Disparities in Access to Oral Health Care

The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada

BACKGROUND

Children with special healthcare needs (SHCN) often require specialized interventions due to their disabilities. Dental general anesthesia (DGA) is a treatment modality, which improves their access to care but concerns about repeated DGAs persist.

AIM

This study investigated DGA utilization in children with SHCN and identified factors associated with multiple DGAs in Alberta, Canada (2010-2020).

DESIGN

This retrospective population-based study used administrative data encompassing all children (<18 years) undergoing DGA in publicly funded facilities. Children were identified as SHCN based on their diagnosis codes and categorized into behavioral/psychiatric disorders, mental/intellectual disabilities, physical disabilities, systemic conditions, syndromes/congenital anomalies, physical-mental disabilities, and disabilities with medical conditions.

RESULTS

This study analyzed 3884 DGA visits for children with SHCN, predominantly males aged 6-11 and from low-income families. Mental/intellectual disabilities were prevalent (31.8%), and autism was the leading disease. Caries was the primary dental diagnosis across all groups, whereas pulp problems were higher in psychiatric/behavioral disorders (23.6%), and periodontal problems were more common in physical-mental disabilities (13.2%). 28.7% had multiple DGAs, with younger age, disabilities with medical conditions, mental/intellectual disabilities, and initial pulp treatments, increasing the likelihood of multiple DGAs.

CONCLUSION

This study highlights the importance of individualized prevention and less conservative treatments for younger children to reduce oral health disparities.

Empowering access: unveiling an overall composite spatial accessibility index to healthcare services in Southeastern Iran

BACKGROUND

Access to healthcare is critical for population health; however, geographic barriers persist especially in rural and deprived regions. This study aims to develop an overall composite potential spatial accessibility index to healthcare facilities and services in Sistan and Baluchestan Province in southeast Iran.

METHODS

This study employed the enhanced two-step floating catchment area (E2SFCA) method to create an overall composite spatial accessibility index for healthcare facilities and services in Sistan and Baluchestan Province, southeast Iran. Spatial accessibility for general practitioners, nursing, dentistry, midwifery, pharmacy, medical laboratory, nutrition, public health, radiology, psychology, environmental health, rural health workers, inpatient hospital beds, and five medical specialty services were calculated. Spatial accessibility scores were normalized from 0 to 1 (no access = 0, low = 0.01 to 0.33, moderate = 0.331 to 0.66, high = 0.661 to 1) and aggregated into overall indices of primary, secondary, and overall healthcare accessibility for each district. Inequality was assessed using the Lorenz curve and Gini coefficient analysis.

RESULTS

Low geographic accessibility was found across Sistan and Baluchestan Province, especially in rural areas. Almost 75% of the population had low/no access to overall primary care services within a 30-minute drive time. For secondary care, nearly 45% had low/no access to hospital inpatient beds within a 30-minute drive time, and around 40% had low/no access to specialists within a 60-minute drive time. Just 11.6% of the population had high overall healthcare access. The calculated Gini coefficient of 0.517 for the overall spatial accessibility index to healthcare services in Sistan and Baluchestan Province highlights a highly unequal distribution of healthcare services.

CONCLUSIONS

This study demonstrates a useful replicable methodology that combines individual service accessibility metrics into an overall spatial healthcare access index. Furthermore, this study provides evidence of major shortfalls in healthcare access across Sistan and Baluchestan Province. Targeted strategies are required to increase the availability and capacity of services in underserved communities. Improving geographic access is key for progressing towards universal coverage and better population health.

Big Data and Oral Health Disparities: A Critical Appraisal

Big data has emerged as a pivotal asset in addressing oral health disparities in recent years. Big data encompasses the vast pool of health care-related biomedical information sourced from diverse channels, such as claims data, patient registries, and electronic health records (EHRs). This study is a critical review that synthesizes the evidence, identifies gaps in knowledge, and discusses future implications regarding big data analytics and oral health disparities. Published reports from 2014 to 2023 that studied associations between big data, social determinants of oral health, and oral health disparities, published in English and available in electronic databases, were included. Search engines were MEDLINE via PubMed, Google Scholar, and Web of Science. A total of 23 studies were included in the review, and all were retrospective data analytics. Studies have used a variety of big data sources, including EHRs, claims, and national or regional registries. This study used a framework of data quality dimensions with intrinsic (data attributes) and contextual values (information provided by the data, in this case, oral health disparities) to critically appraise the included studies. Big data revealed disparities in oral health outcomes and dental care utilization based on race, ethnicity, socioeconomic status, geographical location, insurance category, access to care, and other barriers to care. For the intrinsic data dimension, none of the studies addressed or reported data missingness or consistency of the data. The studies clearly provided contextual data dimensions. From a value-added perspective, several studies provided novel and new information related to racial oral health inequities. Several studies used more than one oral health disparities variable or a composite variable. However, the conclusions from several studies were based on association-based analytics, and few studies used artificial intelligence approaches to understand the population's oral health inequities-gaps were seen in the study designs and causal analytics.

Effectiveness of dental sealant under insurance coverage in South Korea

OBJECTIVES

This study aimed to investigate the effectiveness of a national population-based dental sealant in South Korea.

MATERIALS AND METHODS

This nationwide, population-based cohort study involved all children in South Korea aged 6-7 years who received sealants from 2010 to 2011 and were followed up for 10 years using the Korea National Health Insurance Service (NHIS) database. After 1:2 propensity score matching, 857,723 children were selected for analysis. During the 10-year follow-up, the permanent first molars of the participants were assessed for caries-related treatments (pulpotomy and pulp capping, root canal treatment, and tooth extraction) using multilevel Cox proportional hazards models. The risk of caries-related treatment was lower in the sealant treatment group than in the control group.

RESULTS

The hazard ratios (HRs) for caries-related treatments among participants were 0.59 (95% confidence interval [CI] 0.57-0.61) for pulpotomy and pulp capping, 0.57 (95% CI 0.55-0.58) for root canal treatment, and 0.29 (95% CI 0.27-0.32) for tooth extraction. This large-scale nationwide cohort study indicated that the sealant treatment in children aged 6-7 years significantly reduced the risk of caries-related treatments (pulpotomy and pulp capping, endodontic treatment, and tooth extraction) by at least 40% during the 10-year follow-up period.

CONCLUSION

Sealant treatment in children reduced the caries risk during the 10-year follow-up.

CLINICAL RELEVANCE

The results demonstrate the effectiveness of the insurance policy for dental sealants.

Key factors associated with oral health services at Federally Qualified Health Centers

OBJECTIVE

This study aimed to investigate changes in oral health services from 2012 to 2021 and identify factors influencing the number of different types of services directly provided by all Federally Qualified Health Centers (FQHCs).

METHODS

Data from the 2012-2021 Uniform Data System were analyzed using multilevel mixed-effect negative binomial regression models. These models explored associations between oral health staffing, federal grant revenue, and state Medicaid dental policies for adults, and the number of different types of oral health services provided at FQHCs. Regressions were adjusted for FQHC and state characteristics, and survey year.

RESULTS

FQHC visits for any oral health service increased significantly with each additional full-time equivalent (FTE) in all types of oral health staffing, ranging between 0.8% and 13.7% (e.g., IRR = 1.137, 95% CI = 1.126-1.148 for preventive services by dental hygienists/therapists). Preventive dental visits increased significantly by 32% (IRR = 1.320, 95% CI = 1.028-1.694) for every 1% increase in the proportion of capital development grants to the total revenue. Although not statistically significant, FQHCs in states with extensive Medicaid dental coverage had a 2%-7% increase in all types of oral health services except emergency services compared to those in states with emergency-only coverage.

CONCLUSIONS

This study found that increasing dental staffing, particularly of dental hygienists/therapists, enhances FQHCs' ability to provide preventive services. Capital development grants also positively influence preventive dental care delivery. Expanding Medicaid dental coverage may also increase service utilization, particularly among underserved groups, reducing oral health disparities.

Global burden and trends of severe periodontitis among women of childbearing age, 1990-2021

BACKGROUND

The global burden and trend of severe periodontitis, as well as its association with sociodemographic development, among women of childbearing age (WCBA) have been unclear so far. This study aims to assess the epidemiological pattern of severe periodontitis in WCBA from 1990 to 2021 and provide projections through 2040.

METHODS

Data on the incidence, prevalence, and disability-adjusted life years (DALYs) of severe periodontitis among WCBA from 1990 to 2021 were retrieved from the Global Burden of Disease (GBD) study 2021. The Bayesian age-period-cohort model was run to project the age-standardized incidence rate (ASIR) through 2040.

RESULTS

In 2021, an estimated 26,315,786 incident cases, 257,234,399 prevalent cases, and 1,680,425 DALYs were reported globally. From 1990 to 2021, a consistent annual increase in the age-standardized rate of severe periodontitis was observed, and the ASIR is projected to continue to rise until 2040. Additionally, the burden of severe periodontitis demonstrated a downward trend with increasing sociodemographic development. In 2021, age-specific rates of severe periodontitis increased with age, with the most significant changes occurring in younger age groups.

