA & SAUDE COLETIVA 2024; 29:e06752023. [PMID: 38451648 DOI: 10.1590/1413-81232024293.06752023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
The aim was to associate living, health and oral health conditions with the quality of life (QL) of children and adolescents (CA) with sickle cell disease (SCD). Of the 120 eligible users of a public hematological service, 106 CA with SCD from 6 to 18 years of age, and their caregivers, answered semi-structured questions about socio-demographic, health and oral health conditions. For QL, we used the validated instrument PedsQLSCD™. The oral clinical examination occurred according to the guidelines of WHO and SB Brazil 2010. The majority of CA were non-white people (88%), mean age of 10.4 (±2.9) years, family income of up to two monthly minimum wages, for 03 to 05 members, with diagnosis of sickle cell anemia by neonatal screening, hospitalizations were due allergic crises, polypharmacy and dental caries (51%) were present. "About the Impact of My Pain" was the best-fit model for the QLSCD (adjusted R²=56%; AIC=28.67; p=0.04). Dental caries in permanent dentition worsened the QLSCD (OR=0.53; IC95%=0.35-0.78; p<0.05) and was associated with the type of school, car ownership, number of family members, of complications and of the medications. To overcome this scenario, programmatic actions are required, and implementation of public policies specifically directed towards these groups.
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Affiliation(s)
| | - Patrícia A Risso
- Faculdade de Odontologia, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
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Sartori LRM, Henzel LT, Chisini LA, de Oliveira LJC, Sabóia VDPA, Correa MB. Discrimination and dental students: What is the reality in Brazilian institutions? EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:130-141. [PMID: 37315153 DOI: 10.1111/eje.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/05/2022] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION This study aimed to evaluate whether there is discrimination in the dental educational environment, assess the main reasons for the discriminatory events, and if there is an association between discriminatory episodes and sociodemographic characteristics of undergraduate dental students. MATERIALS AND METHODS This observational cross-sectional study was conducted with a self-administered questionnaire to students enrolled in three Brazilian dental schools. Questions included sociodemographic characteristics and the occurrence of discriminatory episodes in the dental academic environment. Descriptive analysis was performed in RStudio 1.3 (R Core Team, RStudio, Inc., Boston, USA) software and the associations were tested using Pearson's chi-square test, considering 95% confidence intervals. RESULTS A total of 732 dental students were included, with a response rate of 70.2%. The vast majority of students were female (66.9%), with white/yellow skin colour (67.9%), and with a mean age of 22.6 (SD 4.1) years. Sixth-eight percent of students reported having experienced some discrimination in the academic environment and most reported feeling uncomfortable with the episode. The main reasons to have been discriminated against raised by students were specific behaviour/habit, have specific moral, ethical, and aesthetic values, gender, and socioeconomic status or social class. The occurrence of discriminatory episodes was associated with female gender (p = .05), non-heterosexual sexual orientation (p < .001), studying in public institutions (p < .001), receiving an institutional scholarship (p = .018), and being in the final undergraduate cycle (p < .001). CONCLUSION The occurrence of discriminatory episodes was common in Brazilian dental higher education. Discriminatory situations generate traumas and psychological marks, causing a loss of diversity within the academic environment that leads to loss of productivity, creativity, and innovation. Thus, strong institutional policies against discrimination are crucial to create a healthy dental academic environment.
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Raskin SE, Thakkar-Samtani M, Santoro M, Fleming EB, Heaton LJ, Tranby EP. Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01821-0. [PMID: 37848669 DOI: 10.1007/s40615-023-01821-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Abstract
Racism, an oppressive and fallacious sociopolitical hierarchy, is a fundamental cause of oral health inequities worldwide. Everyday discrimination is associated with worse self-rated oral health, toothache and adult tooth loss, and lower oral care utilization. Few studies examine discrimination or microaggressions within oral care settings or their effects on oral health outcomes. We adapted the seven-item Everyday Discrimination Scale to the oral care setting (EDSOC); developed a four-item Dignity in Oral Care Scale (DOCS); fielded them to a probability-based nationally representative sample of US households as part of the 2022 State of Oral Health Equity in America survey (SOHEA, n = 5682); and examined associations between EDSOC and DOCS scores and three outcomes: self-rated oral health, duration since last oral care visit, and planning for future preventive/routine oral care. Nearly, all EDSCOC and DOCS measures were significantly associated with oral health outcomes. Discrimination experience in dental settings had an additive effect on reporting fair/poor oral health and a suppressive effect on planning a future dental visit. Indignity experience doubled-to-quadrupled the likelihood of reporting fair/poor oral health, not having visited a dentist in 2 years, and not planning a future oral care visit. Racio-ethnically minoritized patients may experience the unjust double bind of resolving urgent dental or completing preventive services needs amidst being treated in a discriminatory manner or without dignity. Oral health stakeholders should invest more effort to understand relationships between racism and oral health outcomes and introduce evidence-based interventions to ultimately abolish this societal harm.
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Affiliation(s)
- Sarah E Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, 1001 W. Franklin Street, Richmond, VA, 23284, USA.
