Social determinants of oral health inequalities: implications for action

Self-perceived quality of social roles, activities and relationships predicts incident gingivitis

OBJECTIVES

While physical health status is known to impact social functioning, a growing literature suggests that social well-being may affect oral health. This investigation evaluated whether self-perceived quality of social roles, activities and relationships (social well-being) influences gingival inflammation.

METHODS

Data were from the Population Assessment of Tobacco and Health Study, a nationally representative cohort of US adults, biennial waves 4 (2017) to 6 (2021). Social well-being was derived from the validated PROMIS Global-10 survey instrument, categorized for this longitudinal analysis as high, moderate or low. The main outcome was incident self-reported gum bleeding (dichotomous, proxy for gingivitis). Survey-weighted logistic regression modelling adjusted for overall health status, sociodemographic (e.g. age, sex, race/ethnicity), socioeconomic (e.g. income, education) and behavioural (e.g. tobacco, alcohol) confounders and was used to predict marginal mean gum bleeding incidence.

RESULTS

Cross-sectionally at wave 4 (N = 23 679), gum bleeding prevalence was higher along a stepwise gradient of decreasing satisfaction with social activities and relationships (extremely satisfied: 20.4%; not at all: 40.1%). Longitudinally, among participants who had never reported gum bleeding through wave 4 (N = 9695), marginal predicted new gum bleeding at wave 6 was greater with each category of lower wave 4-5 social well-being (high: 7.6%; moderate: 8.6%; low: 12.4%). Findings were robust to alternative model specifications. Results should be interpreted considering study limitations (e.g. potential unmeasured confounding; outcome by self-report).

CONCLUSIONS

Social functioning may affect physical health. Specifically, social roles, activities and relationships may influence inflammatory oral conditions, like gingivitis. Confirmatory research is warranted, along with policies and interventions that promote social well-being.

Inequalities in the use of dental services by people with and without disabilities in Brazil: a National Health Survey

OBJECTIVES

The present cross-sectional study aimed to evaluate if social, racial, and gender inequalities disproportionally affect the use of dental services by people with and without disabilities in Brazil in the year 2013.

MATERIALS AND METHODS

The study used data from the 2013 National Health Survey and the dependent variable was the use of dental services. The outcome was stratified by gender, race, and social variables. Descriptive analysis was represented by absolute and relative frequencies. Two inequality measures were used to investigate the inequalities: the Slope Index of Inequalities (SII) and the Concentration Index of Inequalities (CIX). The SII expresses the absolute difference and the CIX identifies the relative inequality.

RESULTS

Of 145,580 adults evaluated, 7.7% reported disability. The proportion of adults without disabilities who used dental services in the last 12 months was higher (45.2%; 95%CI 44.2-46.1) than adults with disabilities (33.9%; 95%CI 32.0-35.9). There was an absolute difference of 40% points (SII 0.40; CI95% (0.36-0.45) in the use of dental services between poorer and richer people with disabilities. Absolute and relative inequalities were identified in the use of dental services, considering the education of the head of the family and family income, with similar results for people with and without disabilities. High inequality is observed concerning race. Racial minorities (Black, Brown, Yellow, and Indigenous) without disabilities presented a higher use of dental services in the last 12 months than racial minorities with disabilities.

CONCLUSIONS

Our findings demonstrate that social and racial inequities negatively affect individuals with and without disabilities.

CLINICAL RELEVANCE

Inequalities exist in the use of oral health services for people with and without disabilities.

A scoping review of early childhood caries, poverty and the first sustainable development goal

BACKGROUND

Poverty is a well-known risk factor for poor health. This scoping review (ScR) mapped research linking early childhood caries (ECC) and poverty using the targets and indicators of the Sustainable Development Goal 1 (SDG1).

METHODS

We searched PubMed, Web of Science, and Scopus in December 2023 using search terms derived from SDG1. Studies were included if they addressed clinically assessed or reported ECC, used indicators of monetary or multidimensional poverty or both, and were published in English with no date restriction. We excluded books and studies where data of children under 6 years of age could not be extracted. We charted the publication year, study location (categorized into income levels and continents), children age, sample size, study design, measures of ECC, types and levels of poverty indicators and adjusted analysis. The publications were also classified based on how the relation between poverty and ECC was conceptualized.

RESULTS

In total, 193 publications were included with 3.4 million children. The studies were published from 1989 to 2023. Europe and North America produced the highest number of publications, predominantly from the UK and the US, respectively. Age-wise, 3-5-year-olds were the most studied (62.2%). Primary studies (83.9%) were the majority, primarily of cross-sectional design (69.8%). Non-primary studies (16.1%) included reviews and systematic reviews. ECC was mainly measured using the dmf indices (79.3%), while poverty indicators varied, with the most common used indicator being income (46.1%). Most studies measured poverty at family (48.7%) and individual (30.1%) levels. The greatest percentage of publications addressed poverty as an exposure or confounder (53.4%), with some studies using poverty to describe groups (11.9%) or report policies or programs addressing ECC in disadvantaged communities (11.4%). In addition, 24.1% of studies requiring adjusted analysis lacked it. Only 13% of publications aligned with SDG1 indicators and targets.

CONCLUSION

The ScR highlight the need for studies to use indicators that provide a comprehensive understanding of poverty and thoroughly examine the social, political, and economic determinants and impact of ECC. More studies in low and middle-income countries and country-level studies may help design interventions that are setting- and economic context-relevant.

Obesity and dental caries in childhood: trends in prevalence and socioeconomic inequalities-a multicohort population-wide data linkage study

OBJECTIVES

To quantify levels of coexisting obesity and caries experience in children in Scotland, and any associated socioeconomic inequalities over the years 2011/2012-2017/2018.

DESIGN

A multicohort population-wide data linkage study.

SETTING

Local authority primary schools in Scotland.

PATIENTS

335 361 primary 1 (approximately 5 years old) schoolchildren in Scotland between 2011/2012 and 2017/2018.

MAIN OUTCOME MEASURES

Prevalence and inequalities in coexisting caries and obesity.

RESULTS

The prevalence of coexisting obesity and caries experience was 3.4% (n=11 494 of 335 361) and did not change over the 7 years. Children living in the 20% most deprived areas had more than sixfold greater odds of coexisting obesity and caries experience than children from the 20% least deprived areas (adjusted OR=6.63 (95% CI=6.16 to 7.14; p<0.001)). There was a large persistent socioeconomic gradient across the Scottish Index of Multiple Deprivation groups, with the Slope and Relative Indices of Inequality remaining unchanged over the 7 cohort years.

CONCLUSIONS

Despite improvements in oral health in children in Scotland, the prevalence of coexisting obesity and caries experience has remained static, with large persistent inequalities. These conditions are likely to signal increased risk of chronic conditions including multimorbidity in adulthood and therefore early identification of children most at risk and timely intervention tackling common risk factors should be developed and evaluated.

Spatial disparities in access to NHS dentistry: a neighbourhood-level analysis in England

Over the past decade, access to National Health Service (NHS) dentistry in England has been problematic. There are increasing media reports of patients being unable to find treatment at a local NHS dentist. However, the extent of this issue varies by location and by the characteristics of the neighbourhood. The study uses official data sources on NHS dental provision and population. Travel accessibility is measured using car journey times. An advanced form of Floating Catchment Area accessibility is used, which accounts for supply competition, varying catchments, and distance decay. Spatial availability and accessibility indices are calculated. Ways in which the method can be used to explore various types of 'what-if' scenarios are outlined. Both availability and accessibility vary by the level of neighbourhood deprivation and the urban/rural nature of the neighbourhood. A case study, based on a real-world situation, shows the impact on the local neighbourhood of the closure of a dental practice. For all neighbourhoods, NHS dental provision is generally less than would be needed to provide basic dental care. The interpretation of outputs needs to take account of edge-effects near to Scotland and Wales. Possible improvements include the inclusion of other modes of travel and the exclusion of the population that does not want to access NHS care.

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

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

Protocol for CARES-HAPIN: an ambidirectional cohort study on exposure to environmental tobacco smoke and risk of early childhood caries

INTRODUCTION

Prenatal and postnatal exposure to environmental tobacco smoke (ETS) has been linked with early childhood caries (ECC), but the specific molecular mechanisms and pathways remain largely unknown. The Caries Risk from exposure to Environmental tobacco Smoke (CARES) within the Household Air Pollution Intervention Network (HAPIN) study aims to establish the association between ETS and ECC by employing epidemiological and novel biomarker-based approaches. Here, we outline the overall design and rationale of the project.