CONCLUSION

The rising global burden of severe periodontitis, along with regional and age variations, highlights the urgent need for innovative prevention and healthcare strategies to reduce this burden among WCBA globally.

PLAIN LANGUAGE SUMMARY

Women of childbearing age (WCBA) represent nearly a quarter of the global population, yet there is a significant gap in consistent global and regional surveillance data on severe periodontitis in this group. Our study revealed that severe periodontitis among WCBA poses a substantial public health challenge worldwide. From 1990 to 2021, the age-standardized rate of severe periodontitis increased globally, with the most significant rise observed in regions with middle socioeconomic development. This condition disproportionately affects women in their prime years, with the fastest growth seen among younger WCBA. It is essential that healthcare providers recognize the gender disparities and societal factors related to socioeconomic development that contribute to the risk of severe periodontitis in this population. To address this issue effectively, it is crucial to develop region- and age-specific prevention strategies, as well as targeted healthcare interventions.

A co-produced mixed methods protocol: Exploring perceptions of oral health care and quality of life in people with mental health conditions

This planned mixed methods protocol is designed to explore oral health care for individuals living with serious mental health conditions (SMHC). It was co-produced by academics, people with lived experience of mental health conditions, and oral and mental health clinicians. The study seeks to explore oral health quality of life predictors and oral health care experiences of people diagnosed with serious mental health conditions (e.g. schizophrenia, bipolar disorder, major depression and general anxiety disorder) about their oral health care experiences. The research research will generate recommendations for creating positive oral healthcare experiences for people living with SMHC. Research co-production with people diagnosed with mental health conditions is a recommended strategy to improve the utility and relevance of health research, as well as empower a disenfranchised population.

Developing and validating a scale to measure perceived barriers to prosthodontics treatments among partially edentulous patients

Background

People experiencing tooth loss need dental prostheses to preserve the integrity of their oral structures and replace the missing teeth. Patient-related outcome measures (PROMs) for perceived barriers to prosthodontics treatment are scarce in the literature.

Aims

The aim of this study was to develop a comprehensive scale to identify and measure barriers to prosthodontic treatment as perceived by partially edentulous patients.

Methods

This cross-sectional study was conducted among N = 334 partially edentulous adults who seeking prosthodontic treatment. Data collection was carried out in February to September 2024. Exploratory factor analysis was utilized to elucidate the latent factor structure. A six-factor model was validated through confirmatory factor analysis. Reliability was evaluated using Cronbach's alpha. The convergent and discriminant validity of the final scale were assessed.

Results

EFA produced a 21-item scale grouped into six factors that explain 75.78% of the total variance with eigenvalues >1. All items showed acceptable reliability, ranging from 0.807 to 0.935. The first factor pertained to financial constraints; the second factor was concerning lack of knowledge and awareness; the third factor was related to anxiety and fear; the fourth factor related to negative past dental experiences; the fifth factor included issues related to limited accessibility to dental services; and the last factor was concerning insufficient dental guidance. The CFA results indicate an acceptable model fit, with standardized factor loadings spanning from 0.54 to 0.99. The model factors' convergent and discriminant validity were confirmed.

Conclusion

This study enhances the understanding of barriers to prosthodontic treatment in a Saudi Arabian teaching dental hospital. It introduces a novel scale for further data collection, aiding policymakers and stakeholders in addressing these barriers and improving public oral health. Future studies should validate this scale and explore its applicability in various contexts and populations.

Oral Health and Quality of Life in Type 2 Diabetic Patients: Key Findings from a Romanian Study

Background: Diabetes mellitus is associated with various oral health complications that can negatively impact quality of life. Despite evidence of the relationship between diabetes and oral health issues, limited research exists on the perceptions, behaviors, and oral health-related quality of life (OHRQoL) of diabetic patients in Romania. This study aims to evaluate self-reported oral health, knowledge, behaviors, and OHRQoL among diabetic patients in western Romania. Methods: A cross-sectional study was conducted in early 2024 at Pius Brinzeu County Emergency Hospital, Timisoara, involving 121 patients with type 2 diabetes. Data were collected using self-administered questionnaires that assessed oral health status, behaviors, and OHRQoL, with the OHIP-14 instrument employed for quality-of-life measurement. Statistical analyses included descriptive statistics, multiple linear regression, and correlation analyses to identify the predictors of oral health knowledge and OHRQoL. Results: Participants (mean age: 63.24 years; 52.1% female; 60.5% urban residents) reported significant oral health challenges. Over half (56.2%) did not visit a dentist regularly, with financial constraints identified as the primary barrier (23.5%). Oral hygiene practices were suboptimal: only 38.0% brushed twice daily, while 78.5% used fluoride toothpaste. Auxiliary hygiene tools, such as mouthwash and toothpicks, were rarely used (13.22% and 11.57%, respectively). Regression analyses identified the significant predictors of oral health knowledge, including tooth mobility (β = 0.33, p < 0.01) and brushing frequency (β = -0.18, p < 0.05). The mean OHIP-14 score (0.55) indicated a moderate impact on OHRQoL, with domains such as psychological discomfort and social disability revealing nuanced challenges. Conclusions: Diabetic patients in Romania face oral health challenges and care barriers, emphasizing the need for preventive strategies, oral health education, and integrated diabetes care. Addressing these gaps can improve oral health outcomes and overall quality of life in this vulnerable population.

Clinical, radiographic, and histopathological characterization of Osteomyelitis of the Jaws: A 51-Year experience at an oral pathology service

INTRODUCTION

Osteomyelitis is an inflammatory condition of the bone with a multifactorial etiology, including trauma and odontogenic infections. Despite being a common condition in clinical practice, limited research exists on the clinical and pathological profile of Osteomyelitis of the Jaws (OJ). This 51-year retrospective study aimed to describe the clinical, radiographic, and histopathological features of OJ diagnosed at a single oral pathology referral center.

MATERIAL AND METHODS

Clinical, radiographic, and histopathological data of cases diagnosed as OJ were collected and categorized using Zurich Classification System.

RESULTS

Among 17,991 cases diagnosed at the service, 75 (0.004 %) were identified as OJ. Patients were predominantly female (n = 67; 89.3 %), with a mean age of 42.68 years (±21.10) at diagnosis. OJ commonly presented as slow-growing, symptomatic lesions (n = 69; 92.0 %) with a predilection for the mandible. Secondary chronic osteomyelitis (SCO) was the most common subtype (n = 44; 84.0 %). Odontogenic infections were identified as the most common etiological factor associated with OJ (n = 41; 54.7 %). Radiographic analysis frequently revealed generalized, moderate bone loss, while histopathological examination often showed a discrete mononuclear inflammatory infiltrate (n = 29; 38.7 %). Bacterial colonies were observed in 26 cases (34.7 %) and were significantly associated with SCO (p = 0.04).

CONCLUSION

The findings indicate that OJ is a rare condition in oral pathology centers, predominantly affecting white females in their fifth decade at life, with a predilection for the mandible. Dental infections were the primary causative factor. SCO is the most common OJ subtype in cases requiring surgical management.

Factors associated with the dental service utilization by enrollees on the Lagos State health insurance scheme, Nigeria

BACKGROUND

Despite assumptions that insurance coverage would boost oral healthcare utilization in Nigeria, there is insufficient evidence supporting this claim. This study investigates the associations between residential location, awareness of the oral health insurance scheme, history of dental service utilization, and acceptance of oral health insurance among individuals benefiting from the Ilera Eko Scheme; a scheme that integrates preventive and curative oral health care into the state health insurance scheme.

METHODS

A cross-sectional survey was conducted from July to November 2023 recruiting from a database of 1520 enrollees aged of 18 and 72-years-old who had been on the scheme for at least three months. An interviewer-administered questionnaire was used to collect the data from participants living in five regions of Lagos State. The dependent variable was dental service utilization. The independent variables were awareness about Ilera Eko health insurance scheme, history of oral health problem, residential location of the respondents (Lagos Island, Badagry, Epe, Ikorodu and Ikeja), and perception about the scheme. The confounding variables were the age at last birthday, sex at birth (male or female), educational level (no education, primary, secondary, and tertiary education), level of income (< 50,000, 50,000-10000, 150,000-200,000, > 200,000), employment status (employed, self-employed and unemployed), marital status (single, married, divorced. widow/widower) and duration on the scheme (< 6 months, 6-12 months, > 12 months). A binary logistic regression analysis was conducted to determine the associations between the dependent and independent variables, controlling for confounders.

RESULTS

The study recruited 485 participants of which 31 (6.4%) had used the oral health care services. Respondents with oral health problems had higher odds of using the scheme (AOR:21.065; p < 0.001). Residents in Ikeja had significantly lower odds of using the scheme when compared with residents in Lagos Island (AOR: 0.174; p = 0.005).