| | | | - Morgan Santoro
- Analytics and Data Insights, CareQuest Institute for Oral Health, Boston, MA, USA
| | | | - Lisa J Heaton
- Analytics and Data Insights, CareQuest Institute for Oral Health, Boston, MA, USA
| | - Eric P Tranby
- Analytics and Data Insights, CareQuest Institute for Oral Health, Boston, MA, USA
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Heaton B, Bond JC, Bae J, Cozier Y. Perceived experiences of racism linked to dental fear and anxiety among Black women. Community Dent Oral Epidemiol 2023; 51:896-907. [PMID: 35964228 PMCID: PMC9925613 DOI: 10.1111/cdoe.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Dental fear and anxiety are known determinants of delaying or avoiding dental care and vary considerably based on factors such as age and gender. However, little is known about dental fear and anxiety in racial/ethnic minority populations, which bear a disproportionate burden of poor oral health outcomes. Structural and social pathways responsible for producing these disparities are also understudied. Experiences of racism over the lifecourse may contribute to poor oral health outcomes through a pathway of dental fear and anxiety. This paper aimed to evaluate perceived experiences with racism, dental fear and anxiety, and the utilization of dental services, in the Black Women's Health Study (BWHS), a United States-based prospective cohort. METHODS Analysis of prospective data obtained from a geographic subset of participants in the BWHS was conducted. In 2014, BWHS participants residing in Massachusetts responded to a mailed oral health questionnaire that included the Index of Dental Anxiety and Fear (IDAF-4C+) instrument (N = 484; 69% response rate). Previously collected demographic and health information, along with reported experiences of everyday and lifetime racism, obtained from national BWHS questionnaires between 1995 and 2009, were merged with the Massachusetts-based sub-sample. Associations between high dental anxiety (HDA) (mean IDAF-4C+ score ≥2.5 on the dental fear and anxiety module) and oral health outcomes and perceived racism and HDA were explored via prevalence ratios (PR) calculated using log-binomial regression models, including adjustment for potential confounders. RESULTS Reported exposures to everyday racism occurred weekly on average for the top 25% of the sample, while 13% of participants reported exposure to multiple (n = 3) experiences of unfair treatment due to their race over their lifetime. HDA was prevalent among 17.8% of the sample and was significantly associated with indicators of poor oral health status. High exposures to everyday and lifetime experiences of racism were positively associated with HDA (PR = 1.08; 95% CI: 0.90, 1.58 and PR = 1.72; 95% CI: 1.03, 2.88, respectively). CONCLUSIONS Significant associations between racism and HDA, and between HDA and poor oral health and reduced utilization of dental care were observed. Dental anxiety may be a pathway through which perceived experiences with racism may impact oral health outcomes.
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Affiliation(s)
- Brenda Heaton
- Department of Health Policy & Health, Services Research, Boston University, Henry M. Goldman School of Dental, Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston, University School of Public Health, Boston, Massachusetts, USA
| | - Julia C. Bond
- Department of Health Policy & Health, Services Research, Boston University, Henry M. Goldman School of Dental, Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston, University School of Public Health, Boston, Massachusetts, USA
| | - Jaeyoung Bae
- Department of Health Policy & Health, Services Research, Boston University, Henry M. Goldman School of Dental, Medicine, Boston, Massachusetts, USA
| | - Yvette Cozier
- Department of Epidemiology, Boston, University School of Public Health, Boston, Massachusetts, USA
- Slone Epidemiology Center, Boston, University, Boston, Massachusetts, USA
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12
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Cozier YC, Heaton B, Robles Y, C Bond J, I Garcia R, Coogan P, Rosenberg L. Perceived racism associated with declines in self-rated oral health among U.S. Black women. Ann Epidemiol 2023; 84:54-59. [PMID: 37244316 PMCID: PMC10525027 DOI: 10.1016/j.annepidem.2023.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Racial disparities in oral health are well-documented. Stress has been associated with both perceived racism and oral health, yet little research has directly investigated the association between perceived racism and oral health. METHODS We used data from the Black Women's Health Study, a longitudinal cohort study that includes a geographically diverse sample of Black women across the United States. Perceived exposure to racism was assessed via two scales, one assessing lifetime exposure and one everyday exposure. Self-rated oral health was subsequently assessed over multiple time points. We used Cox proportional hazard models to calculate adjusted incidence rate ratios estimating the association between higher levels of perceived racism and incident "fair" or "poor" oral health, and explored potential effect measure modification using stratified models. RESULTS The adjusted incidence rate ratios (n = 27,008) relating perceived racism to incident fair or poor oral health were 1.50 (95% confidence interval 1.35, 1.66) comparing the highest quartile of everyday racism to the lowest and 1.45 (95% confidence interval 1.31, 1.61) for the highest score of lifetime racism compared to the lowest. We did not see evidence of effect modification. CONCLUSIONS Higher levels of perceived racism documented in 2009 were associated with declines in self-rated oral health from 2011 to 2019.
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Affiliation(s)
- Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Brenda Heaton
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; Department of Health Policy and Health Services Research, Boston University Goldman School of Dental Medicine, Boston, MA.
| | - Yvonne Robles
- Slone Epidemiology Center at Boston University, Boston, MA
| | - Julia C Bond
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; Department of Health Policy and Health Services Research, Boston University Goldman School of Dental Medicine, Boston, MA
| | - Raul I Garcia
- Department of Health Policy and Health Services Research, Boston University Goldman School of Dental Medicine, Boston, MA
| | | | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA
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13
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do Amaral Júnior OL, Fagundes MLB, Menegazzo GR, Giordani JMDA. Wealth index association with self-reported oral health between white and non-white older Brazilians. CAD SAUDE PUBLICA 2023; 39:e00188122. [PMID: 37377295 PMCID: PMC10494672 DOI: 10.1590/0102-311xen188122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/02/2023] [Accepted: 03/30/2023] [Indexed: 06/29/2023] Open
Abstract
This cross-sectional study aimed to identify the association between self-reported oral health status and a wealth index among white and non-white older adults in Brazil. Data from individual assessments of 9,365 Brazilians aged 50 years or older were analyzed. Poisson regression models were performed to estimate the prevalence ratio between wealth index and self-reported oral health among whites and non-whites adjusted for intermediate and proximal determinants. The total prevalence of poor self-reported oral health on white and non-white individuals was 41.6% (95%CI: 40.0-43.4) and 48% (95%CI: 47.1-49.8) respectively. The adjusted analysis showed that, for whites, the wealth index is associated with self-reported oral health since individuals in the 3rd, 4th, and 5th quintiles have 25% (PR = 0.75; 95%CI: 0.65-0.88), 20% (PR = 0.80; 95%CI: 0.67-0.95), and 39% (PR = 0.61; 95%CI: 0.50-0.75) lower prevalence of poor self-reported oral health than those in the poorest quintile. For non-white individuals, the wealth index is associated with self-reported oral health only for those in the 5th quintile, with 25% (PR = 0.85; 95%CI: 0.72-0.99) lower prevalence of poor self-reported oral health than those in the poorest quintile. The wealth index showed different effects on self-reported oral health among whites and non-whites. Socioeconomic status indicators may reflect racial inequalities due to the historical legacy of institutional discrimination. This study highlights the importance of developing policies to combat racial inequities and how these can contribute to better oral health conditions for the older Brazilian population.