METHODS AND ANALYSIS

We will leverage the infrastructure and data from the HAPIN trial (India) to mount the CARES study. In this ambidirectional cohort study, children (n=735, aged: 3-5 years) will undergo ECC examination by a trained dentist using standard criteria and calibrated methods. Structured questionnaires will be used to gather information on sociodemographic variables, dietary habits, oral hygiene, oral health-related quality of life and current exposure to ETS. We will collect non-invasive or minimally invasive biospecimens (i.e., saliva, buccal cells, dried blood spots and urine) from a subset of HAPIN children (n=120) to assess a battery of biomarkers indicative of exposure to ETS, early biological effect and epigenetic modifications. Both self-reported and objective measures of ETS exposure collected longitudinally during in utero and early postnatal periods will be accessed from the HAPIN database. We will apply current science data techniques to assess the association and interrelationships between ETS, ECC, and multiple biomarkers.

ETHICS AND DISSEMINATION

Information gathered in this research will be published in peer-reviewed journals and summaries will be shared with the key stakeholders as well as patients and their parents/guardians involved in this study. Sri Ramachandra Institute of Higher Education and Research Ethics Board has approved the study protocol (IEC-NI22/JUL/83/82).

TRIAL REGISTRATION NUMBER

NCT02944682.

Co-production of health and social science research with vulnerable children and young people: A rapid review

BACKGROUND

The term 'care-experienced' refers to anyone who is currently in care or has been in care at any stage in their life. A complex interplay of factors leads to care-experienced children and young people (CECYP) experiencing poorer oral health and access to dental care than their peers. A rapid review of the co-production of health and social care research with vulnerable children and young people (CYP) was carried out to inform the development of a co-produced research project exploring the oral health behaviours and access to dental services of CECYP. Here, 'co-production' refers to the involvement of CYP in the planning or conduct of research with explicit roles in which they generate ideas, evidence and research outputs.

AIM

To learn how to meaningfully involve vulnerable CYP in the co-production of health and social science research.

OBJECTIVES

To identify: Different approaches to facilitating the engagement of vulnerable CYP in co-production of health and social science research; different activities carried out in such approaches, challenges to engaging vulnerable CYP in co-production of health and social science research and ways to overcome them and areas of best practice in relation to research co-production with vulnerable CYP.

SEARCH STRATEGY

A rapid review of peer-reviewed articles was conducted in six databases (MEDLINE, Embase, SocINDEX, CINAHL, PsycINFO and Web of Science) and grey literature to identify studies that engaged vulnerable CYP in co-approaches to health and social research.

MAIN RESULTS

Of 1394 documents identified in the search, 40 were included and analysed. A number of different approaches to co-production were used in the studies. The CYP was involved in a range of activities, chiefly the development of data collection tools, data collection and dissemination. Individual challenges for CYP and researchers, practical and institutional factors and ethical considerations impacted the success of co-production.

DISCUSSION AND CONCLUSION

Co-production of health and social science with vulnerable CYP presents challenges to researchers and CYP calling for all to demonstrate reflexivity and awareness of biases, strengths and limitations. Used appropriately and well, co-production offers benefits to researchers and CYP and can contribute to research that reflects the needs of vulnerable CYP. Adherence to the key principles of inclusion, safeguarding, respect and well-being facilitates this approach.

PATIENT AND PUBLIC CONTRIBUTION

Members of our patient and public involvement and stakeholder groups contributed to the interpretation of the review findings. This manuscript was written together with a young care leaver, Skye Boswell, who is one of the authors. She contributed to the preparation of the manuscript, reviewing the findings and their interpretation.

What factors influence refugees' attendance to dental care services?

DATA SOURCES

Four electronic databases: MEDLINE (via Ovid), Embase (via Ovid), Web of Science, and American Psychology Association PsycINFO.

STUDY SELECTION

Quantitative observational or interventional studies, published until the end of February 2022 with no restrictions to date, language, or region of publication.

DATA EXTRACTION AND SYNTHESIS

Screening performed by one author and a second author independently reviewed a random sample of 10% of the articles. Disagreements were resolved in consultation with a third author.

RESULTS

The results were presented as a narrative review due to large heterogeneity of data. Nine studies met the eligibility criteria and most of them were rated as fair quality. The main factors influencing refugees access to dental care services were demographic and socioeconomic characteristics and English language proficiency.

CONCLUSIONS

The review suggests that individual-level factors may have a predisposing effect on refugees' access, but had limited evidence on other enabling and contextual factors.

Diversifying the dental curriculum: A review of the Bachelor of Dental Surgery degree reading lists in a UK dental school

INTRODUCTION

Analysis of the diversity of reading lists on courses offered by universities is one way to assess what is being taught and how it shapes our understanding of the world. Very little work has been carried out so far within dentistry on decolonising the curriculum. Existing work looks at the representation of women or ethnic minorities but not at the dental curriculum per se. This article starts to address this.

METHODS

The reading lists within the 5 year Bachelor of Dental Surgery curriculum in a large UK dental school were collected and assessed. A data extraction spreadsheet was developed and journal articles on every course reading list across the 5 year curriculum were read in detail. Information on authorship and author affiliations, alongside patient and population representation within the article itself, were collected and collated.

RESULTS

We found that there are 2.5 times more male authors than female authors, and almost three times more male lead authors in the articles evaluated. The majority of journal articles included in the reading lists are written by academics and/or clinicians affiliated with institutions in the United Kingdom and most articles are from the global north. In addition, 65% of articles do not specify the focus patient or population group studied.

DISCUSSION

It is unlikely that current reading lists within dentistry fully reflect the composition of the profession itself, the variety of knowledge needed to provide evidence-based practice in a globalised oral health arena or the heterogeneous nature of the patient population.

The Association Between Economic Status and Religious Identity With Oral Health Disparities and Inequalities Around the World

INTRODUCTION

The inequalities in oral health remain one of the current issues in the global public health agenda. The number of studies investigating health disparity by religious identity is limited and there is currently no such report relating to oral health. Similarly, there is compelling evidence for oral health disparities between socioeconomic statuses, education levels, and ethnic groups. This ecological study aimed to explore the disparity in oral health-related outcomes between Muslim and non-Muslim countries and country income status.

METHODS

Publicly available data related to oral health measures, country income status, and membership in the Organization of Islamic countries were used. Five oral health-related measures were examined: caries experience (decayed, missing, and filled teeth (DMFT)), percentage of the population with no periodontal disease, and disability-adjusted life years (DALY) attributed to oral conditions, and mouth and oropharynx cancer. One-way analysis of variance (ANOVA) and Kruskal-Wallis tests were used to compare the oral health parameters by country income status and simple linear regression was used to compare the parameters between the non-member countries (n-MC) and member countries (MC). For the significant parameters, adjusted coefficients were obtained using multiple linear regression.

RESULTS

From 170 countries included, 53 (31%) were MC and 117 (69%) were n-MC. Analysis showed that the mean DMFT in adults aged 35-44 years was significantly higher in the n-MC compared to MC after adjusting for country income status (p<0.05) but the latter was the stronger explanatory predictor of the outcome. The strength of the effect of country membership classification (standardized coefficient β: DMFT35-44-year-old = -0.16) was smaller than country income status (β = -0.60) in the multiple regression.

CONCLUSION

There is significant but weak evidence from the available data to support the claim that economic status and religion contribute to oral health disparity.

Barriers and enablers for oral health promotion programs amongst primary healthcare stakeholders in Qatar - a qualitative investigation

BACKGROUND

Oral health of preschool children remains a concern globally. Primary healthcare providers are in a vital position to support preventive oral care programmes. This study explored current practices, perception and barriers of primary health care professionals towards oral health promotion program of children in Qatar.

METHODS

The qualitative research used focus group discussions and interviewed a total of 108 participants that were audio recorded and transcribed verbatim. Four major themes emerged and were analysed to explore contextual patterns within the data.

RESULTS

Participants acknowledged the high prevalence of caries in children and identified the causes in the local context which included parental practices, poor dietary habits, impact of culture lack of oral health knowledge, limitations in the healthcare system, and negative role of the media. However, complex barriers were exposed, including lack of time and ownership, system coordination between organizations, and lack of policy.

CONCLUSION

Health professionals and bureaucrats involved in decision-making held a positive attitude towards oral health prevention programs and were enthusiastic to initiate and support these programs.

Last dental visit and severity of tooth loss: a machine learning approach

The aims of the present study were to investigate last dental visit as a mediator in the relationship between socioeconomic status and lack of functional dentition/severe tooth loss and use a machine learning approach to predict those adults and elderly at higher risk of tooth loss. We analyzed data from a representative sample of 88,531 Brazilian individuals aged 18 and over. Tooth loss was the outcome by; (1) functional dentition and (2) severe tooth loss. Structural Equation models were used to find the time of last dental visit associated with the outcomes. Moreover, machine learning was used to train and test predictions to target individuals at higher risk for tooth loss. For 65,803 adults, more than two years of last dental visit was associated with lack of functional dentition. Age was the main contributor in the machine learning approach, with an AUC of 90%, accuracy of 90%, specificity of 97% and sensitivity of 38%. For elders, the last dental visit was associated with higher severe loss. Conclusions. More than two years of last dental visit appears to be associated with a severe loss and lack of functional dentition. The machine learning approach had a good performance to predict those individuals.

