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Wiernik E, Renuy A, Kab S, Steg PG, Goldberg M, Zins M, Caligiuri G, Bouchard P, Carra MC. Prevalence of self-reported severe periodontitis: Data from the population-based CONSTANCES cohort. J Clin Periodontol 2024; 51:884-894. [PMID: 38430050 DOI: 10.1111/jcpe.13969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Abstract
AIM To assess the prevalence of severe periodontitis based on the population-based CONSTANCES cohort using a validated self-reported questionnaire. MATERIALS AND METHODS Individuals were selected from the adult population in France using a random sampling scheme. Analyses were restricted to those invited in 2013-2014 who completed the periodontal health questionnaire at the 2017 follow-up. The risk of severe periodontitis was assessed using the periodontal screening score (PESS) and weighting coefficients were applied to provide representative results in the general French population. RESULTS The study included 19,859 participants (9204 men, mean age: 52.8 ± 12.6 years). Based on a PESS ≥ 5, 7106 participants were at risk of severe periodontitis, corresponding to a weighted prevalence of 31.6% (95% confidence interval: 30.6%-32.7%). This prevalence was higher among participants aged 55 and over, those with lower socio-economic status as well as current smokers, e-cigarette users and heavy drinkers. Among individuals at risk of severe periodontitis, only 18.8% (17.3%-20.4%) thought they had gum disease, although 50.5% (48.6%-52.5%) reported that their last dental visit was less than 6 months. CONCLUSIONS The present survey indicates that (1) self-reported severe periodontitis is highly prevalent with marked disparities between groups in the general French adult population, and (2) periodontitis could frequently be under-diagnosed given the low awareness.
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Affiliation(s)
- Emmanuel Wiernik
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
| | - Adeline Renuy
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
| | - Sofiane Kab
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
| | - Philippe Gabriel Steg
- UFR de Médecine, Université Paris-Cité, Paris, France
- Cardiology Department, AP-HP, Hôpital Bichat, Paris, France
- Laboratory for Vascular Translational Science, INSERM U1148, Paris, France
- Institut Universitaire de France, Paris, France
| | - Marcel Goldberg
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
| | - Marie Zins
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
- UFR de Médecine, Université Paris-Cité, Paris, France
| | - Giuseppina Caligiuri
- UFR de Médecine, Université Paris-Cité, Paris, France
- Cardiology Department, AP-HP, Hôpital Bichat, Paris, France
- Laboratory for Vascular Translational Science, INSERM U1148, Paris, France
| | - Philippe Bouchard
- UFR of Odontology, Université Paris Cité, Paris, France
- URP 2496, Montrouge, France
| | - Maria Clotilde Carra
- UMS 011 Population-based Cohorts Unit, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Paris, France
- UFR of Odontology, Université Paris Cité, Paris, France
- Service of Odontology, Rothschild Hospital (AP-HP) and Department of Periodontology, UFR of Odontology, Université Paris Cité, Paris, France
- INSERM-Sorbonne Paris Cité Epidemiology and Statistics Research Centre, Paris, France
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Oshima K, Miura H, Tano R, Fukuda H. Urban-rural differences in the prevalence of having a family dentist and their association with income inequality among Japanese individuals: a cross-sectional study. BMC Oral Health 2024; 24:741. [PMID: 38937717 DOI: 10.1186/s12903-024-04528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Few reported studies evaluate the status of those who have a family dentist (FD) by regional differences and the socioeconomic factors associated with this status. This study aimed to assess the prevalence of having an FD among Japanese individuals across three samples of municipality type: urban, intermediate, and rural areas, and determine the factors associated with having an FD. METHODS This was a cross-sectional study involving a web-based survey. In total, 2,429 participants (comprising men and women aged 20-69 years) were randomly selected from among the registrants of a web research company: 811 urban residents, 812 intermediate residents, and 806 rural residents. In each area, we categorized the participants into those who had an FD (FD group) and those who did not (non-FD group). A multivariate modified Poisson regression analysis was used to determine the factors associated with the FD group as compared to the non-FD group. RESULTS The proportion of the FD group was lowest in rural areas (42.3%), followed by intermediate (48.6%) and urban areas (49.7%). The regression analysis revealed a statistically significant tendency between associated factors in the two groups; that is, the higher the household income, the more likely that the family belonged to the FD group (prevalence ratio (95%CI), JPY 4-6 million: 1.43 (1.00-2.03), JPY ≥ 8 million: 1.72 (1.21-2.44)). CONCLUSIONS Rural areas have the lowest proportion of people with an FD among the three areas, and income inequality is associated with having an FD. Thus, when planning policies to encourage individuals to have an FD to manage their oral health, it is necessary to consider regional differences.