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Affiliation(s)
| | | | - Gabriele Rissotto Menegazzo
- Programa de Pós-graduação em Ciências Odontológicas, Universidade Federal de Santa Maria, Santa Maria, Brasil
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14
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Rauber ED, Knorst JK, Noronha TG, Zemolin NAM, Ardenghi TM. Impact of the use of dental services on dental pain according to adolescents' skin colour: a 10-year cohort. Clin Oral Investig 2023:10.1007/s00784-023-04921-7. [PMID: 36829064 PMCID: PMC9957686 DOI: 10.1007/s00784-023-04921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/13/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Evaluate the association of the interaction between the use of dental services and the skin colour on the occurrence of dental pain over time. MATERIAL AND METHODS This study is a cohort with 10 years of follow-up, started in 2010 with a sample of 639 preschool children (1-5 years old). The use of dental services, race and the presence of dental pain were self-reported by the individuals according to predefined criteria. Multilevel logistic regression analysis was performed to assess the interaction between skin colour and use of dental services in the occurrence of dental pain over time. RESULTS About 449 and 429 were reassessed in 2017 and 2020, respectively. The occurrence of dental pain across the cohort was 60.7%. Caucasian individuals who used dental services throughout the cohort had a 51% lower chance of having a dental pain than those who used dental services but were non-white (OR 0.49; 95% IC 0.27-0.90). CONCLUSION There was a racial inequity in the occurrence of dental pain among individuals who managed to make use of dental services throughout the follow-ups. CLINICAL RELEVANCE The differences found should serve as a warning to the way how individuals with different characteristics are treated and must be used to combat this inequity. Individuals should receive resolute and personalized treatments according to their clinical condition and not according to their socioeconomic characteristics.
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Affiliation(s)
- Everton Daniel Rauber
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Rua Conde de Porto Alegre, Santa Maria, RS 961 Brazil
| | - Jessica Klöckner Knorst
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Rua Venâncio Aires, Santa Maria, RS 1434 Brazil
| | - Thaís Gioda Noronha
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Rua Conde de Porto Alegre, Santa Maria, RS 961 Brazil
| | - Nicole Adrielli Monteiro Zemolin
- Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Rua Conde de Porto Alegre, Santa Maria, RS 961 Brazil
| | - Thiago Machado Ardenghi
- Departament of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil. .,Universidade Federal de Santa Maria, Roraima nº 1000 Bairro Camobi, CEP: 97105900, Santa Maria, RS, Brazil.
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15
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Fleming E, Bastos JL, Jamieson L, Celeste RK, Raskin SE, Gomaa N, McGrath C, Tiwari T. Conceptualizing inequities and oppression in oral health research. Community Dent Oral Epidemiol 2023; 51:28-35. [PMID: 36749670 DOI: 10.1111/cdoe.12822] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 02/08/2023]
Abstract
Major sociohistorical processes have profound effects on oral health, with impacts experienced through structural oppression manifested in policies and practices across the lifespan. Structural oppression drives oral health inequities and impacts population-level oral health. In this global perspective paper, we challenge old assumptions about oral health inequities, address misleading conceptualizations in their description and operation and reframe oral health through the lens of intersecting systems of oppression. Furthermore, we emphasize the need for oral health researchers to explore causal pathways through which oppression harms oral health and engage in social science concepts to understand the root causes of oral health inequities fully. Finally, we call on policymakers, dental scholars and decision makers to consider health equity in all policies and to take a systems-oriented approach to effectively address oral health inequities.
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Affiliation(s)
| | - João L Bastos
- Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - Roger K Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sarah E Raskin
- iCubed Initiative Oral Health Core, Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Virginia, USA
| | - Noha Gomaa
- Oral Diagnostic Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Colman McGrath
- Applied Oral Sciences & Community Dental Care, University of Hong Kong, Hong Kong, Hong Kong
| | - Tamanna Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
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16
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Chisini LA, Varella de Carvalho R, Dos Santos Costa F, Salvi LC, Demarco FF, Britto Correa M. Genes and single nucleotide polymorphisms in the pathway of saliva and dental caries: a systematic review and meta-analysis. BIOFOULING 2023; 39:8-23. [PMID: 36644905 DOI: 10.1080/08927014.2022.2162891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/01/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
The aim of this systematic review and meta-analysis was to investigate the influence of single nucleotide polymorphisms (SNPs), related to genes in salivary composition and flow, on dental caries experience. Sixteen studies were included in the systematic review and ten in the meta-analysis. Forty-four SNPS, covering four genes (CA6, AQP2, AQP5, and MUC5B) were identified. Most of the SNPs were not associated with caries in meta-analysis. Homozygous TT genotype of the SNP CA6 rs17032907(C/T) was associated with caries [OR = 3.23(1.39-7.49)]. The pool effect of the SNPs assessed in AQP5 was associated with a reduction in the likelihood of caries [OR = 0.75(0.59-0.95)]. Considering all SNPs of salivary composition and flow, the effect allele was associated with a 75% increase in the likelihood of caries [OR = 1.75(1.06-2.89)] in the homozygous genotype. The present findings showed that the genes in salivary composition and flow can play an important role in dental caries experience.
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Affiliation(s)
- Luiz Alexandre Chisini
- Graduate Program in Dentistry, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Rodrigo Varella de Carvalho
- Graduate Program in Dentistry, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | | | - Luana Carla Salvi
- Graduate Program in Biology, University of Vale do Taquari, Rio Grande do Sul, Brazil
| | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Marcos Britto Correa
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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17
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Vianna RF, Prado M, Prado MC, Athias L, Pereira GD. Do non-clinical subjective factors influence the treatment decisionmaking of Brazilian dentists? ACTA ODONTOLOGICA LATINOAMERICANA : AOL 2022; 35:58-66. [PMID: 35700543 DOI: 10.54589/aol.35/1/58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/01/2021] [Indexed: 06/15/2023]
Abstract
The literature contains little information on several non-clinical factors such as the association between graduate residency programs and the application of minimally invasive dentistry, or on dentists' clinical decision-making processes for replacing restorations for esthetic reasons. This study evaluated whether non-clinical subjective factors influence the treatment decisions made by Brazilian dentists regarding technical and esthetic matters. Dentists were invited to participate in a cross-sectional survey by answering an electronic questionnaire containing clinical cases, regarding what treatment they would select for: T1 - a molar tooth with significant crown destruction and spontaneous pain, and T2 - premolar teeth with extensive amalgam restorations and no carious lesion or associated complaint. The survey also included questions about subjective variants (sociodemographic and professional). Chi Square test and Fischer's Exact test were used toanalyzetheanswers to T1, and one-factor analysis of variance and post-hoc Tamhane were applied to T2. The significance level was set at 5% for all analyses. A total 302 professionals participated in the study. For T1, it was found that clinical decision-making was influenced by the Brazilian region of clinical practice (p=0.005). For T2, a significant association was found between increased loss of patient tooth tissues and whether the professional had completed a residency program in Operative Dentistry (p=0.035), worked in a private practice (p=0.033), or if most of his/her patients belonged to a high estimated socioeconomic level (household income above $4350) (p=0.002). In conclusion, the clinical decision-making of Brazilian dentists varies according to professional profile, mainly with relation to the replacement of restorations due to esthetic concerns.