CONCLUSION

Respondents with oral health problems had higher odds of using the oral health insurance scheme. Innovative approaches are needed to drive the utilization of free dental service packages on health insurance schemes in Lagos State, especially for preventive care.

Models of DEIB: Part I - Approaches to Inclusion from Other Health Professions for Consideration by Dentistry

This article represents a prologue of the discussion of the article "Models of DEIB: Part II-Exploring Models of Inclusion from other Health Professions for Dentistry". It explores existing practices and philosophies from other disciplines that could be applied toward creating environments of inclusion and belonging in dentistry. The primary focus here is to provide an opportunity for the dental profession to leverage knowledge and experiences from other health professions to enhance and expand inclusion efforts and provide enhance engagement at all levels.

Models of Diversity, Equity, Inclusion, and Belonging: Part II-Exploring Models of Inclusion from Other Health Professions for Dentistry

This study describes examples of models and frameworks from other professions that could be applied toward creating environments of inclusion and belonging in dentistry. Examples are provided of activities, frameworks, and models that can serve to launch similar activities within dentistry. Selected models of inclusion from library science, medicine, nursing, dental hygiene, and social work can be used by the dental profession to help make definitive strides in the inclusion arena to combat challenges of access and inequitable oral health status.

Impact of sending vouchers for a community-based oral screening program on dental service usage promotion among adults: a difference-in-difference analysis

BACKGROUND

Community- and evidence-based approaches are essential for improving dental public health. We evaluated the effectiveness of sending vouchers in a community-based oral screening program to encourage dental visits and improve oral health among adults.

METHODS

We analyzed the data from April 2014 to March 2019 obtained from administrative claims and screening program databases in Tsukuba City, Japan. This longitudinal observational study utilized the difference-in-difference approach to evaluate the impact of the screening program on dental service use. The exposure group, which comprised residents aged 30, 40, 50, 60, and 70 years who were eligible for the screening program and had received dental check-up vouchers, was compared with an age-matched control group, which comprised individuals aged ± 2 years. Dental service use was evaluated in terms of (1) whether monthly dental visits occurred, (2) the number of dental visits per person, and (3) the total monthly dental expenditure.

RESULTS

Data were obtained from 43,438 residents (14,392 and 29,046 in the exposure and control groups, respectively). The program positively affected the likelihood of attending a dental visit (adjusted risk ratio, 1.04; 95% confidence interval [CI], 1.00-1.07) and the overall monthly expenditure on dental services (adjusted mean ratio, 1.03; 95% CI, 1.03-1.03).

CONCLUSIONS

The oral screening program slightly increased dental service use among adults in Japan. The findings enable evidence-based policy-making on the improvement of the population-level oral health status.

A systematic review and meta-analysis of the association between sugar intake and dental caries in Nigeria

BACKGROUND

There is no national data on the association between sugar intake and caries experience in Nigeria. This systematic review and meta-analysis aimed to assess the association between sugar intake and caries experience in Nigeria.

METHODS

A search was conducted across the PubMed, Web of Science, Scopus, and Embase databases for articles published between January 2001 and March 2023 on the associations between sugar consumption and caries experience. This systematic review and meta-analysis were registered with PROSPERO (CRD42022372689). Data extracted included details of the study design, sample size, age and gender of study participants, and regions/states in Nigeria where the study was conducted. In addition, the types of sugary foods/beverages consumed, frequency and quantity of sugar intake, and periods of high sugar consumption were extracted. The studies' bias risks were also assessed.

RESULTS

The review included 14 cross-sectional studies conducted between 2007 and 2023. Twelve (85.7%) studies were conducted in Southwest Nigeria. Seven (50.0%) had study participants with primary dentition, while eight (57.1%) had study participants with permanent dentition. The odds of caries are 18% higher in the group that consumes sugar compared to the group with low sugar intake (OR = 1.18, 95% CI: 0.87, 1.59). The odds of caries in primary (OR = 1.13, 95% CI: 0.23, 5.44) and permanent (OR = 1.15, 95% CI: 0.88, 1.52) dentition were higher in the group that consumes sugar compared to the group with low sugar intake. There were no statistical associations between sugar consumption and caries experience. Of the 14 included studies, thirteen (92.8%) were classified as "low risk."

CONCLUSION

Although a high frequency of sugar intake increased the risk of dental caries, this association did not reach statistical significance in Nigeria's primary and permanent dentitions. Future studies should include longitudinal studies and studies that assess differences in the measures for sugar consumption and its association with the risk of caries.

Impact of lack of transportation on access to dental care

Objectives

Access to healthcare may be influenced by the availability of transportation. Nevertheless, the impact of transportation challenges on access to dental care has not been thoroughly examined. This study investigates the influence of transportation availability on dental care visits, dental cleanings, and exams.

Methods

This is a retrospective observational study. The 2021 Medical Expenditure Panel Survey (MEPS), a national survey in the United States, was used for this study. Adults (≥18 years old) from the 2021 survey were included. The 2021 Full Year Consolidated File and the Dental Visits file were linked to identify the main independent variable and the outcomes.Weighted zero-inflated negative binomial regression and weighted logistic regression were employed to analyze the outcomes of dental care visits, and dental cleanings, and exams.

Results

The study included a total of 204,704,044 adults, with an average age of 49 (SD: 18) years, and a 51 % female representation. Approximately 5.5 % (n=11,285,968) of the population reported facing transportation challenges. Subjects encountering transportation challenges exhibited a 26 % decrease in dental care visits compared to those without such challenges (Incidence Rate Ratio (IRR)=0.74, p < 0.01, 95 % CI: 0.64-0.87). Individuals lacking transportation had 39 % lower odds of receiving a dental cleaning (odds ratio (OR)=0.61, p < 0.01, 95 % CI: 0.48-0.77) and 29 % lower odds of undergoing a checkup or exam (OR=0.71, p < 0.01, 95 % CI: 0.56-0.90).

Conclusions

The study's findings underscore the significant impact of transportation challenges on access to dental care. Limited access to dental care due to transportation issues could exacerbate disparities in oral health outcomes. Implementing targeted interventions to address transportation challenges could contribute to improved oral health outcomes.

Every bite counts to achieve oral health: a scoping review on diet and oral health preventive practices

OBJECTIVE

To examine the landscape of preventive strategies and interventions directed to achieve oral health equity, with particular emphasis on the interplay between dental caries prevention, individual behaviors, and population-level strategies across various demographic and geographic regions.

METHODS

This scoping review was guided by Peters et al.'s framework, which incorporates four key concepts aimed at reducing caries: education for individuals and healthcare providers, behavioral modifications, addressing broader social determinants of health, and extending oral health education programs beyond traditional dental settings. A systematic search was conducted across five databases, from 2011 to 2022.

RESULTS

This review identified 107 studies highlighting three main themes: behavioral practices (N = 33), which focused on reducing the prevalence of caries, improving oral hygiene practices, and enhancing overall oral health knowledge; educational interventions (N = 39), which explored strategies to integrate oral health with broader public health initiatives; and dietary interventions (N = 35), which emphasized the critical relationship between diet and oral health.

CONCLUSION

This SR highlights the critical need for comprehensive multilevel approaches that address the complex interplay between nutrition, oral health, and sociodemographic factors, while emphasizing the critical relationship between societal factors and individual health behaviors. Multifaceted interventions that include behavioral change, education, and dietary modifications are crucial for improving oral and overall health outcomes across diverse populations. Comprehensive strategies should prioritize medical-dental integration and data-driven approaches to effectively reduce oral health disparities for vulnerable populations, promoting long-term health equity.

Dental care access for children in the United States

OBJECTIVES

To evaluate access to dental care for children in the United States.

METHODS

The study population included children in 48 states and the District of Columbia. Using multiple data sources, dental care access was estimated at the community level by matching dental care supply and demand using mathematical modeling accounting for access constraints. Outcome measures included percent-met demand, travel distance, and percentage of underserved and unserved communities. Multiple scenarios to improve Medicaid/CHIP participation of dentists were evaluated.

RESULTS

Medicaid-insured and CHIP-insured children exhibited lower access compared to those privately insured. The percent-met demand was lower than 50% for Medicaid-insured children and CHIP-insured children for 42 and 34 states, respectively. Percent-met demand was higher than 50% for private-insured children except for Texas and West Virginia. Increasing Medicaid/CHIP participation of dentists resulted in improving access for public-insured children. At 100% Medicaid/CHIP participation, all states exhibited different degrees of percent-met demand increase for publicly insured children, from 7% to 46%. The percent-met demand across all children ranged in 23.8%-82.9% under 70% participation rate versus 22%-83% under 100% participation rate. No single participation rate improved access for all children uniformly across all states.