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Affiliation(s)
- Katsuo Oshima
- Department of Dental Technology, The Nippon Dental University College at Tokyo, 2-3-16 Fujimi, Chiyoda-ku, Tokyo, 102-0071, Japan.
| | - Hiroko Miura
- Division of Disease Control and Epidemiology, School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun, Hokkaido, 061-0293, Japan
| | - Rumi Tano
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako- shi, Saitama, 351-0197, Japan
| | - Hideki Fukuda
- National Institute of Public Health, 2-3-6 Minami, Wako-shi, Saitama, 351-0197, Japan
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Peterson DE, Koyfman SA, Yarom N, Lynggaard CD, Ismaila N, Forner LE, Fuller CD, Mowery YM, Murphy BA, Watson E, Yang DH, Alajbeg I, Bossi P, Fritz M, Futran ND, Gelblum DY, King E, Ruggiero S, Smith DK, Villa A, Wu JS, Saunders D. Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline. J Clin Oncol 2024; 42:1975-1996. [PMID: 38691821 DOI: 10.1200/jco.23.02750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer. METHODS The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008. RESULTS A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation. RECOMMENDATIONS Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | - Noam Yarom
- Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Charlotte Duch Lynggaard
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lone E Forner
- Department of Oral and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Yvonne M Mowery
- UPMC Hillman Cancer Center, Pittsburgh, PA
- University of Pittsburgh, Pittsburgh, PA
| | | | - Erin Watson
- Department of Dental Oncology, Princess Margaret Cancer Center/Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - David H Yang
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - Ivan Alajbeg
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Neal D Futran
- University of Washington School of Medicine, Seattle, WA
| | | | - Edward King
- Northern Colorado Head and Neck Cancer Support Group, Windsor, CO
| | - Salvatore Ruggiero
- New York Center for Orthognathic and Maxillofacial Surgery, New York, NY
| | | | | | - Jonn S Wu
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - Deborah Saunders
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Health Sciences North, Sudbury, Ontario, Canada
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Singh A, Hegde S, Silva M, Whelan M, Karahalios A, Manton DJ, Goldfeld S, English DR, Dashper S. Social inequities in early childhood caries in Australia: A population-based study on statewide public dental services data. Int J Paediatr Dent 2024. [PMID: 38816920 DOI: 10.1111/ipd.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Social disadvantage leads to dental caries during childhood. AIM This study investigated whether dental caries occur earlier in children from households experiencing social disadvantage than those not experiencing social disadvantage. DESIGN The overall risk of, and relative time to, early childhood caries (ECC) according to sociodemographic characteristics in Victoria, Australia, was quantified. Records for 134 463 children in Victoria, Australia, from 2009 to 2019 were analysed. Time ratios (TR) and hazard ratios (HR) of carious lesion(s) in early childhood were estimated. RESULTS Compared with reference groups, Indigenous children had an adjusted TR of 0.80 (95% CI: 0.78, 0.82), children from households with languages other than English had an adjusted TR of 0.83 (95% CI: 0.82, 0.84), and dependants of concession cardholders had an adjusted TR of 0.81 (95% CI: 0.80, 0.81); therefore, 20%, 17% and 19% reduced times to the first carious lesion, respectively. The estimated HRs were 1.57 (95% CI: 1.49, 1.67) for Indigenous children, 1.46 (95% CI: 1.42, 1.50) for children from households with other languages and 1.57 (CI: 1.53, 1.60) for dependants of concession cardholders. CONCLUSION Preventive oral health interventions must be targeted early in children from households experiencing social disadvantage to avoid social inequities in ECC.