Determinants of oral health status: an ecological study in Iran

OBJECTIVES

The aim of this ecological study was to assess the association between behavioral, social position, circumstance factors, and caries experience in 35- to 44-year-old adults in Iran at a provincial level.

MATERIALS AND METHODS

The data from the 2011 Iranian Oral Health Survey were obtained from all 31 provinces across Iran on the population level. Oral health status was measured as the number of decayed, missing (MT), and filled (FT) teeth and the percentage of the population who were edentulous. Data were also gathered from each province on the percentage of smokers (Non-Communicable Diseases Risk Factors Surveillance Provincial Report 2009), per capita consumption of free sugars, concentration of fluoride in the drinking water (National and Sub-national Burden of Disease (NASBOD) Survey), number of dentists per 10,000 people, mean years of schooling of adults, expected years of schooling of children, life expectancy at birth and Gross National Income (Integrated Public Use Microdata Series, Global Data Lab). The data were analyzed using simple and multiple linear regression (α = 0.05).

RESULTS

Mean DMFT was positively associated with the percentage of smokers (B = 0.01 95%CI 0.01-0.14), and negatively with fluoride concentration (B =-2.6 95%CI -4.3- -0.96). The edentulousness percentage was positively associated with smoking (B = 0.2 (with 95%CI: 0.07-0.37) and negatively with mean years of education (B =-1.08 (with 95%CI: -2.04- -0.12). DT was associated with expected years of schooling (B =-0.6 (with 95%CI: -1.07- -0.17), negatively. Mt was negatively associated with life expectancy (B =-0.5 (with 95%CI: -1.1- -0.007), fluoride concentration (B =-3.4 (with 95%CI: -4.5- -1.5) and number of dentists per 10,000 people (B =-0.4 (with 95%CI: -0.8- -0.01). Mean Years of Schooling (B = 0.5 (with 95%CI: 0.2-0.8) and number of dentists per 10,000 people (B =-0.62 (with 95%CI: 0.51 - 0.48) were positively in associated with FT.

CONCLUSIONS

The present findings indicate that there were differences in the oral health measures and their social determinants among the provinces of Iran. Regarding the limitations of the study especially the limitation of the number of independent variables, it seems, this discrepancy could be better explained by social variables of the provinces such as income than by environmental factors.

The oral health-related quality of life for individuals with fetal alcohol spectrum disorder - a cross-sectional study

BACKGROUND

The oral health status of an individual can dramatically influence quality of life. Most individuals in Canada report having good oral health, however, this is not true for individuals with developmental disabilities such as fetal alcohol spectrum disorder (FASD). The purpose of this study is to compare the oral health-related quality of life (OHRQoL) of individuals with FASD and the general population in Saskatoon, Saskatchewan. Additionally, it aims to suggest ways to improve the oral health status and OHRQoL of these individuals.

METHODS

For this cross-sectional study, the Oral Health Impact Profile-14 (OHIP-14) survey was used to assess the impact that oral health related problems can have on an individual's quality life. This study used a cross-sectional cohort study design with a survey methodology. The sample population compromised of 154 individuals with FASD along with a separate control group of 154 otherwise healthy adults.

RESULTS

The results of the study showed that most of the individuals in the FASD group experienced pain in the past month. In both groups, cost was most frequently cited as a barrier to accessing care. The majority of individuals in the control group experienced a low impact across all OHIP-14 domains except for physical disabilities. However, in the FASD group, most individuals experienced higher impact scores in some of the categories including functional limitation, psychological discomfort, psychological disability and handicap.

CONCLUSION

The findings clearly demonstrate that there is a discernible effect on an individual's quality of life if they have poor oral health. In conclusion, further research is required to determine the most effective methods to improve the OHRQoL of individuals with disabilities.

Sedentary behaviour and traumatic dental injuries in adolescents: A population-based study

OBJECTIVE

Analyse factors associated with dental trauma in 12-year-old adolescents.

METHODS

An epidemiological survey was carried out in the five largest cities in the state of Mato Grosso do Sul, Brazil. Data on traumatic dental injuries (TDI) based on the World Health Organization (WHO), sociodemographic characteristics and individual clinical and behavioural characteristics in 615 adolescents were collected. Univariate and adjusted multilevel logistic regressions were performed to test the association of dental trauma with behavioural and sociodemographic factors. The study was approved by the Ethics Committee (CAAE number 85647518.4.0000.0021).

RESULTS

The prevalence of TDI at 12 years was 3.4% (95% CI 1.8; 6.4). In the adjusted models, clinical characteristics of adolescents such as overjet >3 mm (OR = 1.51 [95% CI 1.00; 2.41]) were associated with trauma. Sociodemographic characteristics such as female sex (OR = 0.13 [95% CI 0.07; 0.25]), income above the poverty level (OR = 0.34 [95% CI 0.15; 0.78]), who declared themselves white (OR = 0.23 [95% CI 0.11; 0.47]) and with sedentary behaviour (OR = 0.69 [95% CI 0.59; 0.80]) were associated with trauma, as protective factors.

CONCLUSION

Sociodemographic, behavioural and individual clinical characteristics were associated with TDI in adolescents. Oral health teams should focus on the most vulnerable groups, encouraging the use of mouthguards and access to treatment services.

Socioeconomic inequalities in the use of dental health care among the adult population in Serbia

Objectives

The aim of this paper is to assess the association of demografic and socioeconomic determinants with utilization of dental services among Serbian adults.

Materials and methods

The study is a part of the population health research of Serbia, conducted in the period from October to December 2019 by the Institute of Statistics of the Republic of Serbia in cooperation with the Institute of Public Health of Serbia "Dr. Milan JovanovićBatut" and the Ministry of Health of the Republic of Serbia. The research was conducted as a descriptive, cross-sectional analytical study on a representative sample of the population of Serbia. For the purposes of this study, data on the adult population aged 20 years and older were used.

Results

Men were approximately 1.8 times more likely than women to not utilize dental healthcare services (OR = 1.81). The likelihood of not utilizing dental healthcare protection rises with increasing age, reaching its peak within the 65-74 age range (OR = 0.441), after which it declines. Individuals who have experienced marital dissolution due to divorce or the death of a spouse exhibit a higher probability of not utilizing health protection (OR = 1.868). As the level of education and wealth diminishes, the probability of abstaining from health protection increases by 5.8 times among respondents with an elementary school education (OR = 5.852) and 1.7 times among the most economically disadvantaged respondents (OR = 1.745). Regarding inactivity, respondents who are not employed have a 2.6-fold higher likelihood of not utilizing oral health care compared to employed respondents (OR = 2.610).

Conclusion

The results suggest that individual sociodemographic factors influence utilization of dental services by Serbian adults and confirmed the existence of socioeconomic disparities.

The Participation of Pediatric Dentists in Oral Health Promotion and Education in Serbia

Objectives

To identify the involvement of Serbian paediatric dentists in oral health promotion and education, and to propose further actions for the improvement of these activities.

Methods

This is an analysis of data collected by a cross-sectional, questionnaire-based survey of 445 dentists involved in the provision of dental health services to children at the primary healthcare level. We explored dentists' involvement in oral health education and promotion and the cooperation with other health professionals at the healthcare centre and the community level as well as their attitudes towards the importance of some factors influencing their work.

Results

Dentists estimate their cooperation with different services with ratings higher than 3 on the scale of 1 to 5. They reported the highest satisfaction in cooperation with paediatric services for preschool and schoolchildren (4.0±1.0). At the community level, they reported excellent cooperation with kindergartens (4.4±0.8), while collaboration with Roma health mediators (3.14±1.34) and nongovernmental organizations (2.5±1.4) received lower ratings. According to the average rating (4.7±0.7), dentists perceive the motivation of patients and/or their guardians for keeping good oral health as the factor with the highest importance for the quality of interventions they provide.

Conclusions

Dentists involved in the provision of dental healthcare for children and adolescents in primary healthcare centres in Serbia participate in different oral healthcare education and promotion activities in the community, and highlight the importance of strengthening cooperation with healthcare and other professionals and services aimed at vulnerable population groups, both within the health sector and nongovernmental organizations.

Evaluation of a digital oral health intervention (Know Your OQ™) to enhance knowledge, attitudes and practices related to oral health

OBJECTIVE/AIM

Optimal oral health behaviours are crucial to avoid preventable dental diseases and maintain good oral health. This research aimed to evaluate the impact of a digital oral health intervention (Know Your OQ™) in changing knowledge, attitudes and practices related to oral health.