CONCLUSIONS

This study found that dental care access was lower for children with public insurance than those with private access across all states, although states responded differently to changes in Medicaid/CHIP participation. Increasing access for children with public insurance would reduce disparities, but overall children's access to dental care would be better improved by expanding the oral health workforce.

Teledentistry utilization by oral health professionals and policy considerations: A mixed methods case study

OBJECTIVES

To examine variations in the delivery of teledentistry after the COVID-19 pandemic and to explore oral health professionals' utilization of various teledentistry modes of delivery.

METHODS

In this mixed methods case study, we collected teledentistry claims data from patient electronic health records (n = 78,756) encompassing various types of teledentistry utilization in clinical settings and through community outreach from a Dental Support Organization (DSO) in Oregon from January 2021 to November 2022. We analyzed the patient demographic and claims data using descriptive statistics and logistic regression analyses to identify patterns of teledentistry service delivery. Qualitatively, we conducted virtual interviews (n = 13) through Microsoft Teams with oral health professionals about their experiences with teledentistry utilization. We used inductive and deductive coding to code individual transcripts and identify common themes among provider experiences.

RESULTS

Out of the 78,756 electronic health record claims for teledentistry, 75.7% used synchronous audio, 13.4% used synchronous video, and 10.9% used asynchronous teledentistry methods. We observed a 8.6% increase in synchronous audio teledentistry utilization at the end of the study period, compared with a 4.2% increase in synchronous video and a 4.4% decrease in asynchronous teledentistry. Oral health professionals interviewed reported choosing the type of teledentistry delivery based on patient and provider access to the virtual teledentistry platform.

CONCLUSION

Oral health professionals' knowledge of and experiences with teledentistry need to be considered when developing policy and best practices for the use of teledentistry for patient care.

Epidemiological and Oral Public Health Aspects of Dental Pain: A Narrative Review

The aim of this narrative review is to synthesize and discuss existing evidence on the epidemiological aspects of dental pain, addressing its prevalence, risk factors, population distribution, impact on the quality of life, and implications for public health. Dental pain is a common condition that involves complex mechanisms of pain transmission and perception. Dental pain can be due to various causes, such as caries, pulpitis, periodontitis, dental trauma, and soft tissue conditions (e.g., stomatitis). In addition, psychological and social factors influence pain perception and severity, such as anxiety and previous negative experiences. The global burden of dental pain is considerable, generating a significant impact on the quality of life of people at individual and collective levels. This impact manifests itself in a reduction in productivity, due to absenteeism from work and school, as well as difficulties in performing daily tasks. In addition, dental pain entails high costs for health systems, including expenses associated with diagnosis, treatment, and the care of complications arising from the lack of timely care. These costs also include indirect expenses associated with the loss of productivity and impacts on the general well-being of the population. The magnitude of these effects, both at individual and population levels, underlines the importance of prevention and access to timely and effective treatment of dental pain. The prevalence of dental pain varies by region and factors such as age, socioeconomic status, and access to services. Risk factors include sociodemographic (age, gender, and ethnicity), socioeconomic (income, education, and occupation), psychological (anxiety and depression), and behavioral (oral hygiene and diet) dimensions. People with lower socioeconomic and educational status are more likely to suffer from dental pain due to a lack of access to services and inadequate preventive practices. Dental pain negatively affects the quality of life, disrupting daily functions and causing emotional distress. Public health proposes improving access to preventive dental care, oral health education, and equitable policies to reduce disparities. Strategies aimed at reducing the burden of dental pain at the population level include expanding access to dental care, promoting healthy habits, and ameliorating the significance of care costs as a barrier. Future research should focus on innovative assessment methods, expanding the accessibility to various levels of care, and understanding the biopsychosocial determinants of dental pain to develop effective interventions.

Utilization of Oral Healthcare Among Uninsured Populations During the COVID-19 Pandemic in the United States

BACKGROUND

Accessibility to dental care is vital for uninsured low-income individuals. There is a deficit of research that examines oral healthcare seeking during the COVID-19 pandemic among uninsured low-income individuals. The purpose of this study is to describe oral health-related issues among patients of a free clinic that does not provide dental care during the COVID-19 pandemic.

METHODS

The sample consists of 254 patients of a free clinic located in the Intermountain West. Data were collected by distributing self-administered paper surveys to patients 18 or older who spoke English and/or Spanish from December 2021 to May 2022.

RESULTS

Nearly 40% of study participants reported being long overdue for dental appointments, with many not receiving care within the past two years (n = 96, 37.8%). Less than 30% of free clinic patients had a dental appointment within the past six months (n = 73, 28.9%). Cost is the most substantial barrier for free clinic patients to receive dental care (n = 150, 60%).

CONCLUSION

This study's findings bridge the research gap on dental care experience during the pandemic among uninsured populations and are helpful in increasing knowledge for improving access to dental care at free clinics.

Microbiomic insights into the oral microbiome's role in type 2 diabetes mellitus: standardizing approaches for future advancements

The burgeoning field of microbiomics has unveiled significant insights into the role of the oral microbiome in the pathophysiology of Type 2 Diabetes Mellitus (T2DM), with this review focusing on recent advancements in diabetic oral microbiology, its clinical applications, and identifying factors that may affect study interpretations. A comprehensive review across various databases, including PubMed and Google Scholar, was conducted to collate original research data published in the past five years, specifically targeting studies exploring the impact of the oral microbiome on T2DM and emphasizing research that employs microbiomic approaches in clinical patient populations. The findings delineate the intricate interplay between T2DM and oral microbiome dysbiosis, highlighting significant microbial shifts following periodontal and antidiabetic treatments, and pointing to the complexity of the relationship between oral health and systemic disease. The observed oral microbial shifts in T2DM underscore the critical need for standardized research methodologies in microbiomic studies, suggesting that by adopting a unified approach, future research can more effectively elucidate the oral microbiome's role in T2DM. This could pave the way for innovative diagnostic and therapeutic strategies in managing T2DM and its oral health complications, thus making a pertinent overview of the work within the field.

Exploring the obstacles affecting the oral health of adolescents with intellectual disabilities: insights from maternal perspectives-a qualitative study

BACKGROUND

Oral health plays a critical role in overall well-being, particularly among adolescents, including those with intellectual disabilities. Caregivers, particularly mothers, play an essential role in guiding and supporting these adolescents in maintaining good oral health. This study examined the oral health problems and challenges faced by children with intellectual disabilities from the perspective of their mothers.

METHODS

Semi-structured interviews were conducted with 22 mothers of intellectually disabled adolescents aged 12-18 years in Pondicherry, India. A purposive sampling method was employed to gather information-rich insights from a diverse group of mothers. The interviews were guided by an interview protocol that included open-ended questions about the challenges in maintaining oral health, experiences with dental care providers, and perceived need for support. Thematic analysis was conducted to identify and interpret key themes.

RESULTS

The study identified six key themes affecting the oral health of adolescents with intellectual disabilities from maternal perspectives: physical and behavior challenges, limited access to specialized dental care, financial constraints, lack of professional support and education, emotional and psychological impact on mothers, and social stigma and isolation.

CONCLUSION

The identified themes highlight the need for comprehensive and multifaceted interventions to address the physical, logistical, financial, educational, and emotional challenges. By understanding and addressing these barriers, healthcare providers, policymakers, and support organizations can improve oral health outcomes and the overall quality of life for adolescents with intellectual disabilities and their families.

Factors influencing utilization of healthcare services for internal migrant older adults in Xuzhou, China: based on Anderson's model

Background

As population migration increases and the aging process accelerates, the number of migrant older adults is growing significantly. This trend presents a substantial challenge to urban health services in regions experiencing an influx of older adults individuals. Consequently, examining the healthcare service utilization of the migrant older adults population is crucial to promote healthy aging.

Methods

A multi-stage random sampling method was employed to select a study population of 568 migrant older adults individuals, aged 60 years and above, residing in urban Xuzhou City. Multivariate logistic regression analysis, based on Anderson's model, was conducted to explore the factors influencing outpatient and inpatient health service utilization among this population.

Results

Among the 568 migrants, 73 (12.9%) had received outpatient services within the past 2 weeks, while 109 (19.2%) had received inpatient services within the past year. Migrant older adults with education level, time to health centers, and self-assessed health status negatively influenced the outpatient services utilization among migrant older adults. Possession of pension insurance, convenience to visit, sick for the past 2 weeks, and health services need positively influenced the outpatient services utilization among migrant older adults. Furthermore, age, possession of pension insurance and health insurance, convenience to visit, number of chronic diseases, sick for the past 2 weeks, and healthcare service need positively influenced inpatient service utilization among migrant older adults. Education level, self-assessed health status, and time to health centers negatively influenced the inpatient services utilization among migrant older adults.

Conclusion

The overall utilization of healthcare services by migrant older adults in Xuzhou remains inadequate. Addressing this issue requires enhanced medical policy support and assistance, stronger health education initiatives, and improved social integration for the older adults. Additionally, efforts should be made to reduce their financial burdens and improve the accessibility of healthcare services.