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Affiliation(s)
- Ankur Singh
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Shalika Hegde
- Dental Health Services Victoria, Melbourne, Victoria, Australia
| | - Mihiri Silva
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
- Inflammatory Origins, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Dentistry, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Whelan
- Dental Health Services Victoria, Melbourne, Victoria, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David J Manton
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
- Centrum voor Tandheelkunde en Mondzorgkunde, University Medical Center Groningen, Groningen, The Netherlands
| | - Sharon Goldfeld
- Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Stuart Dashper
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
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Fukuda H, Kobori E, Miura H, Mizumoto K, Nozue M, Hazano S, Kamata K, Maeda Y. Regular dental check-up status and related factors among Thai residents in Japan. Odontology 2024:10.1007/s10266-024-00954-w. [PMID: 38805093 DOI: 10.1007/s10266-024-00954-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
The objectives of this online study were to determine the status of regular dental check-ups among Thai nationals living in Japan and to identify barriers to regular dental check-ups by comparing them with general health check-ups. We conducted the online survey twice, in 2021 and 2022, among Thai nationals aged 18 years and older living in Japan via social networking services by an organization that supports Thai nationals living in Japan. Respondents between the ages of 30 and 59 were included in this study. Independent factors included gender, age, length of stay in Japan, family economic status, confidence in Japanese and stay for work purposes. Dependent factors were regular dental check-ups and general health check-ups in the past year. Chi-square tests and multiple logistic regression analyses were used for analysis. 56.6% of respondents had regular dental check-ups. The adjusted odds ratio for the proportion of people with regular dental check-ups was significantly higher for those with high economic status, 2.15 (1.06-4.33), compared with those with low economic status. It was also significantly higher 1.88 (1.10-3.21) for those with confidence in the Japanese language compared with those without. The study suggested the need for Japanese language support in addition to financial support for dental health prevention programs for foreigners living in Japan.
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Affiliation(s)
- Hideki Fukuda
- National Institute of Public Health, 2-3-6 Minami, Wako-city, Saitama, 351-0197, Japan.
| | - Eiko Kobori
- Graduate School of Nursing, Setsunan University, 45-1 Nagaotoge-cho, Hirakata-city, Osaka, 573-0101, Japan
| | - Hiroko Miura
- Division of Disease Control and Epidemiology, School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Hokkaido, 061-0293, Japan
| | - Kaori Mizumoto
- Department of Food Management, Faculty of Nutritional Sciences, Nakamura Gakuen University, 5-7-1 Befu, Jonan-ku, Fukuoka-city, Fukuoka, 814-0198, Japan
| | - Miho Nozue
- Department of Health and Nutritional Sciences, Faculty of Health Promotional Sciences, Tokoha University, 1230 Miyakoda-cho, Hamana-ku, Hamamatsu-city, Shizuoka, 431-2102, Japan
| | - Sayaka Hazano
- Department of Health and Nutritional Science, Faculty of Human Health and Science, Matsumoto University, 2095-1 Niimura, Matsumoto-city, Nagano, 390-1295, Japan
| | - Kanami Kamata
- Graduate School of Nursing, Setsunan University, 45-1 Nagaotoge-cho, Hirakata-city, Osaka, 573-0101, Japan
| | - Yuko Maeda
- Institute for Liberal Arts and Sciences, Kyoto University, Yoshida-Nihonmatsu-cho, Sakyo-ku, Kyoto, 606-8316, Japan
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Karam SA, Schuch HS, Demarco FF, Horta BL, Borrell LN, Celeste RK, Correa MB. Differential effect of social mobility on tooth loss by race in adulthood: 1982 Pelotas Birth Cohort Study. Community Dent Oral Epidemiol 2024. [PMID: 38778564 DOI: 10.1111/cdoe.