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Affiliation(s)
- Renato Fc Vianna
- Universidade Federal do Rio de Janeiro, Faculdade de Odontologia, Programa de Pós-Graduação em Clínica Odontológica, Rio de Janeiro, Brasil
| | - Maíra Prado
- Universidade Veiga de Almeira, Faculdade de Odontologia, Programa de Pós-Graduação em Clínica Odontológica, Rio de Janeiro, Brasil
| | - Marina C Prado
- Universidade Federal do Rio de Janeiro, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa em Engenharia, Programa de Engenharia Metalúrgica e de Materiais. Rio de Janeiro, Brasil.
| | - Leonardo Athias
- Instituto Brasileiro de Geografia e Estatística. Rio de Janeiro, Brasil
| | - Gisele Ds Pereira
- Universidade Federal do Rio de Janeiro, Faculdade de Odontologia, Programa de Pós-Graduação em Clínica Odontológica, Rio de Janeiro, Brasil
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18
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Paajanen A, Karaharju-Suvanto T, Koivumäki J, Kaila M. Finnish dentists' experiences with foreign-background patients-a qualitative study. Acta Odontol Scand 2022; 80:529-534. [PMID: 35276056 DOI: 10.1080/00016357.2022.2047779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The population in many countries is becoming more diverse. The number of people from foreign backgrounds is growing in Finland as well. The aim of this study was to better understand how the foreign background of a patient affects the dentist's work. METHODS The research was carried out as a semi-structured interview. Six dentists from Helsinki municipality public dental care were interviewed between December 2019 and January 2020. After the interviews were transcribed verbatim, two members of the research group read individually the interviews to find emerging themes. RESULTS The most common problems that arose in the interviews were problems within communication and interpretation. Periodontal diseases and the importance of self-care in treating them were observed to be unfamiliar to many foreign-background patients. The dentists also noticed different expressions of pain among foreign-background patients compared with native Finnish patients. The interviewed dentists thought that the length of time a patient had lived in Finland affected the experienced difficulties and the prejudice that the patients and dentists faced. CONCLUSION In this qualitative research, we were able to identify some of the common difficulties that the dentists experience while treating patients from foreign backgrounds, despite the small number of participants.
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Affiliation(s)
- Anna Paajanen
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Terhi Karaharju-Suvanto
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Minna Kaila
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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19
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Tooth loss over 13 years of follow-up: can regular dental visits reduce racial and socioeconomic inequalities? J Dent 2022; 122:104110. [DOI: 10.1016/j.jdent.2022.104110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 11/22/2022] Open
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20
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Fleming E, Raskin SE, Brody E. From describing disparities to understanding why disparities exist: Anti-racist methods to support dental public health research. J Public Health Dent 2022; 82 Suppl 1:73-78. [PMID: 35726470 PMCID: PMC9541958 DOI: 10.1111/jphd.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Racism is understudied in the oral health literature at the same time that race is overutilized as an explanatory factor in study design. Social and behavioral methodologies offer conceptual models that can be used to include racism in dental public health questions. In addition, interdisciplinary and mixed methods approaches allow for understanding racism as an underlying cause of social and health disparities and exploring solutions that address historical, institutional, social, political, and economic drivers of oral health inequity, while recognizing the limits of measuring racism quantitatively. In a collective acknowledgement of the limitations of conventional methods, there are new opportunities to explore how qualitative and mixed methods research can serve as drivers for both social justice and health equity, while building and sustaining a diverse research workforce that can better close these disparities and offer antiracist solutions to oral health inequities.
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Affiliation(s)
- Eleanor Fleming
- Department of Dental Public health, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Sarah E Raskin
- iCubed Oral Health Core, L. Douglas Wilder School of Government and Public Affairs and Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Erica Brody
- Health Sciences Library, Virginia Commonwealth University, Richmond, Virginia, USA
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21
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Bomfim RA, da Cunha IP, Lacerda VRD. Health ombudsman and racial inequities in Dental Specialities Centers performance in Brazil: A multilevel analysis. Community Dent Oral Epidemiol 2021; 50:11-18. [PMID: 34870337 DOI: 10.1111/cdoe.12713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/22/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to verify racial differences in the performance of Dental Specialities Centers in Brazil, according to the presence of active health ombudsman on four primary outcomes: (1) access and dental appointment, (2) reception services, (3) bond and responsibility, and (4) social participation. METHODS Data came from the PMAQ-CEO national evaluation of public healthcare services, 2018-2019. The two main explanatory variables were the self-classified race at the individual level and the presence of the health ombudsman at the second level (level of services provision). Individual covariates included age, sex and schooling. Multilevel logistic regression was used to calculate the OR (Odds Ratios) in racial gaps according to the primary outcomes with individuals at the first level and public health services at the second level. RESULTS The analytical sample comprised of 8993 respondents. Brown people were less likely to report better Access (27%), good reception services (31%), bond and responsibility (30%) and social participation (22%) than Whites. Black people showed similar patterns. Dental Specialities Centers that use health ombudsman for planning have attenuated racial inequities in all analysed dimensions. CONCLUSIONS Dental Specialities Centers that use active health ombudsman for planning showed lower racial inequities in access, reception, bond and responsibility and social participation than those who did not use. Therefore, the health ombudsman should be implemented and used for planning better specialized dental services in Brazil.