MATERIALS & METHODS

Two studies were conducted with a total of 296 healthy adults. Demographic data as well as knowledge, attitudes, and practices (KAPs) related to oral health were collected before and after completion of the Know Your OQ™ intervention. The KAPs questionnaire included 19 multiple choice questions. Comprehension and feedback were also collected.

RESULTS

In total, 134 (45%) male and 162 (55%) female participants completed the two studies. Across both studies, 5 out of 7 knowledge questions and 2 out of 5 attitude questions showed significant changes pre/post-intervention with participants increasing their knowledge and improving their attitudes towards oral health. Only 1 practice changed in the first study, however, in the second study, 4 out of 7 practice questions showed significant changes pre/post-intervention. Comprehensibility was high across both studies with overall, positive feedback on the intervention.

CONCLUSION

A digital oral health intervention was successful in increasing knowledge, changing attitudes and self-reported practices with regards to oral health in a diverse sample of the US population.

Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study

The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.

Primary caregivers' perceptions of factors influencing preschool children's oral health: social practices perspective-a protocol for qualitative metasynthesis

INTRODUCTION

The role of primary caregivers in setting the foundation for a child's oral health throughout life is well recognised. Due to the dominant behaviour-based approach, research to date has mainly focused on exploring individual primary caregivers' oral health knowledge and behaviours. A social science approach involving social practice theories moves beyond individual attitudes, behaviour and choices to offer a better understanding of the ways in which collective activity relates to health. This qualitative metasynthesis will involve an interpretive synthesis of data found in published qualitative literature from developed countries. The aim of the metasynthesis is to identify social practices in families from published qualitative research with caregivers on preschool children's oral health.

METHODS AND ANALYSIS

This is a protocol for qualitative metasynthesis. The following databases will be used: MEDLINE, EMBASE, Global Health and Dentistry & Oral Sciences Source (DOSS) using the web-based database search platform Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. The research team has determined search strategies by using relevant key terms. Qualitative studies published in English language on family factors related to preschool children (aged 0-5 years) from developed countries (2022 United Nations classification) will be included. Qualitative data analysis will involve thematic analysis of the reported factors influencing oral health of preschool children, from the perspective of social practice theory. Researchers will use NVivo software for organising and managing the data.

ETHICS AND DISSEMINATION

No ethics approval is required, as this study does not involve human subjects. Findings will be disseminated through professional networks, conference presentations and submission to a peer-reviewed journal.

Explaining income inequities in tooth loss among Brazilian adults

OBJECTIVE

To determine the extent to which individual and contextual variables explain income inequities in tooth loss in Brazilian adults.

METHODS

A nationally representative sample of 65,784 Brazilian adults aged 18-59 who participated in the Brazilian National Health Survey 2019 was analyzed. Self-reported tooth loss was the outcome. Per capita income was the main exposure, and minimum wage was the cutoff point. Individual covariates included sex, race, and schooling, dental visits, smoking status, use of dental floss, and self-reported chronic conditions. Contextual covariates included access to treated water and geographic region of residence. Blinder-Oaxaca decomposition analysis was used to estimate the share of each factor in income-related tooth loss inequities by age groups.

RESULTS

Age-standardized tooth loss showed large income inequities. The average difference in tooth loss related to income inequities in the 18-34-year-old group was 0.50 (95% CI 0.39; 0.60), increasing to 4.51 (95% CI 4.09; 4.93) in the 45-59 years. Individual and contextual covariates explained almost 90% of income inequities in the 45-59 year group. Use of dental floss, schooling, and geographic region of residence (a proxy for human development level) had a higher proportion of contribution to the inequities examined.

CONCLUSIONS

Individual and contextual covariates (proxy for human development level and water fluoridation coverage) explained a large share of income-related tooth loss inequities. Tailored strategies to act at both levels can help reduce tooth loss inequities among Brazilian adults.

Clustering of Health and Oral Health-Compromising Behaviours in Army Personnel in Central Peninsular Malaysia

Health- and oral health-compromising behaviours (HOHCBs) impact the health readiness of military personnel, resulting in decreased fitness performance, thus affecting combat readiness. This study aimed to identify the clustering patterns and number of HOHCBs in army personnel in Central Peninsular Malaysia. Thus, a cross-sectional study using a multistage sampling technique and a validated 42-item online questionnaire was conducted to assess ten health (medical screening, physical activity, sedentary lifestyle, smoking status, alcohol consumption, substance abuse, aggressive behaviours, sleep, and road safety habits) and five oral health behaviour domains (tooth brushing, fluoridated toothpaste use, flossing, dental visits, and bruxism). Each HOHCB was dichotomised into healthy and health-compromising behaviour and analysed using hierarchical agglomerative cluster analysis (HACA). With the majority being males (92.5%), of other ranks (96.8%), and healthy (83.9%), 2435 army members of a mean age of 30.3 years (SD = 5.9) participated, with a response rate of 100%. HACA identified two clustering patterns: (i) 'high-risk behaviours' (30 HOHCBs) and (ii) 'most common risk behaviours' (12 HOHCBs) with a mean clustering number of 14.1 (SD = 4.1). In conclusion, army personnel in Central Peninsular Malaysia displayed 2 broad HOHCB clustering patterns, 'high-risk' and 'most common risk', with an average of 14 HOHCB clusters per person.

A comparative examination of the role of need in the relationship between dental service use and socio-economic status across respondents with distinct needs using data from the Scottish Health Survey

BACKGROUND

Disparities in oral health and distinct patterns in service use related to socio-economic status have been shown to exist in the United Kingdom. A number of studies have used the Andersen behavioural model to better understand the factors that influence utilization and thereby inform policies aimed at improving service uptake. As the nature of need may differ across distinct types of patients, however, so too may the distribution of enabling and pre-disposing factors and observed relationships between need, other factors and service use. In this study we compare samples with distinct self-assessed needs in terms of their characteristics and patterns of service use to compare application of the Andersen model to dental services among respondents to a population based survey.

MATERIALS AND METHODS

Data were taken from the Scottish Health Survey, for 2019. Data on service use, oral hygiene habits, perceived treatment need, and socio-demographic characteristics were extracted. Data were analysed using descriptive statistics, t-tests and ordered logistic regression analyses.

RESULTS

Two thousand one hundred forty-eight usable responses were obtained from the survey, 74.95% of the sample had visited the dentist less than a year ago, 11.82% between 1 year and up to 2 years ago, 7.12% between 2 and 5 years ago and 6.10% more than 5 years. Descriptive statistics, t-tests and ordered logistic regression analyses revealed distinct patterns of service use when the sample was partitioned based on perceived treatment need. Specifically those with self-assessed treatment need were older, more likely to smoke, be male and be less likely to have a degree than those who did not. While service use was positively related to age (predisposing) among those who did not have self-assessed treatment need, it was negatively related for those with perceived treatment need. Distinct patterns were also evident with respect to sugar exposure (need) and ease with which time off work could be organised (enabling).

DISCUSSION

The study shows common and distinct patterns of service use related to enabling and predisposing factors across groups differentiated by self-perceived treatment need. If inequalities in health and healthcare use are to be addressed, it is important to understand their origins. Conflation of distinct types of need that may correlate with predisposing and enabling factors complicates this.

CONCLUSION

In applying the Andersen model, it is important to take account of potential differences in the types of need expressed where possible to understand the role of other variables in service use.

Oral health perceptions and practices of caregivers at children's religious schools and foster care centers: a qualitative exploratory study in Lahore, Pakistan

BACKGROUND

Oral diseases are one of the major public health problems worldwide and affect the population of all age groups. This qualitative study aimed to explore the perceptions and practices of caregivers at care centres and boarding religious schools responsible for managing children's oral health.

METHODS

A qualitative ethnomethodological approach was used to collect data from the caregivers at the children's religious schools and foster care centres. A purposive sampling technique was used to conduct focus group discussions comprising 4-7 caregivers from five foster care centres and religious schools located in Lahore, Pakistan. An interview guide was developed based on results from previous studies. An inductive approach was used to analyse data on broader oral health concepts to generate themes in this qualitative research. A three-step thematic analysis was applied to develop codes that were merged to generate categories and to conclude into themes from the transcribed data. Five focus group discussions were conducted at two foster care centres (FG1 & FG2) and three religious schools (FG3, FG4 & FG5). Foster care centres had children of both gender within the same premises; however, religious schools had segregated settings.

RESULTS

The following four themes emerged from the thematic analysis: development of the desired living environment and responsibilities of the caregivers, preexisting traditional personal knowledge of the caregivers determine children's oral health, use of religio-cultural driven and convenience-based oral hygiene practices, and ethnomedicine, spiritual healing, and self-medication. Development and the existing living environment of the foster care centres and religious schools appeared important to manage the matters of the boarding children.