The unrevealed links: periodontal health, human milk composition, and infant gut microbiome dynamics

AIM

This review aims to identify the mechanistic relationships related to periodontal diseases and its possible association with changes in human milk composition and the composition and function of infants' gut microbiome.

BACKGROUND

Maternal health conditions, especially inflammatory, are associated with altered human milk composition. It is not known whether maternal oral inflammatory diseases, including periodontal diseases, deleteriously affect human milk composition.

METHODS

A narrative review was conducted according to SANRA, the Scale for the Assessment of Narrative Review Articles, guidelines. PubMed, Google Scholar, and Cochrane database of systematic reviews were searched from September 2019 up to December 2023 using keywords such as breast/human milk, maternal health/infections, and periodontal diseases. Reference lists of relevant articles were also screened. Our primary outcome of interest was human milk composition (i.e., any changes in macronutrients, immunological components, etc.). Secondary outcomes included changes in human milk microbiome and subsequent changes in the infant gut microbiome. Outcomes were synthesized using a narrative approach where the existing evidence and current literature were summarized. No risk of bias assessment of the studies was performed in this review.

FINDINGS

The search yielded no studies investigating the relationship between periodontal diseases in nursing mothers and changes in human milk composition. However, a dose-response relationship exists between the severity of periodontal diseases and the risk of adverse pregnancy outcomes such as preterm birth. Mastitis and diabetes affected milk lipids. Immunoglobulin A (sIgA) was increased in mastitis, whereas reduced concentrations were reported in diabetes. Potential biological pathways through which periodontal diseases can negatively affect human milk composition include the systemic dissemination of inflammatory cytokines like IL-6, PGE2, and tumor necrosis factor (TNF)-β that can be up-regulated by bacterial by-products. This biological plausibility needs to be investigated, given the potentially negative impact on the quality of human milk that could be caused by periodontal inflammation.

Periodontal diseases in Africa

Periodontal diseases, a group of complex conditions marked by an excessive immune response and periodontal tissue destruction, are a global health concern. Since 1990, the incidence of these diseases has doubled, with Western sub-Saharan Africa experiencing the highest burden. Accurate diagnosis and case identification are crucial for understanding the etiology, features of disease, research, treatment and prevention. Modern perspectives on periodontal disease classification are based on commonality among those affected. However, current literature is often plagued by methodological inconsistencies and focused on disease mechanisms in European populations. Health inequalities in low- and middle-income countries (LMICs) are exacerbated by these challenges, with sub-Saharan Africa, and Nigeria specifically, facing unique difficulties such as clinical personnel shortages and limited research infrastructure. This review explored disparities in periodontal disease research, care and outcomes in African populations. We highlighted these disparities and identified the factors contributing to inequities in periodontal health outcomes. We further demonstrated the critical need for inclusive and equitable healthcare and research practices tailored to the unique challenges faced by diverse populations and regions with limited resources. Addressing these disparities is essential for ensuring that advancements in healthcare are accessible to all, thereby improving global oral health and general health.

Oral health status of 916 children in Tibetan settlement (Bylakuppe, India): A cross-sectional descriptive study

BACKGROUND

Dietary and oral hygiene habits among integrated migrant cultural minorities can vary and could impact susceptibility to caries.

AIM

This study aimed to assess and compare the oral health status of Tibetan schoolchildren living in the Tibetan settlement of Bylakuppe, India, stratified by type of residence.

DESIGN

A descriptive cross-sectional study was conducted among Tibetan schoolchildren attending nine schools in the Bylakuppe region.

RESULTS

The study population consisted of 916 children aged 5-17: 702 (76.6%) living in secular houses (LSH) and 214 (23.4%) living in monasteries (LM). The prevalence of dental caries was 70.9%, and the mean value of decayed, missing, filled teeth for mixed and primary dentition (DMFT*; dmft) of LSH children (1.56 ± 2.34/1.74 ± 2.66) was higher than of LM ones (1.14 ± 2.34/0.83 ± 2.80; p < .001). DMFT for LM children (1.46 ± 2.04) was slightly higher than for LSH children (1.38 ± 1.96; p > .05). Among the sample, 99.1% had a good simplified Oral Hygiene Index (OHI) and LM children showed higher rates of good values (99.5% vs. 98.2% in LSH children). Most children needed preventive/routine dental treatment, whereas 16.6% needed urgent dental treatment. In 4.5% of children, oral mucosal lesions were present.

CONCLUSION

This study confirms the high need for dental treatment in the children of the Tibetan settlement investigated.

Knowledge About Food Insecurity Among Dental Practitioners: Preliminary Findings From the National Dental Practice-Based Research Network

Food insecurity is a household-level economic and social condition characterized by limited access to nutritious food. This study explored dental practitioners' views on food insecurity screening and its impact on oral health. A five-question survey ("Quick Poll") was conducted through the National Dental Practice-Based Research Network (PBRN) in the United States. A total of 332 dental practitioners responded. Preferences for food insecurity screening in dental practice settings showed substantial variability: 30% in favor, 39% neutral, and 29% against. When identifying the primary oral health issue influenced by food insecurity, 68% pinpointed dental caries. Over half (53%) expressed comfort in directing patients experiencing food insecurity to relevant resources. Notably, 61% of respondents expressed interest in being involved in future food insecurity clinical studies. This preliminary study underscores the relevance of food insecurity in the professional dental setting and suggests that the clinical setting may be well suited for educational programs designed to improve the oral health of patients experiencing food insecurity. Future research may achieve this goal, including a PBRN clinical study of interventions to improve oral health among patients experiencing food insecurity.

Predictors of oral healthcare utilization and satisfaction among Indian migrants and the host population in the Netherlands

BACKGROUND

The aim of this study was to explore predictors associated with reasons for visiting an oral healthcare professional (OHP) and satisfaction with OHPs in the Netherlands among the Indian migrants and the host population.

METHODS

A random sample was obtained for this cross-sectional questionnaire study. Variables were classified according to the Andersen Behavioural Model of Health Services Utilization. Multivariable binary logistic regression analysis was conducted to identify significant predictors for reasons for visiting an oral healthcare professional (OHP) (routine checkups and preventive care or visiting only for pain and/or treatment) and satisfaction with OHPs (satisfied or dissatisfied).

RESULTS

The sample consisted of 391 participants (Indian migrants = 147 and host population = 244). Indian migrants with higher internal locus of control (LoC) [OR = 7.73 (95% CI: 2.13;27.99)], more trust in OHPs [OR = 4.12 (95% CI:1.68;10.14)] and higher integration level [OR = 1.09 (95% CI:1.03;1.17)] had higher odds of visiting an OHP for routine checkups and preventive care. In the host population, having dental insurance [OR = 2.64 (95% CI:1.00;6.95)] was significantly associated with increased odds of visiting an OHP for routine checkups and preventive care. For satisfaction, Indians with low paid jobs [OR = 16.26 (95% CI:2.83;93.36)] and those with higher integration levels [OR = 1.29 (95% CI:1.16;1.42)] had higher odds of being satisfied with the Dutch OHPs. Among the host population, those with more trust in OHPs [OR = 2.86 (95% CI:1.19;6.88)] had higher odds of being satisfied.

CONCLUSION

Our study emphasize that integration levels and trust emerged as two crucial factors, policy makers can leverage upon to improve access to care for Indian migrants.

CLINICAL TRIAL

N.A as this is a survey based cross sectional study.

Association of self-reported periodontal disease and inequities with long haul COVID-19

In 2000, the Surgeon General's report highlighted that the mouth is a mirror for overall health of an individual and that disparities in oral health are directly proportionate to general health inequities. Among patients hospitalized due to COVID-19, diabetes and cardiovascular disease are the most common comorbidities; several studies support the association of these conditions with periodontal disease. This study's main aim is to assess the disproportionate impact of the COVID-19 pandemic on populations from lower socioeconomic statuses. The study also aims to assess the association of self-reported periodontal disease with COVID-19 disease course and severity. A sample population of Indiana residents with positive diagnosis of SARS-CoV-2 were recruited. A validated survey tool was sent to this cohort inquiring about sociodemographic distribution; co-morbid conditions, current symptoms of "long haul COVID," course of their COVID-19 infection; history of periodontal disease, existing periodontal disease symptoms, and oral hygiene habits. 209 individuals with a history of positive COVID test were returned to the survey, and association of participant characteristics and periodontal disease-related survey items with COVID-related survey items were evaluated using chi-square tests. Lower sense of smell ratings was associated with less education (p = 0.021), being unemployed/disabled (p = 0.008), worse health status (p<0.001), more frequent bleeding gums (p = 0.031), more frequent toothache (p<0.001), lower oral health rating (p = 0.002), and vaccine status (p = 0.011). Lower sense of taste ratings were associated with older age (p = 0.018), worse health (p<0.001), more frequent bleeding gums (p<0.001), more frequent mobile or loose tooth (p = 0.010), presence of gum disease (p<0.001), more frequent loss of teeth (p = 0.013), more frequent toothache (p<0.001), worse oral health (p = 0.001), teeth lost due to gum disease (p = 0.006), and vaccine status (p = 0.001). History of hospitalization due to COVID-19 was found to be associated with a history of gum disease within the past 12 months.