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Affiliation(s)
- Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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22
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Bulgarelli AF, Dos Santos CM, Rech RS, Baumgarten A, Goulart BN. Tooth Loss Condition and Social Discrimination in Brazilian Healthcare Services. Int J Public Health 2021; 66:586597. [PMID: 34744559 PMCID: PMC8565290 DOI: 10.3389/ijph.2021.586597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/24/2021] [Indexed: 01/16/2023] Open
Abstract
Objective: To explore factors associated with social discrimination against users of health services regarding dental aesthetic conditions. Methods: Based on a Brazilian National Survey, multivariate Poisson regressions with robust variance were used to explore the association of outcome discrimination related to different motivations in health services and exposure to sociodemographic and dental variables. Effect modification by complete prosthesis wearing was assessed. Results: Among the 60,200 people interviewed, 11.5% reported being discriminated against in health services. For women, a higher prevalence of discrimination was found among those in the age group of 30–44 years. For both sexes, discrimination was associated with black and brown skin color. Regarding dental characteristics, the higher the tooth loss was, the higher the prevalence of discrimination; however, complete prosthesis wearing presented as a protective factor. Social discrimination was the major motivation for reported discrimination and presented higher prevalence in edentulous individuals who did not wear prosthesis. Conclusion: Dental loss may lead to self-reported discrimination in health care services. The prevalence of discrimination increases when tooth loss increases, and the major reason associated is social discrimination.
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Affiliation(s)
- Alexandre F Bulgarelli
- Graduate Program in Collective Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila M Dos Santos
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafaela S Rech
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre Baumgarten
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bárbara N Goulart
- Psychology Institute, Department of health and human communication, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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23
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What should people expect from person-centred dental visits? The Montreal-Toulouse Wheel of expectations. Br Dent J 2021; 231:249-253. [PMID: 34446900 DOI: 10.1038/s41415-021-3322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/17/2020] [Indexed: 11/08/2022]
Abstract
There is a dearth of tools designed to inform people about what to expect from person-centred dental encounters and to guide them during the care process. This is why we propose the Montreal-Toulouse Wheel of patients' expectations for dental visits, which describes what people could expect during person-centred clinical encounters. The Wheel comprises four core expectations: 1) be understood; 2) be respected; 3) have power; and 4) be given enough time. It also includes three expectations that are more specific to the process of care: 5) be informed and understand; 6) share decisions with the dentist and even co-construct the treatment plan; and 7) be comfortable during clinical procedures and the whole care process. We also propose a Q-List to help patients reflect on their relationship with dental professionals and engage them in person-centred dental care. This Q-List describes the seven expectations of the Wheel and provides open-ended questions that we invite patients to reflect upon. We also hope that dental professionals and educators will find the Wheel and the Q-List useful to develop person-centredness and promote inclusive and equitable dentistry.
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Costa F, Wendt A, Costa C, Chisini LA, Agostini B, Neves R, Flores T, Correa MB, Demarco F. Racial and regional inequalities of dental pain in adolescents: Brazilian National Survey of School Health (PeNSE), 2009 to 2015. CAD SAUDE PUBLICA 2021; 37:e00108620. [PMID: 34190752 DOI: 10.1590/0102-311x00108620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/18/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of the study is: (a) investigate the racial inequalities as one specific dimension that affects dental pain in Brazilian adolescents; and (b) investigate the regional variations of dental pain. This cross-sectional study used data from Brazilian National Survey of School Health (PeNSE), carried out with adolescents in 2009, 2012 and 2015. Dental pain was evaluated through the question: "Did you have dental pain in the last six months?". The main exposures were race and Brazilian regions, used to evaluate inequalities related to the outcome. Sex, age, school type and maternal education were used as covariables. The statistical significance of the trends in dental pain was tested using linear regression. The analysis was conducted in Stata 13.0 statistical package using the svy command. The standard prevalence of dental pain was 18.8%, 21.1% and 23.7%, showing an increasing trend over time (p < 0.001). We observed absolute inequalities in dental pain related to race and regions. A higher prevalence was found in non-white girls of public schools and in the Northern Region. The indexes of inequalities increased in the group of black girls, related to an increase of dental pain predominantly in girls whose mothers had lower educational level. It was observed that the prevalence of dental pain in Brazilian adolescents increased over time as well as its inequalities, which remained in marginalized populations and linked to Brazilian regions.
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Affiliation(s)
| | - Andrea Wendt
- Universidade Federal de Pelotas, Pelotas, Brasil
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25
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Zamanian N, Jafari-Naeimi A. The Perception of the Severity of Facial Asymmetry among Laypersons, General Practitioners, Orthodontists, and Maxillofacial Surgeons. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2021; 22:102-108. [PMID: 34150946 PMCID: PMC8206593 DOI: 10.30476/dentjods.2020.84790.1103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
STATEMENT OF THE PROBLEM The degree of asymmetry perception of dental and medical practitioners is influenced by several factors. The perceived asymmetry affect the treatment plan design. PURPOSE The aim of the present study was to investigate the consistency of facial asymmetry and identify the amounts of transverse asymmetry that can be regarded as normal and might need correction. MATERIALS AND METHOD In this cross-sectional descriptive study, three-dimensional (3D) images of a man and a women volunteer were obtained. Then transverse changes were applied by ZBrush software so that for each volunteer, seven 3D images of their face with varying degrees of facial transverse asymmetry were created. Then, the images were displayed to four groups of observers including layperson, general dentists, orthodontists, and maxillofacial surgeons. Finally, the consistency of the perception of these four groups of observers with the different degrees of facial asymmetry was compared. RESULTS Fourteen photographic samples were evaluated and ranked by 80 observers in four groups. The consistency of the perception of the facial transverse asymmetry was equal to 33%, which indicated a lack of consistency. CONCLUSION According to the findings of this study, there was no consistency between the groups. The perception of dental professionals and ordinary people regarding the severity of transverse facial asymmetry seems to be inconsistent.