CONCLUSIONS

This qualitative study concludes that the oral health of the children at foster care centres and at religious schools depends upon the personal reasoning and pre-existing religio-cultural knowledge of the caregivers rather than on specialized oral health-oriented approaches. The foster care centres are more involved in supervising the children to maintain oral hygiene and oral health compared to religious schools.

Unemployment and expenditure on health and education as mediators of the association between toothbrushing and global income inequalities

Objective

The study assessed the association of country-level income inequalities with the percentage of schoolchildren toothbrushing-at-least-twice-daily; and the mediating effect of country-level unemployment rate and governmental expenditure on health and education (EH&E).

Methods

This was an ecological study. The dependent variable was country-level toothbrushing-at-least-twice-daily among 11-15-year-old schoolchildren. Data for the period 2009 to 2019 were extracted from two global surveys about schoolchildren’s health and from manuscripts identified through a systematic search of three databases. The independent variable was country-level income inequalities measured by the Gini coefficient (GC) extracted from the Sustainable Development Report 2021. The mediators were the unemployment rate and EH&E. We stratified the sample by the level of GC and assessed the correlation between the dependent and independent variables in each stratum. Linear regression was used to assess the relations between the dependent and independent variables, and mediation path analysis was used to quantify the direct, indirect, and total effects.

Results

Data were available for 127 countries. The mean (SD) percentage of children who brushed-at-least-twice-daily was 67.3 (16.1), the mean (SD) GC = 41.4 (8.2), unemployment rate = 7.5 (4.7) and EH&E = 8.4 (3.3). The percentage of children brushing at-least-twice-daily had weak and non-significant correlation with GC that was positive in countries with the least inequality and negative for countries with higher levels of inequality. A greater percentage of schoolchildren brushing-at-least-twice-daily was significantly associated with higher GC (B = 0.76, 95%CI: 0.33, 1.18), greater EH&E (B = 1.67, 95%CI: 0.69, 2.64) and lower unemployment rate (B=-1.03, 95%CI: -1.71, -0.35). GC had a significant direct positive effect (B = 0.76, 95%CI: 0.33, 1.18), a significant indirect negative effect through unemployment and EH&E (B=-0.47, 95%CI: -0.79, -0.24) and a non-significant total positive effect (B = 0.29, 95%CI: -0.09, 0.67) on the percentage of schoolchildren brushing-at-least-twice-daily.

Conclusion

Unemployment and EH&E mediated the association between income inequality and toothbrushing. Country-level factors may indirectly impact toothbrushing.

Access to oral health care for children with fetal alcohol spectrum disorder: a cross-sectional study

Background

Individuals with developmental disabilities, including Fetal Alcohol Spectrum Disorder (FASD), often suffer from poorer oral health than the general population as they experience challenges with accessing care. However, few studies have investigated access to oral health care specific to children diagnosed with FASD. Thus, the objective of this cross-sectional study is to examine the use of oral health care services by children diagnosed with FASD in Saskatchewan, Canada, and to identify perceived barriers that affect their access to oral health care.

Methods

Parents or caregivers for children with FASD under the age of 16 were recruited through community organizations. Between July 2020 and January 2021, 189 participants completed a 64-item questionnaire that assessed sociodemographic characteristics, oral health care utilization, and perceived barriers to care.

Results

Most children (85%) had visited the dentist within the last 24 months. 55% of children had required sedation for some treatment. 43% of caregivers experienced frustration trying to access care for their child. Common barriers were cost (63%), location (55%), the child’s behaviour (78%) and caregiver anxiety (60%). 35% of caregivers believed their dentist lacked adequate knowledge of FASD. Univariate analysis reveals that income, caregiver education, residence location, and insurance status were significantly associated with reporting barriers. Multivariate logistic regression analysis reveals that caregivers who reported a high school education (OR=1.23; 95% CI 1.03 – 1.38); or public insurance (OR=1.33; 95% CI 1.24 – 1.42) or out-of-pocket payments (OR=1.37, 95% CI 1.20 – 1.46); or rural (OR=1.19, 95% CI 1.07 – 1.26) or remote (OR=1.23; 95% CI=1.12 – 1.31) residences were more likely to report difficulties accessing oral health care.

Conclusion

Our findings indicate that children with FASD experience various barriers to accessing oral health care. Social determinants of health were significant variables that increased likelihood of barriers. Like other vulnerable populations, cost and clinic location are notable barriers. Oral health care providers’ assessment and management of children with FASD are noteworthy for future research.

The impact of COVID-19 on individual oral health: a scoping review

BACKGROUND

Poor oral health due to dental caries is one of the most prevalent non-communicable diseases worldwide. It has a significant impact on individuals across the lifespan and is a leading cause of preventable hospitalizations. The impacts of COVID-19 on oral health at the practice level are well documented, but gaps in understanding the impact on individual oral health remain. This review addresses this gap.

METHODS

Using a JBI scoping review process we mapped and summarized the evidence to identify the impact of COVID-19 on individual oral health. Key search terms were developed, and searches were undertaken by an experienced research librarian.

RESULTS

The 85 included studies were conducted in 23 countries from 5 regions across the world classified using the United Nations Geoscheme system. The majority (82/85) were quantitative, 2 were reviews and there was one qualitative interview study. Cross-sectional surveys were the most common data collection approach followed by an analysis of clinical data, analysis of internet trends and other online methods. Five key areas were identified including changes to the provision of emergency dental services, provision of routine oral health services, oral hygiene maintenance at home, changes in dietary preferences, alternative models of dental provision and help-seeking and attitudes towards dental care in the future.

CONCLUSIONS

This scoping review has demonstrated that the pandemic has impacted on oral health at the individual level. It is important that we are aware of these impacts and ensure that support systems are in place to overcome future periods where access to dental care might be compromised. The provision of preventive care remains a vital first step in ensuring good overall oral health as is paramount during periods where access to dental treatment might be limited.

The association of food insecurity with tooth decay and periodontitis among middle-aged and older adults in the United States and Korea

INTRODUCTION

Food insecurity is an important social determinant of health, but there is limited understanding of its relationship with adult oral health. This study examined the associations between food insecurity and dental diseases (caries and periodontitis) among middle-aged and older adults in the United States and South Korea.

METHODS

This study focused on middle-aged (40-59 years) and older adults (>59 years) who participated in the 2011-2016 US National Health and Nutrition Examination Surveys (NHANES) or the 2013-2015 South Korean NHANES. The exposure was food insecurity severity (food secure/early-stage food insecurity/middle-stage or severe food insecurity) assessed using the 18-item US Household Food Security Survey Module. The two outcomes were any untreated tooth decay and periodontitis measured using the Modified Community Periodontal Index of Treatment Needs. Covariate-adjusted odds ratios (OR) with 95% confidence intervals (CI) were generated using multivariable logistic regression models.

RESULTS

Middle or severe food insecurity was associated with significantly higher odds of having untreated tooth decay than no food insecurity, but only among middle-aged adults in the United States (OR: 1.4, 95% CI 1.2, 1.9; P = .037) and Korea (OR = 1.8; 95% CI:1.0, 3.2; P = .036) and older adults in the United States (OR: 2.6, 95% CI 1.7, 4.0; P < .001). The associations between food insecurity and periodontitis were inconsistent across age group and country.

CONCLUSION

Differing cultural norms and access to dental services in the United States and South Korea may influence the relationship between food insecurity and oral health. Future research should explore how addressing food insecurity could help to promote the oral health of middle-aged and older adults in diverse sociocultural contexts.

Fluoridation cessation and oral health equity: a 7-year post-cessation study of Grade 2 schoolchildren in Alberta, Canada

OBJECTIVE

Community water fluoridation, because of its universal scope and passive mechanism of uptake, is one component of a multifaceted approach to promoting equity in dental health. The objective of this study was to examine social inequities in children's dental health in the Canadian cities of Calgary (fluoridation cessation in 2011) and Edmonton (still fluoridated).

METHODS

We analyzed data from surveys of population-based samples of Grade 2 (approx. age 7) children in Calgary in 2009/2010 (pre-cessation; n=557) and in both Calgary and Edmonton in 2013/2014 (Calgary, n=3230; Edmonton, n=2304) and 2018/2019 (Calgary, n=2649; Edmonton, n=2600) (post-cessation). We estimated associations between several socioeconomic indicators and dental caries indicators (i.e., dental caries experience [deft, DMFT] and untreated decay in two or more teeth [untreated decay]) using zero-inflated Poisson, binary logistic regression, and the concentration index of inequality. We compared those associations over time (between survey waves) and between cities at post-cessation.