Delivery of Oral Health Services at Medical Visits through 3 Medical Dental Integration Models

INTRODUCTION

The Rocky Mountain Network of Oral Health is 1 of 3 regional projects funded by the Health Resources and Services Administration (2019 to 2024) focusing on caries prevention through medical-dental integration (MDI) in community health centers (CHCs). MDI models included provision of preventive oral health services (POHS) at medical visits by the medical team (model 1), by integrated dental hygienists (DHs; model 2), or a hybrid of these models (model 3). The overarching aim is to evaluate the effectiveness of these models on 3 objectives: (1) ≥50% receive POHS, (2) ≥75% with high caries risk receives dental referral, and (3) ≥30% of parents/caregivers set an oral health goal for the child.

METHODS

Primary care association practice facilitators (PFs) recruited 22 CHCs to participate from Arizona, Colorado, Montana, and Wyoming. CHCs completed oral health needs assessments prior to participating. PFs coached CHCs using an MDI change package. CHCs submitted monthly and 6-mo, aggregated, deidentified population metrics for children aged 0 to 40 mo receiving well-child care visits. Monthly CHC-specific reports were used by PFs with teams in continuous quality improvement activities. POHS delivery trends over time were assessed using a linear mixed model, adjusting for number of eligible patients during each 6-mo reporting period.

RESULTS

Participating CHCs were urban (55%), rural (36%), and frontier (8%). Twelve (55%) had co-located dental clinics. Ten CHCs implemented model 1, 5 implemented model 2, and 7 implemented model 3. From September 2020 to August 2023, CHCs reported providing 91,604 POHS to eligible children. After adjustment, there was significant improvement over time for all objectives: objective 1: F(5, 90) = 4.66, P = 0.0008; objective 2: F(5, 90) = 2.99, P = 0.0151; objective 3: F(5, 90) = 4.56, P = 0.0009.

CONCLUSIONS

The implementation of 3 MDI models across 22 CHCs in 4 states resulted in a meaningful increase in POHS delivery. POHS delivery by both medical and embedded DHs was associated with the most substantial increase in POHS delivery.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by medical and dental providers when deciding which approach they wish to use when planning the delivery of preventive oral health services at medical visits.

Toward a Comprehensive Model of Medical-Dental-Behavioral Integration

INTRODUCTION

Existing models of medical-dental integration, as well as those from behavioral health care integrated with primary medical treatment, provide a basis for a truly synthesized and expanded model incorporating medical, dental, and behavioral components. Such a comprehensive model allows for collaborative health care serving patients seamlessly without disciplinary silos, promoting optimal whole-person health. This innovative approach is consistent with recent developments in the behavioral and social oral health sciences that include an imperative for their full inclusion in dental health care, research, and education.

METHODS

Existing models of medical-dental integration are described, along with current models from integrated primary medical and behavioral health care. Using these existing approaches as a basis, a new multilevel model is proposed to include social and cultural determinants of health.

RESULTS

Contemporary approaches to providing health care across disciplines include referral to a geographically separate entity, co-location of services, and integrated, side-by-side care. Integration of electronic health records and interoperability are necessary (but not sufficient) factors that affect transdisciplinary health care. Effective communication among health care providers and the need for interprofessional education, comprehensive training, and ongoing cross-disciplinary consultation also are noted as crucial factors in truly collaborative care. Evidence for existing models varies greatly depending on the target population and type of services provided.

CONCLUSIONS

A fully integrated, transdisciplinary model of health care is possible, theoretically and practically. Combining aspects of extant integrated models and extending them provides opportunity for a greater focus on systemic factors and more emphasis on prevention. Consistent with this new model, medical and dental home concepts can be expanded to that of a person-centered health care home that includes interprofessional practice. This transdisciplinary approach contributes to greater health equity given the multilevel approach. Multidirectional integration of diverse disciplines representing the various realms of medicine, dentistry, and behavioral health care is essential for optimal health of all.

KNOWLEDGE TRANSFER STATEMENT

This article can be used by clinicians, scientists, administrators, and policy makers in developing and implementing integrated systems of care that provide for patients' medical, dental, and behavioral health needs.

History in context: teaching the history of dentistry with rare materials

Background

History and health humanities instruction offers a framework for professional students to examine the arc and development of their profession as well as develop cultural competencies. Exploring ideas, themes, and health care practices and approaches through historical instruction can show students how culture influences health care and practice, therefore providing a context for further development of cultural competence skills.

Case Presentation

This case report describes a collaboration among a dentistry course instructor, a liaison librarian, and curators of a rare book collection. Working together, this team offers an active learning class that examines the historical arc of the dental profession. We aim to have students use primary source materials to examine the experiences, research, and narratives of their profession.

Discussion

Using a World Cafe with thematic tables allows students to safely examine rare materials and artifacts and have meaningful conversations about themes that are critical to dentistry's past, present, and future. Students reported that engaging with artifacts and historical materials provided a different way to understand history and enhanced their learning experience. Engaging students in this work builds critical thinking skills that are essential to evidence-based practice.

Suboptimal Oral Health, Multimorbidity, and Access to Dental Care

INTRODUCTION

Emerging studies on the links between suboptimal oral health and multimorbidity (MM), or the co-existence of multiple chronic conditions, have raised controversy as to whether enhancing access to dental care may mitigate MM in those with suboptimal oral health. In this study, we aim to assess the extent of the association between suboptimal oral health and MM and whether access to dental care can modify this association.

METHODS

We conducted a cross-sectional analysis using data from the Canadian Longitudinal Study on Aging (CLSA) (N = 44,815, 45 to 84 y old). Edentulism, self-reported oral health (SROH), and other oral health problems (e.g., toothache, bleeding gums) were used as indicators of suboptimal oral health. MM was defined according to the Public Health Agency of Canada as having 2 or more of the following chronic conditions: cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. For robustness, we also used a cutoff of having 3 or more of these chronic conditions. Variables for access to dental care included (1) dental visits within the past year, (2) availability of dental insurance, and (3) cost barriers to dental care. We constructed robust Poisson regression models to estimate the association between suboptimal oral health and MM and then assessed the effect measure modification by indicators of access to dental care on a multiplicative scale. We also calculated the relative excess risk due to interaction for prevalence ratio (PR) on an additive scale.

RESULTS

Indicators of suboptimal oral health were significantly associated with MM (edentulism PR 1.17, 95% confidence interval [CI] 1.08, 1.27; poor SROH PR 1.44, 95% CI 1.33, 1.54; other oral health problems PR 1.52, 95% CI 1.44, 1.78). The magnitude of this association was higher in individuals who reported fewer dental visits within the past year, lacked dental insurance, and avoided dental care due to costs.

CONCLUSION

The association between suboptimal oral health and MM may be exacerbated by barriers to accessing dental care. Policies aiming to enhance access to dental care may help mitigate MM in middle-aged and older Canadians with suboptimal oral health.

KNOWLEDGE TRANSFER STATEMENT

This study offers insights into the connection among suboptimal oral health, multimorbidity, and access to dental care factors in middle-aged and older Canadians. The findings can be of value for clinicians and policy makers aiming to enhance medical-dental integration and improve accessibility to dental care and to patients seeking information about the connections between oral health and chronic conditions. Implementation has the potential to enhance individual well-being and drive systemic improvements in health care.

Balancing the Oral-Gut-Brain Axis with Diet

Background: The oral microbiota is the second largest microbial community in humans. It contributes considerably to microbial diversity and health effects, much like the gut microbiota. Despite physical and chemical barriers separating the oral cavity from the gastrointestinal tract, bidirectional microbial transmission occurs between the two regions, influencing overall host health. Method: This review explores the intricate interplay of the oral-gut-brain axis, highlighting the pivotal role of the oral microbiota in systemic health and ageing, and how it can be influenced by diet. Results: Recent research suggests a relationship between oral diseases, such as periodontitis, and gastrointestinal problems, highlighting the broader significance of the oral-gut axis in systemic diseases, as well as the oral-gut-brain axis in neurological disorders and mental health. Diet influences microbial diversity in the oral cavity and the gut. While certain diets/dietary components improve both gut and oral health, others, such as fermentable carbohydrates, can promote oral pathogens while boosting gut health. Conclusions: Understanding these dynamics is key for promoting a healthy oral-gut-brain axis through dietary interventions that support microbial diversity and mitigate age-related health risks.