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Affiliation(s)
- Nazgol Zamanian
- Dept. of Orthodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Alireza Jafari-Naeimi
- Dept. of Orthodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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26
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Sartori LRM, Henzel LT, de Queiroz ABL, Ramos EC, de Oliveira LJC, Chisini LA, Correa MB. Gender inequalities in the dental science: An analysis of high impact publications. J Dent Educ 2021; 85:1379-1387. [PMID: 33855714 DOI: 10.1002/jdd.12603] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the participation of women in publications of dental journals with a high impact factor. METHODS Articles published in 2016, 2011, and 2006 in 10 dental journals chosen for their highest impact factors in each dental fields were included in this research. Articles-related variables collected included the country of origin of each author, the type of study, and gender of the researchers. Gender was examined through PubMed, Scopus, ResearchGate, and respective affiliated institutions. Furthermore, a website designed to discover the gender of names was used when the previous alternatives were not conclusive. Forward stepwise Poisson regression models were used for data analysis. RESULTS A total of 3365 studies were included in the first authorship analysis and 3398 in analysis related to last authorship. The prevalence of women as first authors was 37.2% (confidence interval (CI) 95% 34.5-37.5) and as last authors was 22.6% (CI 95% 21.3-23.9). Having a woman as the last author increased the presence of women in the first author position in scientific dental articles by 16% (prevalence ratio = 1.16, CI 95% [1.04-1.29]). The year of publication, journal, and region of the author were associated with an increase in the prevalence of women as last authors. From 2006 to 2016, the prevalence of women as last authors increased by 61%. Despite these trends, women were still underrepresented in science in the evaluated period. CONCLUSIONS There are meaningful gender inequalities in publications of scientific dental papers. Encouraging women to lead research groups can reduce the inequities observed in the present study.
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Affiliation(s)
| | | | | | | | | | - Luiz Alexandre Chisini
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Marcos Britto Correa
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Chisini LA, Sarmento HR, Horta BL, Demarco FF, Correa MB. Normative and subjective need for dental prosthesis: accuracy and agreement in a population based-study. CAD SAUDE PUBLICA 2021; 37:e0052720. [PMID: 33624740 DOI: 10.1590/0102-311x0052720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of our study was to compare normative need for dental prosthesis (estimated by dentists) with subjective need (self-reported) by testing the accuracy and agreement and comparing direction and magnitude of associations with independent variables using both as outcomes. A representative sample of a birth cohort study (n = 900) was assessed at 31 years of age. Subjective need was obtained from questionnaire. Both normative and subjective need variables were dichotomized in (a) individuals with need for dental prosthesis and (b) without need for dental prosthesis. Accuracy was assessed by sensitivity (SE), specificity (SP), positive (PPV) and negative (NPV) predictive values. Agreement of normative and subjective need was assessed estimating kappa index. Sex, income, educational level, use of dental services and self-reported oral health were used to compare the associations with normative and subjective need. Prevalence of normative need was 48.9% and subjective need was 34.9%. Agreement (kappa: 0.43) and accuracy between normative and subjective need for dental prosthesis was low (SE: 56.5, 95%CI: 50.3-62.6; SP: 85.8, 95%CI: 81.1-89.7; PPV: 79.1, 95%CI: 72.6-84.7; NPV: 67.3, 95%CI: 62.1-72.2). When considering individuals with loss in anterior teeth, results showed a good agreement (kappa: 0.82) and accuracy between normative and subjective need (SE: 93.3, 95%CI: 68.1-99.8; SP: 88.9, 95%CI: 51.8-99.7; PPV: 93.3, 95%CI: 68.1-99.8; NPV: 88.9, 95%CI: 51.8-99.7). Direction and magnitude of associations with normative and subjective need were similar. Thus, normative need for dental prosthesis differs from subjective need in adults, except when anterior losses are present.
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Kadiyo T, Mellish V. Black Lives Matter: the impact and lessons for the UK dental profession. Br Dent J 2021; 230:134-142. [PMID: 33574534 PMCID: PMC7877508 DOI: 10.1038/s41415-021-2613-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/02/2020] [Indexed: 12/15/2022]
Abstract
Black Lives Matter represents positive action towards equality and inclusivity. The Black Lives Matter protests remind us that, as a society, prejudices and unconscious bias still exist throughout the world. So, how does this inequality impact UK dentistry and what lessons can we learn?Black British dentists and dental care professionals (DCPs) are greatly under-represented in the UK workforce. The cause is multifactorial, but clearly measures need to be made from an early age, as Black prospective students have a 19% acceptance rate into dentistry, compared with 54% white and 41% Asian.As a Black British dental student working with my White British dental tutor, we address barriers that affect Black students and offer recommendations. These struggles are not exclusively related to skin colour, but evidence shows that Black British individuals are more likely to experience detrimental factors.We recognise that it is not the majority that suffer from under-representation, but the minorities; it filters into all aspects of dentistry, including treatment planning and disease diagnosis. Black DCPs and dentists have a contextual understanding of the barriers their communities face and will prove pivotal in workforce diversification. However, we all have a part to play in improving healthcare quality. Together, we can do more.
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Affiliation(s)
- Tanaka Kadiyo
- BDS4 Dental Student, Queen Mary University of London, UK.
| | - Victoria Mellish
- Oral Surgery Clinical Lecturer, Queen Mary University of London, UK
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Chisini LA, Sarmento HR, Collares K, Horta BL, Demarco FF, Correa MB. Determinants of dental prosthetic treatment need: A birth cohort study. Community Dent Oral Epidemiol 2020; 49:394-400. [PMID: 33314248 DOI: 10.1111/cdoe.12608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 10/20/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To estimate the incidence of the need for a dental prosthesis during early adulthood and its association with socioeconomic and oral disorder trajectories. METHODS In 1982, in the city of Pelotas, all live births (n = 5914) and their mothers were assessed. A representative sample of this cohort study was examined for oral health conditions at 15, 24 and 31 years (Oral Health Study-OHS). The need for a dental prosthesis was assessed at 24 and 31 years of age, and variables of interest (gender, skin colour, socioeconomic status (SES), use of dental services, caries and periodontal disease) were collected from different waves of this cohort. Longitudinal association between outcome and variables of interest was assessed using multilevel mixed models. RESULTS A total of 539 individuals were assessed in 2013 (60.7% response rate). The need for a dental prosthesis was 28.9% at 24 years. (95% CI 24.9-33.2) and 49.0% at 31 years (95% CI 44.7-53.3). Risk of presenting with a need for a dental prosthesis was higher in users of public services. Downwardly mobile and lower SES trajectory groups presented a higher risk of the need for a dental prosthesis. High-risk caries trajectory group showed a higher risk of presenting with the need for a dental prosthesis from 24 to 31 years. CONCLUSIONS Our findings demonstrate that the need for dental prosthesis from 24 to 31 years old was determined by trajectories of exposure during the life cycle, reinforcing that tackling socioeconomic inequalities at any stage of life can have an effect on an individual's oral health.