RESULTS

Persistent social inequities in deft and untreated decay were evident; for example, having no dental insurance was significantly associated with higher odds of untreated decay across city and survey wave. In most (but not all) cases, differences between cities and survey waves were consistent with an adverse effect of fluoridation cessation on dental health inequities. For example, the association between no dental insurance and higher odds of untreated decay in Calgary was greater in 2018/2019 (later post-cessation) than in 2009/2010 (pre-cessation; odds ratio [OR] for comparison of coefficients = 1.89 [1.36-2.63], p<0.001) and 2013/2014 (early post-cessation; OR for comparison of coefficients = 1.67 [1.22-2.28], p=0.001); that same association in 2018/2019 was greater in Calgary (fluoridation cessation) than in Edmonton (still fluoridated) (OR for comparison of coefficients = 1.44 [1.03-2.02], p=0.033).

CONCLUSION

Social inequities in dental caries were present in both Calgary and Edmonton. Those inequities tended to be worse in Calgary where fluoridation was ceased. Our findings may be relevant to other settings where income inequality is high, dental services are costly, and dental public health infrastructure is limited.

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: study protocol for the RETURN randomised controlled trial

BACKGROUND

People with disadvantaged backgrounds are less likely to visit the dentist for planned care, even though they have disproportionately poorer oral health. They are correspondingly more likely to experience dental problems and use urgent dental care, general practices and Accident and Emergency departments, which not only makes meeting their needs expensive, but, since these services often rely on prescriptions rather than addressing the clinical cause, can contribute to antimicrobial resistance.

METHODS

The RETURN intervention has been developed with substantial community co-production, to be delivered opportunistically in urgent dental care settings. This brief intervention is delivered by dental nurses and involves material relevant to the 'in-group' targeted. The material includes booklets relating to barriers to planned dental visiting with corresponding short video clips featuring local people and including a modelling element. Dental nurses are trained to have supportive and non-judgemental conversations, assisting patients to set personal goals and action plans, which are reinforced in a follow-up text within a few weeks. A randomised controlled trial will be undertaken in 3 types of sites: dental practices delivering urgent care (a) within working hours, (b) out of hours, and (c) in a Dental Hospital. The trial will recruit 1180 adult urgent dental care users over 12 months, who have not visited a dentist for a planned care appointment for 2 years or more and do not have a dentist who they visit for routine care. It aims to investigate the effectiveness and cost-effectiveness of the intervention and to explore whether the intervention has different effects across the socio-economic gradient. Participants will be followed up at 6, 12 and 18 months after randomisation. Co-primary outcomes are attendance at a dental practice for planned care within 12 months and self-reported oral health-related quality of life at 12 months.

DISCUSSION

This is a pragmatic trial, evaluating the effectiveness of the intervention under the usual condition in which it might be applied. Since dental practices work as independent contractors to the NHS, this brings implementation and fidelity challenges which will be explored and described in embedded qualitative work.

TRIAL REGISTRATION

ISRCTN registry identifier ISRCTN84666712. Registered 12/04/2021.

Missed opportunities for improving oral health in rural Victoria: The role of municipal public health planning in improving oral health

ISSUE ADDRESSED

People in rural areas have poorer oral health than their urban counterparts due to a range of factors. Local governments (LGs) have a key role in addressing health issues that impact on local communities.

METHODS

Publicly available oral health profile (OHP) data and Municipal Public Health and Wellbeing Plans (MPHWPs) (2017-2021) were downloaded from Dental Health Services Victoria and LG websites for 48 Victorian local government areas (LGAs) containing predominately rural areas. OHP data were collated to provide an overview of the oral health status of the communities and a content analysis of the MPHWPs undertaken.

RESULTS

Despite poor oral health in rural Victorian LGAs, oral health was not often in MPHWPs. Twenty of the MPHWPs had some mention of oral health but only four included specific actions or strategies that would be used to improve oral health. None of the plans contained any specific targets for action or details of evaluations that might be used to assess success.

CONCLUSIONS

Poor oral health in rural Victorian communities continues to be demonstrated through local OHPs and is due to modifiable risk factors and poor access to water fluoridation. LGs have a key role to play in improving oral health through utilisation of OHP data in their MPHWPs. SO WHAT?: Oral health remains a low priority for LG action. This represents a missed opportunity for prioritising oral health prevention and promotion activities that improve oral health in rural Victoria.

Is neighborhood income associated with untreated dental caries irrespective of family income?

OBJECTIVE

To assess the status of untreated dental caries in adolescents exposed to different conditions of family and neighborhood income.

MATERIALS AND METHODS

This cross-sectional study included a representative sample of 1197 15-19-year-old adolescents attending high schools from Santa Maria, southern Brazil. Data collection included a questionnaire and clinical examination (DMFT index). Neighborhood mean income was collected from official sources. The main predictor variable was a combination of household income and neighborhood mean income resulting in four categories: low household income/low neighborhood income, low household income/high neighborhood income, high household income/low neighborhood income, or high household income/high neighborhood income. The outcome was untreated caries (number of teeth with dentin cavities or residual roots). Multilevel Poisson regression analysis was used to assess the association between predictors and untreated caries. Rate ratio (RR) and 95% confidence intervals (CI) were estimated.

RESULTS

The prevalence of untreated dental caries was 26% (n = 312), with a mean (± standard deviation) of 0.47 (± 1.05) teeth. Adolescents with low household income living in areas with low neighborhood income had the worse caries scenario. Compared with them, those classified as low-income households residing in high-income neighborhoods had 37% lower rate of untreated dental caries (adjusted RR = 0.63; 95%CI = 0.44-0.89). No neighborhood effect was detected among adolescents of more affluent families.

CONCLUSIONS

Neighborhood income contributed to the rate of untreated dental caries over and above household income among adolescents with low household income only.

CLINICAL RELEVANCE

Improving living conditions in disadvantaged neighborhoods may positively impact the oral health of residents, thus reducing oral health inequalities.

Undoing structural racism in dentistry: Advocacy for dental therapy

Like other areas of health, structural racism has a deep impact on oral health and is a key driver of racial inequities in access to care and outcomes. Racism also structures the relationship between oral health and access to economic opportunities. As a result, communities of color, American Indian/Alaska Native (AI/AN) communities, and low-income populations experience the highest rates of the health, social, and economic costs of dental disease. This is compounded by issues of community-level dental fear/trauma resulting from receiving itinerate care. Dentistry has long struggled to equitably distribute care and diversify its overwhelmingly white and affluent workforce, resulting in many communities not having access to providers who represent their identity and/or live in their community. While multi-generational lack of access to dental care is not unique to Alaska, Alaska Native communities are the home to a reimagined, community-centered care delivery system that is improving health outcomes. For almost two decades, AI/AN leaders have recruited and trained community members to serve as dental therapists-dental team members who offer routine and preventive care responsive to local geographic and cultural/community norms. As members of the communities they serve, dental therapists are fluent in the language and cultural norms of their patients, improving patient-provider trust, access to care, and oral health outcomes. The communities that dental therapists serve are also now investing money and training in their community members, building educational opportunities, and professional wage jobs and directly countering the economic impact structural racism has on oral health.

Non-communicable Diseases and Oral Health: An Overview

Non-communicable diseases (NCDs) such as cardiovascular and metabolic diseases, diabetes, cancer and diseases of the oral cavity such as caries or periodontitis represent a global and highly relevant problem due to demographic and epidemiological changes. NCDs are not only responsible for millions of deaths worldwide, but they cause relevant costs for national economies arise for the health care of societies. Assuming that oral health and general health are directly linked, emerging interactions between systemic and oral diseases are increasingly being researched. Common important risk factors have implications for economic, social, and moral determinants of health. Interdisciplinarity trained oral health professionals are needed to address the excessively high rates of inequities in oral health. The main reason that oral diseases are still a global health problem is related to mainly individual subjective high-risk approaches, which resulting in high costs and low effectiveness. A paradigm shift for a public health approach is needed at population level that integrates different health professionals who deal with NCDs. Oral care, like physical activity, is one of the most important lifestyle-related determinants of health. Widespread recognition of this kind of approach is critical to both reducing the impact of oral and non-oral NCDs. A multi-sectoral, comprehensive and integrated strategy is therefore necessary. The focus should be on social, environmental and population strategies, but should also support individual strategies.

Magnetism in Dentistry: Review and Future Perspectives

Tissue engineering or tissue reconstruction/repair/regeneration may be considered as a guiding strategy in oral and maxillofacial surgery, as well as in endodontics, orthodontics, periodontics, and daily clinical practice. A wide range of techniques has been developed over the past years, from tissue grafts to the more recent and innovative regenerative procedures. Continuous research in the field of natural and artificial materials and biomaterials, as well as in advanced scaffold design strategies has been carried out. The focus has also been on various growth factors involved in dental tissue repair or reconstruction. Benefiting from the recent literature, this review paper illustrates current innovative strategies and technological approaches in oral and maxillofacial tissue engineering, trying to offer some information regarding the available scientific data and practical applications. After introducing tissue engineering aspects, an overview on additive manufacturing technologies will be provided, with a focus on the applications of superparamagnetic iron oxide nanoparticles in the biomedical field. The potential applications of magnetic fields and magnetic devices on the acceleration of orthodontic tooth movement will be analysed.