Multifactorial Contributors to the Longevity of Dental Restorations: An Integrated Review of Related Factors

PURPOSE

This integrated review aims to identify and analyze the multifactorial contributors to the longevity of direct restorations, focusing on tooth-, patient-, and dentist-related factors.

MATERIALS AND METHODS

A search of the literature was performed using an electronic database, PubMed/Medline, Web of Science, and Scopus, on papers published between 1980 and 2024. The titles and abstracts of papers that evaluated aspects categorized into tooth-related, patient-related, and dentist-related factors influencing restoration failure were selected and screened. Full-text assessments were conducted, and the extracted data were compiled, summarized, and synthesized. The reference lists of the collected papers were also screened, and relevant citations were included in this review. Data were gathered from clinical and laboratorial studies, systematic reviews, and meta-analyses to provide a comprehensive understanding of restoration longevity.

RESULTS

Among the tooth-related factors, multiple-surface restorations, deep margins, tooth location, and tooth vitality significantly impact restoration survival. Patient-related factors such as medical conditions, risk predictors of caries, age, sex, parafunctional habits, smoking, periodontal health, number of restorations, and socioeconomic status all play crucial roles. Regarding dentist-related factors, the decision-making process, age, experience, and dentist manual dexterity are vital aspects. Furthermore, the technique used, including isolation methods for moisture control, as well as the type of dental practice (large group vs. small practice), notably influenced the restoration survival.

CONCLUSIONS

The longevity of dental restorations is influenced by a complex interplay of tooth-related, patient-related, and dentist-related factors. Strategies to improve restoration outcomes should consider all these multifactorial contributors. Continuing professional education, diligent patient guidance on the factors that influence restoration survival, careful material selection and restorative technique, and tailored individual treatment are crucial factors to reduce failure rates and improve the lifespan of restorations.

Assessing Oral Health Content in Non-dental Professional Association Websites in India: A Cross-Sectional Study

INTRODUCTION

There is a growing need for inter-professional education (IPE) to reduce the burden of oral diseases and address oral health disparities. Professional websites associated with inter-professional education can serve as a reliable source of information about oral health. Hence, the study was conducted to determine the prevalence of oral health content on non-dental health professional associations' websites in India.

METHODS

Eighty-nine organizations were selected from five types of health professional associations. Six dental search terms were used on searchable websites. The keywords were dental, oral, dentistry, mouth, teeth, and fluoride. Websites were assessed for any oral health content.

RESULTS

Only four websites (4.5%) had any oral health content, and all four were physician-related.

CONCLUSION

The study highlights the limited and inconsistent oral health content on non-dental professional association websites. Improving the availability, accuracy, and comprehensiveness of oral health information on these platforms is crucial to enhancing oral health literacy and promoting better oral health outcomes.

Educating long-term care staff on older adult oral health: Maine's oral team-based initiative vital access to education (MOTIVATE) program

INTRODUCTION

The oral health status of older adults in the United States is a public health crisis and a silent epidemic. Maine's Oral Team-Based Initiative Vital Access to Education (MOTIVATE) Program is an innovative interprofessional oral health program aimed at enhancing oral health education and practice of interprofessional health care teams in nursing homes. Using a blended learning model, a combination of in-person and online learning, this program provides a foundation from which to implement evidenced based oral care in nursing homes.

METHODS

Learning outcomes were assessed via a three-part timed series survey. A set of self-report assessment items measured skills implemented at baseline and post-training.

RESULTS

Learning domain scores increased over time from baseline to post-training. Confidence in providing oral healthcare and role clarity in providing oral health care improved over time. Staff identified using new skills in daily oral care and communication across the interprofessional team.

DISCUSSION

The MOTIVATE program is an effective collaborative-based model for developing oral health competencies and promoting evidence-based oral health care in nursing homes.

Appropriateness of antimicrobial prescribing for oral and dental conditions in Australian hospitals: 2013 to 2022

OBJECTIVES

Dentists manage a variety of oral infections in clinical practice. Inappropriate antimicrobial prescribing by dentists occurs frequently and antimicrobial stewardship strategies should include dentistry. The aim of this retrospective analysis of the Australian Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) dataset, was to describe the types of oral and dental indications where antimicrobials were prescribed, and assess the guideline compliance and appropriateness of the antimicrobials in Australian hospitals.

METHODS

Data from the Hospital NAPS was extracted for oral and dental indications from 2013 to 2022. The types of oral and dental indications presented, and the corresponding antimicrobials prescribed were assessed for compliance according to national prescribing guidelines, and appropriateness according to the NAPS structured algorithm.

RESULTS

A total of 8,001 prescriptions for 7,477 patients were identified, from 433 hospitals. Antifungal, antibiotic and antiviral agents accounted for 84.5 %, 15.4 % and 0.03 % of prescriptions respectively. A greater proportion of antibiotics were prescribed in regional and rural areas compared to antifungals. The prescriptions assessed as compliant were 80.0 % and 44.7 % of antifungals and antibiotics respectively. Prescriptions assessed as appropriate were 84.4 % of antifungals, and 65.3 % of antibiotic prescriptions.

CONCLUSIONS

A wide variety of antimicrobials were used with moderate levels of compliance and appropriateness. Future interventions should include targeted education, utilisation of prescribing guidelines, and tools to diagnose and manage oral and dental conditions. Consideration can be given to adjustment of the Hospital NAPS tool to cater for oral conditions and include the provision of dental treatment in the management of these infections.

CLINICAL SIGNIFICANCE

A wide variety of oral and dental conditions are presented in Australian hospital settings, managed by a range of antibiotics and antifungals, with moderate levels of compliance to guidelines and appropriateness. Antimicrobial stewardship strategies should target and support dentistry in hospital settings.

Precision Medicine for Apical Lesions and Peri-Endo Combined Lesions Based on Transfer Learning Using Periapical Radiographs

An apical lesion is caused by bacteria invading the tooth apex through caries. Periodontal disease is caused by plaque accumulation. Peri-endo combined lesions include both diseases and significantly affect dental prognosis. The lack of clear symptoms in the early stages of onset makes diagnosis challenging, and delayed treatment can lead to the spread of symptoms. Early infection detection is crucial for preventing complications. PAs used as the database were provided by Chang Gung Memorial Medical Center, Taoyuan, Taiwan, with permission from the Institutional Review Board (IRB): 02002030B0. The tooth apex image enhancement method is a new technology in PA detection. This image enhancement method is used with convolutional neural networks (CNN) to classify apical lesions, peri-endo combined lesions, and asymptomatic cases, and to compare with You Only Look Once-v8-Oriented Bounding Box (YOLOv8-OBB) disease detection results. The contributions lie in the utilization of database augmentation and adaptive histogram equalization on individual tooth images, achieving the highest comprehensive validation accuracy of 95.23% with the ConvNextv2 model. Furthermore, the CNN outperformed YOLOv8 in identifying apical lesions, achieving an F1-Score of 92.45%. For the classification of peri-endo combined lesions, CNN attained the highest F1-Score of 96.49%, whereas YOLOv8 scored 88.49%.

Effects of online marketplace-sourced over-the-counter tooth whitening products on the colour, microhardness, and surface topography of enamel: an in vitro study

OBJECTIVES

This study compared the whitening effect, microhardness, and enamel surface alterations of over-the-counter (OTC) tooth bleaching products with those of a dentist-prescribed at-home bleaching agent.

MATERIALS AND METHODS

The products available on a popular online marketplace were comprehensively searched and then rated using a specific formula. The effects of the lowest-rated OTC agent (LRA) and the highest-rated OTC agent (HRA) were compared with those of a dentist-prescribed bleaching agent (DPA) on the enamel of extracted human teeth. The bleaching efficacy, post-bleaching microhardness changes, and morphological alterations were assessed by spectrophotometric analysis, Vickers hardness testing, and scanning electron microscopy (SEM) respectively. Statistical analyses included one-way ANOVA and post hoc tests, maintaining a significance level of P < 0.05.

RESULTS

The search of the online marketplace revealed 15 products. The LRA (Teeth Whitening Serum Gel, GEN, China) and the HRA (Bright White-Lovely Smile Premium Teeth Whitening strips, Ray of Smile, USA) were identified on the basis of their ranking. DPA resulted in significantly better tooth whitening than did LRA. The enamel microhardness was lower in the LRA treatment group (14.2%) than in the control and HRA treatment groups (8.84% and 7.26%, respectively). LRA also caused severe topographical alterations to the enamel.

CONCLUSION

Compared with the poorly rated product, the dentist-prescribed tooth bleaching product resulted in greater colour improvement, less microhardness reduction, and surface changes. The highest-rated product was comparable with the dentist-prescribed agent in this study.

Dietary inflammatory index and type 2 diabetes in US women: a cross-sectional analysis of the National Health and Nutrition Examination Survey, 2007-2018

Objective

Type 2 diabetes (T2D) is a major public health concern in the United States and worldwide. The dietary inflammatory index (DII) is a useful tool for assessing dietary inflammation. Although much research links the DII to diabetes, little is known about the relationship in adult women with a reproductive history in the United States. We aimed to investigate how the relationship between the DII and T2D varies among different subgroups of American women.