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Affiliation(s)
| | | | - Kauê Collares
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
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Schuch HS, Haag DG, Bastos JL, Paradies Y, Jamieson LM. Intersectionality, racial discrimination and oral health in Australia. Community Dent Oral Epidemiol 2020; 49:87-94. [PMID: 33022103 DOI: 10.1111/cdoe.12581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a dearth of studies on the extent to which perceived racial discrimination shapes oral health. Following an intersectional perspective, we estimated the prevalence of perceived racial discrimination in Australia, its association with oral health impairment, and examined whether this association was more severe among low socioeconomic status (SES) groups. METHODS Data came from the 2013 National Dental Telephone Interview Survey (N = 2798), a population-based study of Australian adults. Multivariable Poisson regression models were estimated to test the relationship between perceived racial discrimination and self-reported oral health impairment, as well as to investigate whether the magnitude of this association was greater among low-SES respondents. Relative Excess Risks due to Interaction (RERI) were used to indicate the presence of potentially large discrimination effects within low-SES strata. RESULTS Racial discrimination in the past 12 months was reported by 11.5% of all participants. Australians reporting racial discrimination had 1.4 (95% CI 1.1, 1.7) times the prevalence of impaired oral health. The association between perceived racial discrimination and oral health impairment was stronger among low-SES groups. The RERI was 0.55, indicating a super-additive Effect Measure Modification (EMM) by income on the additive scale. Similar results were observed with the EMM analyses by educational attainment. CONCLUSION Our findings indicate that perceived racial discrimination, as a specific form of widespread inequality, is associated with higher frequencies of oral health impairment among Australian adults. We also suggest that socially marginalized groups bear a greater burden of the oral health effects of racial discrimination.
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Affiliation(s)
- Helena S Schuch
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Dandara G Haag
- Adelaide Dental School, Australian Research Centre for Population Oral Health (ARCPOH), University of Adelaide, Adelaide, Australia
| | - João Luiz Bastos
- Department of Public Health, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood, Australia
| | - Lisa M Jamieson
- Adelaide Dental School, Australian Research Centre for Population Oral Health (ARCPOH), University of Adelaide, Adelaide, Australia
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Bastos JL, Constante HM, Celeste RK, Haag DG, Jamieson LM. Advancing racial equity in oral health (research): more of the same is not enough. Eur J Oral Sci 2020; 128:459-466. [PMID: 32969112 DOI: 10.1111/eos.12737] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 12/19/2022]
Abstract
By critically appraising the literature on the oral health effects of race-based oppression, this focus article makes four recommendations that may both facilitate more nuanced research on the topic and mitigate racial/ethnic inequities in (oral) health. The first is recognizing that science itself may perpetuate racial/ethnic injustice, such that adopting a 'neutral' position must be replaced with actively fostering anti-racist narratives. The second is to not imply that racial oppression is bad because it harms oral health. Rather, studies should help build a fairer world, wherein oral health inequities would not abound. The third recommendation is encouraging initiatives that understand systems of oppression as conjointly operating to shape oral health. The fourth and final recommendation is taking race-based oppression as a multi-level system that operates on three inter-related conceptual levels - intra-personal, inter-personal, and structural. The extent to which scholars, practitioners, and policymakers are willing to follow these recommendations may determine how successful attempts to eradicate (oral) health inequities might be. Learning from, and avoiding mistakes made in, previous publications is one ethical pathway towards this end.
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Affiliation(s)
- João L Bastos
- Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Helena M Constante
- Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Roger K Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Dandara G Haag
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
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Genes in the pathway of tooth mineral tissues and dental caries risk: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:3723-3738. [PMID: 32945961 DOI: 10.1007/s00784-019-03146-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To perform a systematic review of the literature, investigating the influence of tooth mineral tissues genes on dental caries. MATERIALS AND METHODS Five databases were searched. Only human studies with cross-sectional, longitudinal, and case-control design were included. Meta-analysis was performed for each polymorphism, providing allele and genotype estimates. A meta-analysis was performed, pooling several polymorphisms for each gene. A Funnel Plot and Egger's test were also performed. RESULTS A total of 1124 records were found. Of these, 25 papers were included in the systematic review and 18 in the meta-analysis. Most of the studies (52%) were of medium quality. With regard to the allele analysis, the T allele of rs134136 (TFIP11) (OR 1.51; 95%CI 1.02-2.22) showed an association with high experience of caries and the summarization of polymorphisms investigated in the TFIP11 gene, after exclusion of SNP linkage disequilibrium, showed an association with caries experience (OR 1.64; 95%CI 1.08-2.50). An analysis of the homozygous genotype did not show any significant association. The pooled SNPs of AMBN showed associations with caries (OR 0.45; 95%CI 0.29-0.72). The pooled polymorphisms of AMELX were associated with caries experience (OR 1.78; 95%CI 1.23-2.56). In the analysis of the homozygous genotype, no SNP showed a significant association. Egger's test showed no significant publication bias for all models (p > 0.05). CONCLUSION The present findings showed that the genes TFIP11, AMBN, and AMELX play an important role in dental caries. CLINICAL RELEVANCE Several single nucleotide polymorphisms related to the genes in the formation of tooth mineral are linked to the occurrence of dental caries, and these genes have proved to be important for an explanation of differences in the risk of dental caries.
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Demarco FF, Correa MB, Cenci MS, Burke FJT, Opdam NJM, Faria-E-Silva AL. Practice based research in dentistry: an alternative to deal with clinical questions. Braz Oral Res 2020; 34 Suppl 2:e071. [PMID: 32785489 DOI: 10.1590/1807-3107bor-2020.vol34.0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/01/2019] [Indexed: 11/22/2022] Open
Abstract
Clinical interventions in dental practice should be determined based on the best scientific evidence available. Well-designed randomized clinical trials (RCTs) provide important evidence supporting the efficacy of interventions and are usually considered as the best primary evidence. However, the strict criteria adopted by most RCTs reduce their external validity since some findings from these studies might not work under usual conditions. On the other hand, practice-based research (PBR) studies have been designed to better define the effectiveness of clinical interventions under settings closer to "real-world" conditions. Therefore, this review aimed to describe different PBR designs discussing some advantages and limitations of such studies. The stimulus to organization PBR networks is discussed since the studies performed by these networks involve large number of clinicians and important conclusions can be drawn. Designs of observational studies including surveys and cohort studies based on practice are presented. Survey methods are important to know the behavior of practitioners regarding diagnostic and decision of treatment. Cohorts allow assessing different cofounders contributing to some outcome since large sample sizes and long follow-up periods can be observed in some of these studies. Pragmatic trials designed to take place in real-world clinical practice settings are also discussed as a useful design to assess the effectiveness of clinical interventions. In conclusion, this review sought to present PBR studies as alternative designs to answer clinical questions, but not replacing randomized clinical trials.