Multimorbidity and tooth loss: the Brazilian National Health Survey, 2019

Background

Little is known about the presence of two or more chronic conditions (multimorbidity) on tooth loss between adults and older adults. Understanding the mechanisms of multimorbidity on tooth loss is essential to inform policy development. This study aims to investigate the association between multimorbidity and severity of tooth loss in Brazilian adults and older adults.

Methods

We analysed data from a nationally representative sample of 88,531 Brazilian individuals aged 18 and over who participated in the 2019 Brazilian Health Survey. Tooth loss was the outcome by two different classifications: functional dentition (lost 1–12 teeth) and severe tooth loss (lost 23–32 teeth). The presence of multimorbidity was the main exposure and based on 13 self-reported doctor-diagnosed chronic diseases that were further categorised into two groups, i.e., ≥2 or ≥ 3 comorbidities. Sociodemographic covariates included sex, age, race, income, level of education and tobacco smoking and geographic region of residency. Multivariate logistic regression models estimated the OR (Odds Ratios) and 95%CI of the associations between multimorbidity and tooth loss.

Results

For 65,803 adults (aged 18 to 59), the presence of multimorbidity (≥2) was associated with 32% higher odds of having severe tooth loss (95% CI, 1.17; 1.49) and 33% lower odds of having functional dentition (95% CI, 0.60; 0.75). For the 22,728 older adults (aged 60 and older), multimorbidity (≥2) was associated with a 17% higher odds of severe tooth loss (95% CI, 1.06; 1.29) and 23% lower odds of having functional dentition (95% CI 0.70; 0.85). The sensitivity analysis, excluding hypertension, confirmed our findings.

Conclusions

Brazilian adults and older adults with multimorbidity are more likely to have severe tooth loss and less likely to have functional dentition.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12392-2.

Does motivational interviewing promote oral health in adolescents?

Design In total, 15 secondary schools were designated to one of three groups: (I) prevailing health education (PHE); (II) motivational interviewing (MI); and (III) MI with interactive dental caries risk assessment (MI + RA). Adolescents (n = 512) with negative oral health patterns (irregular tooth brushing and/or regular snacking) were recruited from groups I-III; 161, 163 and 188, respectively. Selected candidates received interventions corresponding to their assigned group. Participants completed a questionnaire on their oral health self-efficacy and routines at 0, 6 and 12 months. Dental caries (number of decayed surfaces/teeth status) and oral hygiene (dental plaque score) of the participants was also recorded at these intervals.Case selection The 15 secondary schools were recruited from the three main districts in Hong Kong. Those included in the study were required to be full-time students in a participating school, 12 or 13 years old, not have any major systemic disease, able to communicate in Cantonese or Mandarin and have unfavourable oral health behaviour - this was defined as brushing teeth less than twice a day and/or snacking more than twice a day.Data analysis The Statistical Package for Social Sciences was used for data processing. For the lost to follow-up cases, the intention-to-treat analyses were performed using the carry forward imputation (for example, the latest known outcome). The Kruskal-Wallis test was used to compare the medians through nonparametric methods. The distribution was compared using the chi-square test. Where the outcome was continuous, a linear mixed model was constructed (for example, plaque score and dental caries). Where the outcome was dichotomous, mixed-effects logistic regression was constructed (for example, 1) changes in oral health self-efficacy - remain negative versus change to positive; and 2) changes of oral health behaviours - remain unfavourable versus changed to favourable). Sociodemographic variables (for example, parental education and sex) were controlled for.Results Participants in groups II and III were more likely to increase tooth brushing frequency and reduce their snacking after 12 months, compared to group I. In addition to this, groups II and III had a lower number of new carious teeth compared to group I.Conclusions PHE was less effective than MI in evoking favourable changes in the oral health patterns of adolescents and preventing dental caries.

Intersectoral collaboration and coordination mechanisms for implementing water fluoridation: Challenges from a case study in Brazil

OBJECTIVES

Community water fluoridation has been associated with better oral health conditions globally and reduced dental caries. While oral health policies are governed by the health sector agenda, water fluoridation is undertaken by public, private, and mixed public/private companies of the sanitation sector. The first aim of this study was to investigate the degree of intersectoral collaboration, and the second was to investigate how the coordination mechanisms are perceived by the sanitation agents of the sectors involved in water quality management, for the potential establishment of water fluoridation in a central-west state in Brazil.

METHODS

Semi-structured interviews were conducted with chief sanitation agents from nonprofit, profit, and mixed public/private companies responsible for water quality and fluoridation in a purposive sample. Theoretical frameworks of intersectoral collaboration and coordination mechanisms were used for analysis.

RESULTS

Twelve interviews were conducted. Informal collaboration was identified in the sanitation sector within companies involved in water provision. The main coordination mechanisms were network-type mechanisms, which involve consultations and knowledge sharing, and market-type mechanisms, which explore new job opportunities and cost-effectiveness, especially in water quality measures. Enabling themes (enablers) were identified, such as positive attitude toward including water quality and fluoridation in a collaborative health and sanitation common agenda. Moreover, fluoridation did not meet the regulatory and surveillance agenda at the state level, and until that moment, there was no proposal of the health sector for water fluoridation.

CONCLUSIONS

Partnership creation, consolidation, and shared mission, especially between health and sanitation sectors, were identified as main challenges for implementing water fluoridation policy.

Tooth wear and socioeconomic status in childhood and adulthood: Findings from a systematic review and meta-analysis of observational studies

OBJECTIVES

To evaluate the association and level of evidence between socioeconomic status (SES) and tooth wear (TW) in children, adolescents, and adults.

DATA

Eligibility criteria comprised population-based observational studies assessing the association between SES and TW in permanent dentition of adolescents and adults. Interventional and descriptive studies or those without an internal comparison between exposed and nonexposed groups were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied where applicable. Risk of bias (RoB) was assessed using the Newcastle-Ottawa scale. Meta-analyses were conducted to estimate the pooled effect measures. Q-statistic, I²statistic, subgroup and sensitivity analyses assessed study heterogeneity.

SOURCES

PubMed/Medline, Embase, Scopus, Web of Science, LILACS, SciELO, Cochrane Library, and Google Scholar databases were searched for articles published in English between 1st January 1980 and 31st March 2021.

RESULTS

Sixty-five studies were included, involving 63,893 participants in over 30 countries. A positive association was found between TW and education (OR=1.25 [0.96; 1.62]), family income (OR=1.18 [0.91; 1.53]), and private school (OR= 1.24 [0.90; 1.72]) among adolescents. Higher educated adults had a lower risk for TW (OR=0.70 [0.52; 0.93]). Most included studies had a moderate RoB. Limitations relating to population representation and assessment methodologies were identified in the included studies.

CONCLUSIONS

SES was associated with TW with its direction depending on the individuals' age. The overall quality of evidence was moderate.

CLINICAL SIGNIFICANC

SES should be included as part of the routine screening and risk assessment for tooth wear.

A Systematic Review of Cross-Cultural Adaptation and Psychometric Properties of Oral Health Literacy Tools

The aims of this systematic review were to critically appraise the quality of the cross-cultural adaptation and the psychometric properties of the translated versions of oral health literacy assessment tools. CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), and ProQuest Dissertation and Thesis were searched systematically. Studies focusing on cross-cultural adaptation and psychometric properties of oral health literacy tools were included. The methodological quality of included studies was assessed according to the COSMIN Risk of Bias checklist. Sixteen oral health literacy instruments in 11 different languages were included in this systematic review. However, only seven instruments met the criteria for an accurate cross-cultural adaptation process, while the remaining tools failed to meet at least one criterion for suitable quality of cross-cultural adaptation process. None of the studies evaluated all the aspects of psychometric properties. Most of the studies reported internal consistency, reliability, structural validity, and construct validity. Despite adequate ratings for some reported psychometric properties, the methodological quality of studies on translated versions of oral health literacy tools was mostly doubtful to inadequate. Researchers and clinicians should follow standard guidelines for cross-cultural adaptation and assess all aspects of psychometric properties for using oral health literacy tools in cross-cultural settings.

Motivational interviewing for caries prevention in adolescents: a randomized controlled trial

OBJECTIVE

The objective of this study is to investigate the effectiveness of motivational interviewing (MI) in changing health behaviors (snack and toothbrushing) and preventing dental caries among adolescents.

METHODS

Five hundred and twelve adolescents with unfavorable caries-related behaviors ("snacking three times or more a day" and/or "toothbrushing less often than twice a day") were randomly assigned to three groups. Group I received prevailing health education (oral health talks and pamphlets). Participants in group II joined a one-on-one face-to-face MI session. In group III, a patient communication tool (Cariogram) was incorporated to facilitate the MI process. At baseline and 24 months post-intervention, a self-administered questionnaire gathered information of participants' sociodemographic characteristics and oral health self-efficacy and behaviors. Their oral hygiene and tooth status were assessed by a blinded examiner.