Methods

Secondary data from the National Health and Nutrition Examination Survey from 2007 to 2018 were analyzed. Cross-sectional analysis of 8,394 American women aged 20 years or older who had at least one live birth. The main outcome was the diagnosis of T2D. Multivariate survey-weighted regression was used to determine the odds ratio (OR) and 95% confidence interval (95%CI) for the association between DII and T2D. A weighted restricted cubic spline (RCS) model was constructed to establish OR curves at three knots to examine the dose-response association between DII and T2D. Additionally, a weighted subgroup analysis was performed in a fully adjusted model to verify that the association was robust.

Results

The study main found a significant association between the DII and T2D (OR = 1.19, 95%CI: 1.12, 1.26, p < 0.001). Participants in the highest third of DII scores had a 56% increased risk of T2D (OR = 1.56, 95%CI: 1.16, 2.10; p for trend = 0.003) compared with those in the lowest third of DII scores, after adjusting for all covariates. The multivariable RCS demonstrated a linear association between DII and T2D (p = 0.892). The subsidiary found that subgroup analyses revealed a significant variation in the association between DII and T2D according to obesity, oral health, and poverty-income ratio (PIR) status. Among non-obese women, the OR was 1.22 (95%CI: 1.08, 1.37); among women with good oral health, the OR was 1.17 (95%CI: 1.07, 1.28); among women with low PIR, the OR was 1.17 (95%CI: 1.05, 1.30); and among women with high PIR, the OR was 1.26 (95% CI: 1.07, 1.48).

Conclusion

Our findings suggest that there is a significant association between DII and T2D and that oral health, obesity, and PIR status may influence the relationship between DII and T2D risk. Further studies are warranted to validate our results and evaluate whether the results are similar in other populations.

Utilization of Dental Care and Oral Health Outcomes in the United States: Results from the National Health and Nutrition Examination Survey (2017-2020)

PURPOSE

This analysis aims to evaluate the association between the time since and reason for a patient's last dental appointment across clinical oral health outcomes.

MATERIALS AND METHODS

We used data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally-representative survey of noninstitutionalized US adults. The predictors were the time since and the reason for the last dental appointment (routine vs. urgent). We examined the presence and number of missing teeth and teeth with untreated coronal and root caries. Multivariable regression models with interaction were used to assess the association between the time since the last dental appointment and clinical oral health outcomes among routine and urgent users separately.

RESULTS

Two-thirds of the US population had a dental appointment within a year, while nearly 44 million individuals did not visit a dentist for the last three years. The odds of having teeth with untreated coronal or root caries increased with the length of time since the last appointment, and urgent users had worse dental outcomes compared to routine users. Compared to those who had a dental appointment within a year, individuals who had their last dental appointment more than 3 years ago had 2.94 times the average number of teeth with untreated caries among routine users (95%CI=2.39, 3.62) and 1.60 times the average among urgent users (95%CI=1.05, 2.43).

CONCLUSIONS

Recent, routine dental appointments are associated with improved oral health outcomes. The outcomes reiterate how social determinants of health impact access to oral health care and oral health outcomes.

Pressing issues for oral care quality improvement: findings from the EU DELIVER project

BACKGROUND

While oral health often takes a backseat to other health domains, it silently affects nearly half of the Worldwide population. The DELIVER project, funded by the EU's Horizon Europe program, seeks to develop a blueprint model for improving the quality of oral health care for everyone.

METHODS

Applying the Nominal Group Technique (NGT), 17 stakeholders from various backgrounds participated in identifying pressing issues for oral care quality improvement across practice, community, and policy levels.

RESULTS

The results revealed significant differences at the different levels, with accessibility emerging as a prominent issue, encompassing affordability, availability, and acceptability of oral healthcare services.

CONCLUSIONS

These findings emphasizes the need for policy reforms, increased investments, and a shift towards preventive and patient-centered dental care practices. It highlights the importance of collaborative efforts with multi-stakeholders and prioritizing pressing issues on a multi-level to drive positive change in improving oral care quality.

Advances in hybridized nanoarchitectures for improved oro-dental health

On a global note, oral health plays a critical role in improving the overall human health. In this vein, dental-related issues with dentin exposure often facilitate the risk of developing various oral-related diseases in gums and teeth. Several oral-based ailments include gums-associated (gingivitis or periodontitis), tooth-based (dental caries, root infection, enamel erosion, and edentulous or total tooth loss), as well as miscellaneous diseases in the buccal or oral cavity (bad breath, mouth sores, and oral cancer). Although established conventional treatment modalities have been available to improve oral health, these therapeutic options suffer from several limitations, such as fail to eradicate bacterial biofilms, deprived regeneration of dental pulp cells, and poor remineralization of teeth, resulting in dental emergencies. To this end, the advent of nanotechnology has resulted in the development of various innovative nanoarchitectured composites from diverse sources. This review presents a comprehensive overview of different nanoarchitectured composites for improving overall oral health. Initially, we emphasize various oral-related diseases, providing detailed pathological circumstances and their effects on human health along with deficiencies of the conventional therapeutic modalities. Further, the importance of various nanostructured components is emphasized, highlighting their predominant actions in solving crucial dental issues, such as anti-bacterial, remineralization, and tissue regeneration abilities. In addition to an emphasis on the synthesis of different nanostructures, various nano-therapeutic solutions from diverse sources are discussed, including natural (plant, animal, and marine)-based components and other synthetic (organic- and inorganic-) architectures, as well as their composites for improving oral health. Finally, we summarize the article with an interesting outlook on overcoming the challenges of translating these innovative platforms to clinics.

Pediatric Odontogenic Infections

Odontogenic infections are a broad group of head and neck conditions that arise from the teeth and surrounding periodontium. These largely preventable infections disproportionately affect members of ethnic and racial minorities and low-income/uninsured groups, and result in significant costs to our health care system. Left untreated, odontogenic infections can spread to deep spaces of the head and neck and can result in life-threatening complications. The mainstay of treatment includes timely treatment of the affected teeth. These infections are a global public health concern that could be diminished with improved access to routine dental care.

Caries indicators in relation to healthcare access and hygienic-dietary habits in Spanish preschoolers

INTRODUCTION

Dental caries continues to be a public healthcare problem due to its high prevalence and morbidity. It was proposed to evaluate caries indicators in relation to healthcare access and hygienic-dietary habits in Spanish preschoolers.

MATERIALS AND METHODS

A cross-sectional study was carried out on a random sample consisting of 343 patients ranging from 3 to 5 years of age in the primary care setting, the main measurements were: dental care access, hygienic-dietary habits, and caries registration according to WHO criteria.

RESULTS

The prevalence of caries was 35.3% and mean ± standard deviation (SD) dft was 1.51 ± 2.93. Preschoolers who had ever visited the dentist had a higher dft occurrence than those who had never attended the dentist. The lower prevalence of caries was significantly associated with the frequency of two daily brushings versus non-daily brushing (p = 0.007; 25.3% vs. 47.1%) and was 10.7% lower in patients who had the habit of night brushing (p = 0.041). The consumption of sugary liquids between meals implied a higher dft index.

CONCLUSIONS

The high prevalence of early childhood caries and the dental care access associated with poor oral health suggest the need to implement a multidisciplinary oral healthcare program that involves both healthcare and dental healthcare professionals in Primary Health Care Units without forgetting the participation of the community and local administrations.

Improving oral health screening and dental referrals for patients with diabetes in a community health clinic

BACKGROUND

Oral health screening and access to dental care in adults with diabetes lead to improved health outcomes and quality of life. Patients with barriers to accessing health services have a greater risk of poor medical and dental outcomes. People with diabetes are more likely to have periodontal disease and less likely to visit a dentist.

LOCAL PROBLEM

Oral screening and dental referrals were not being done at a community health clinic in Plano, Texas.

METHODS

The aim of this 6-month quality-improvement project was to increase oral health screenings in adults with diabetes from 0% to 80%; subaim was to increase access to dental services by increasing referrals from 0% to 50%. Adults with diabetes without insurance or dental care in the past 12 months were eligible for the project ( n = 263). Outcome measures were tracked using a longitudinal chart.

INTERVENTIONS

Eligible patients were screened and referred to a dental office with an income-based financial assistance program using Plan-Do-Study-Act methodology. Staff education, referral order set, and follow-up calls were additional processes implemented.

RESULTS

Fifty-two percent of eligible patients were screened, 35.9% were referred to dental services, and 17.7% of those referred established care with dental clinic.

CONCLUSIONS

Interventions were successful in improving access to dental care, although target goal was not met. Creating systems that facilitate interdisciplinary care improved health equity and standards of health in chronic disease.