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Affiliation(s)
- Flávio Fernando Demarco
- Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Marcos Britto Correa
- Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Maximiliano Sérgio Cenci
- Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | | | - Niek Johannes Maria Opdam
- Department Radboud, Radboud Institute for Health Sciences, University Medical Center, of Dentistry, Nijmegen, The Netherlands
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Junior OLDA, Menegazzo GR, Fagundes MLB, de Sousa JL, Tôrres LHDN, Giordani JMDA. Perceived discrimination in health services and preventive dental attendance in Brazilian adults. Community Dent Oral Epidemiol 2020; 48:533-539. [DOI: 10.1111/cdoe.12565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 11/27/2022]
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Bispo de Carvalho Barbosa P, de Andrade Vieira W, de Macedo Bernardino Í, Costa MM, Pithon MM, Paranhos LR. Aesthetic facial perception and need for treatment in simulated laterognathism in male faces of different ethnicities. Oral Maxillofac Surg 2019; 23:407-413. [PMID: 31187286 DOI: 10.1007/s10006-019-00784-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to compare the aesthetic perception and treatment need in individuals of different ethnicities with various degrees of laterognathism assessed by orthodontists, oral and maxillofacial surgeons, and laypersons. METHODS Three male descendants of different ethnicities were assessed, in which the mandibular deviation was manipulated digitally in different angulations (from 0 to 8°). The assessment was performed by three groups (orthodontists, maxillofacial surgeons, and laypersons (n = 20)), and it consisted of scoring the degree of pleasantness of the images presented in a numerical scale and indicating or not a corrective treatment for the respective image. RESULTS The higher the degree of deviation, the lower the scores assigned to the image (p < 0.05). Laypersons assigned the highest scores, with a significant difference between laypersons and oral and maxillofacial surgeons (p < 0.05). In terms of treatment need according to the group of evaluators, there were no statistically significant differences among them (p > 0.05). Moreover, the increase in degree of deviation increased the perception of treatment need (p < 0.05). The African faces received the highest scores, with significant differences from the Caucasian faces (p < 0.05). The overall tendency was higher treatment indication for the Caucasian faces, with statistically significant differences from the African faces (p < 0.05). CONCLUSION The greater the mandibular deviation, the lower the aesthetic pleasantness. Laypersons are less critical regarding the assessment of mandibular deviation. There was no difference for treatment indication by the different groups of evaluators. In addition, ethnicity may influence the perception and treatment indication.
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Affiliation(s)
| | - Walbert de Andrade Vieira
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas, UNICAMP, Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil
| | - Ítalo de Macedo Bernardino
- Department of Dentistry, State University of Paraíba, Rua Baraúnas, 351, Campina Grande, PB, 58429-500, Brazil
| | - Marcio Magno Costa
- School of Dentistry, Area of Removable Prosthesis and Dental Materials, Federal University of Uberlandia, Campus Umuarama, Av. Pará, 1720, Uberlândia, MG, 38405-320, Brazil
| | - Matheus Melo Pithon
- Postgraduate Program in Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 325, Rio de Janeiro, RJ, 21941-617, Brazil
| | - Luiz Renato Paranhos
- School of Dentistry, Area of Preventive and Social Dentistry, Federal University of Uberlandia, Campus Umuarama, Av. Pará, 1720, Bloco 2G, sala 1, Uberlândia, MG, 38405-320, Brazil.
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Chisini LA, Cademartori MG, Collares K, Pires ALC, Azevedo MS, Corrêa MB, Demarco FF. Desire of university students for esthetic treatment and tooth bleaching. BRAZILIAN JOURNAL OF ORAL SCIENCES 2019. [DOI: 10.20396/bjos.v18i0.8657267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: The aim of this study was to investigate the prevalence of the desire of university students for esthetic treatment and tooth bleaching, and associated factors. Methods: A cross-sectional study was performed in 2016 with first-semester university students in Pelotas. Data was collected via a self-administered questionnaire including demographic, socioeconomic and psychosocial characteristics. Oral Impact on Daily Performance (OIDP) was assessed and Poisson regression models were used to evaluate the association between the following outcomes: prevalence of desire for esthetic treatment and the tooth bleaching, and exposure variables. A p-value of ≤ 0.05 was considered significant. Results: A total of 2,058 students participated in the study. Refusals represented a mere 1.4% of the total sample. Of the individuals interviewed, 16.1% underwent tooth bleaching and 74.4% reported a desire for esthetic dental treatment. Models showed students with higher family income and with the intention to use private dental services had 65% and 47% higher prevalence of tooth bleaching, respectively. Individuals satisfied with dental color and appearance exhibited a higher prevalence of tooth bleaching, as did those who smoked. On the other hand, students satisfied with dental color (PR= 0.77, 95% CI: 0.73-0.80) and with their dental appearance (PR= 0.82, 95% CI 0.78-0.87) demonstrated less desire to undergo esthetic dental treatment. Moreover, individuals who suffered some impact in OIDP reported a greater desire for esthetic treatment (PR= 1.07, 95% CI: 1.02-1.13). Conclusion: General and psychosocial characteristics were associated with the desire for esthetic treatment and tooth bleaching in university students.
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CHISINI LA, COLLARES K, BASTOS JLD, PERES KG, PERES MDA, HORTA BL, DEMARCO FF, CORREA MB. Skin color affect the replacement of amalgam for composite in posterior restorations: a birth-cohort study. Braz Oral Res 2019; 33:e54. [DOI: 10.1590/1807-3107bor-2019.vol33.0054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022] Open
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