RESULTS

After 24 months, 460 (89.8%) participants were followed up. Compared with group I, (i) restriction of frequent snacking was more likely in group II [OR (95% CI): 3.91 (1.48-10.33)] and group III [OR (95% CI): 6.33 (2.46-16.27)], whereas group III tended to adopt the behavior of toothbrushing twice a day [OR (95% CI): 4.80 (1.79-12.85)]; (ii) no significant between-group difference in plaque score reduction was found (p > 0.05); and (iii) groups II and III developed fewer cavitated teeth (△D_{ICDASII 3-6}MFT) [β (95% CI): - 0.19 (- 0.37, - 0.01) and - 0.20 (- 0.38, - 0.02), respectively], whereas increment of total carious lesions (△D_{ICDASII 1-6}MFT) was lower in group III [β (95% CI): - 0.63 (- 1.24, - 0.02)].

CONCLUSION

MI outperformed prevailing health education in improving oral health behaviors and preventing dental caries among adolescents.

CLINICAL RELEVANCE

Incorporating MI into dental care for caries-prone adolescents contributes to optimal health outcomes.

TRIAL REGISTRATION

HKUCTR-1852 ( http://www.hkuctr.com/ ) (Hong Kong, 2013).

Recommendations for delivering oral health advice: a qualitative supplementary analysis of dental teams, parents' and children's experiences

BACKGROUND

Tooth decay has a significant impact on children, their families and wider society. The dental consultation provides an opportunity to prevent tooth decay by engaging in an effective oral health conversation with parents and children. However, there is limited literature which explores how these oral health conversations are delivered, received, and understood.

AIM

To explore the common facilitators of delivering oral health advice from dental teams, parents' and children's experiences, to identify and inform practical recommendations for clinical practice.

METHOD

The current paper used a qualitative supplementary analysis to reanalyse data of existing published studies by applying a different research question. Qualitative focus groups were undertaken following a semi-structured interview guide with 27 dental team members (dentists, dental nurses, practice managers and receptionists), 37 parents and 120 children (aged 7-10 years old) in the northern region of England. Thematic analysis informed the identification of themes and aggregation of findings.

RESULTS

Three overarching themes were developed: (1) An engaging and personalised dental visit for parents and children; (2) Dental teams, parents and children working collaboratively to improve oral health habits; and (3) Recommending appropriate oral health products. Many parents and children had little recollection of any preventive oral health conversations when visiting the dentist. Practical solutions were identified by different stakeholders to facilitate three-way, personalised, non-judgemental and supportive oral health conversations. Adopting these innovative approaches will help to enable parents and their children to adopt and maintain appropriate oral health behaviours.

CONCLUSION

Understanding the context and triangulating the experiences of stakeholders involved in preventive oral health conversations for young children is an essential step in co-designing a complex oral health intervention. This study has provided recommendations for dental practices and wider paediatric health care services. Furthermore, the findings have informed the design of a complex oral health intervention called "Strong Teeth".

A scoping review of pharmacy participation in dental and oral health care

OBJECTIVES

To explore the scope of dental and oral health care (DOHC) provided by the pharmacy profession and associated outcomes, and attitudes of pharmacy staff and other key stakeholders about pharmacy involvement in this context.

METHODS

A scoping review of full-text articles describing outcomes related to pharmacy staff/student involvement in, knowledge of or attitudes towards DOHC in any setting, and stakeholder perspectives was conducted. Articles written in English were searched for using PubMed, EMBASE, EBSCO, International Pharmaceutical Abstracts, Education Resources Information Centre, Web of Science, Google Scholar, and ProQuest for Dissertations and Theses. No date restrictions were used. Key outcomes were mapped: role and practice, knowledge and attitudes, and training and education.

RESULTS

Seventy studies met the inclusion criteria: 49 were conducted in developed countries; 60 were quantitative in design; and 38 involved community pharmacy settings only. Pharmacists and pharmacy support staff commonly managed DOHC inquiries (n = 13), including the provision of advice and products with or without a further referral. Integrated pharmacist-led services in dental settings (n = 4) showed improved prescribing and quality use of medicines but low community pharmacy referrals were identified in studies involving mystery shoppers with potential oral cancer (n = 7). DOHC promotion programmes delivered by pharmacy staff and collaborations with dentists were limited. There was interest from the pharmacy profession for a role in DOHC; however, knowledge gaps were reported and needs for further training identified. Consumer participant DOHC outcomes were not reported.

CONCLUSIONS

Community pharmacists and pharmacy staff were interested in an expanded role in DOHC; however, this scoping review identified lack of knowledge and sub-optimal practice as potential barriers. Research on development, implementation and evaluation of DOHC-related services and practice by pharmacy staff was scarce. Further evidence of consumer-related oral health outcomes and their perceptions of the role of pharmacy is needed.

Parental Ethnic Identity and Its Influence on Children's Oral Health in American Indian Families

Objectives: To examine the relationship between ethnic identity and oral health knowledge, beliefs, behavior, and outcomes in American Indian families. Methods: Secondary data were analyzed for 579 parent–child dyads in a randomized controlled trial aimed at reducing early childhood caries in a Northern Plains tribal community. Data included demographic characteristics; parental ethnic identity; oral health knowledge, beliefs, and behavior; and parental/pediatric oral health outcomes. Ethnic identity was assessed using two measures: perceived importance of tribal identity and tribal language proficiency. We examined the association of baseline ethnic identity with baseline and longitudinal oral health measures. Results: At baseline, importance of tribal identity was significantly associated with several oral health beliefs, and one’s locus of control measure (external-chance). Baseline scores on importance of tribal identity were also associated with one’s oral heath belief (perceived severity), the same locus of control measure, and oral health knowledge and behavior over the three years of study follow up. Tribal language proficiency was not associated with any study measures at baseline, although it was associated with parental oral health status over the three years. Conclusions: Ethnic identity was associated with a range of oral health constructs expected to influence American Indian children’s oral health.

Does the implementation of a national oral health policy reduce inequalities in oral health services utilization? The Brazilian experience

Background

This study aimed to assess the trend in income-related inequalities in oral health services utilization by the Brazilian population from 1998 to 2013. This period represents a timeline that includes different stages of implementation of the National Oral Health Policy.

Methods

The design was based on repeated cross-sectional surveys using secondary data from household-based studies carried out in Brazil in 1998, 2003, 2008, and 2013. The dependent variable was “having access to a dentist appointment at least once in a lifetime (yes/no).” Monthly household per capita income, based on Brazil’s minimum wage, was included as the main independent variable. To measure the inequalities in oral health access related to economic position, the following complex indexes based on regression were used: (a) the slope index of inequality (SII) and (b) the relative index of inequality (RII).

Results

There was a reduction in the percentage of individuals who never had a dentist appointment for all age groups and income classifications. In general, there was a reduction trend in absolute inequality for all age groups (p < 0.001). The relative inequality and reduction trend were different between the age groups studied.

Conclusions

The National Oral Health Policy was very important for expanding free of charge, public access to dental appointment. However, despite policy implementation, there continues to be high levels of inequality in access to dental consultation. Assessing which strategies are necessary to overcome this challenge is discussed.

Spatial distribution analysis of dentists, dental technicians, and dental therapists in Indonesia

Background: Access to health services is needed around the world, from healthcare providers to doctors. One of the needs in public health is a system that is accessible for everyone, but, unequal distribution of healthcare provider and health workers, especially in dentistry fields is still a main problem in several countries, including Indonesia. The aim of this study is to analyze the spatial distribution of dentists, dental technicians, and dental therapists. Methods: This spatial analysis study was conducted after obtaining secondary data in Indonesia. All data were collected between September 1 ^st, 2020 and October 1 ^st, 2020 from open access sources of de-identified data. The data of dentists per area, dental technicians per area, and dental therapists per area were calculated for analysis. A spatial distribution map was prepared using the Quantum Geographic Information System (QGIS Desktop, version 3.10.6). Results: The results of this study found a ratio of dentists to members of the population in Indonesia of 1:17,105. The average number of dental technicians that work in the public health centers in each province (dental technicians per area) in Indonesia was calculated to be 0.13. The average number of dental therapists that work in the public health centers in each province (dental therapists per area) in Indonesia was calculated to be 0.40. This spatial autocorrelation illustrates that there is a relationship between values of dentists per area and dental therapists per area between provinces in Indonesia, and shows geographic clustering relationships or patterns that are grouped and have similar characteristics in adjacent locations. This spatial autocorrelation did not occur in the value of dental technicians. Conclusions: From this study we can conclude that there is an unequal distribution of dental personnel in Indonesia.