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/20/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To examine the association between social mobility and tooth loss in adults from the 1982 Pelotas Birth Cohort Study and whether race modifies this association. METHODS The Oral Health Study used data from 541 individuals who were followed up to 31 years of age. Social mobility, composed of the participants' socioeconomic position (SEP) at birth and at age 30, was categorized as never poor, upwardly mobile, downwardly mobile and always poor. The outcome was the prevalence of at least one tooth lost due to dental caries when the participants were examined at 31 years of age. The effect modifier was race (Black/Brown versus white people). Log-binomial regression models were used to estimate crude and sex-adjusted prevalence ratios (PR) and to determine whether the association varied with race. Statistical interactions were tested using an additive scale. RESULTS The prevalence of any tooth loss was 50.8% (n = 274). In social mobility groups, the prevalence of at least one tooth lost in the never-poor group was about 31% points higher for Black/Brown (68.2%) than for white people (37.4%). Antagonistic findings were found for the interaction between race and social mobility (Sinergy Index = 0.48; 95% CI 0.24, 0.99; and relative excess of risk due to the interaction = -1.38; 95% CI -2.34, -0.42), suggesting that the observed joint effect of race and social mobility on tooth loss was lower than the expected sum of these factors. The estimates for Black/Brown people were smaller for those who were always poor during their lives, relative to their white counterparts. CONCLUSIONS The findings suggest a higher prevalence of at least one tooth lost among people in the downward mobile SEP group and Black/Brown people. Greater racial inequity was found among Black/Brown people who had never experienced episodes of poverty, with Black/Brown people having a greater prevalence of at least one tooth lost than their white counterparts.
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Affiliation(s)
- Sarah Arangurem Karam
- Graduate Program in Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
- Professional Master's in Health in the Life Cycle, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York, USA
| | - Roger Keller Celeste
- Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Abdelrehim M, Singhal S. Is private insurance enough to address barriers to accessing dental care? Findings from a Canadian population-based study. BMC Oral Health 2024; 24:503. [PMID: 38685013 PMCID: PMC11057150 DOI: 10.1186/s12903-024-04271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND In Canada, as in many other countries, private dental insurance addresses financial barriers to a great extent thereby facilitating access to dental care. That said, insurance does not guarantee affordability, as there are issues with the quality and level of coverage of insurance plans. As such, individuals facing barriers to dental care experience poorer oral health. Therefore, it is important to examine more keenly the socio-demographic attributes of people with private insurance to particularly identify those, who despite having insurance, face challenges in accessing dental care and experience poorer oral health. METHODS This study is a secondary data analysis of the most recent available cycle (2017-18) of the Canadian Community Health Survey (CCHS), a national cross-sectional survey. Univariate analysis was conducted to determine the characteristics of Ontarians with private insurance (n = 17,678 representing 6919,814 Ontarians)-bivariate analysis to explore their financial barriers to dental care, and how they perceive their oral health. Additionally, logistic regressions were conducted to identify relationships between covariates and outcome variables. RESULTS Analysis shows that the majority of those with private insurance do not experience cost barriers to dental care and perceive their oral health as good to excellent. However, specific populations, including those aged 20-39 years, and those earning less than $40,000, despite having private dental insurance, face significantly more cost barriers to access to care compared to their counterparts. Additionally, those with the lowest income (earning less than $20,000 annually) perceived their oral health as "fair to poor" more than those earning more. Adjusted estimates revealed that respondents aged 20-39 were six times more likely to report cost barriers to dental care and ten times more likely to visit the dentist only for emergencies than those aged 12-19. Additionally, those aged 40-59 were two times more likely to report poorer oral health status compared to those aged 12-19. CONCLUSION Given the upcoming implementation of the Canadian Dental Care Plan, the results of this study can support in identifying vulnerable populations who currently are ineligible for the Plan but can be benefitted from the coverage.
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Affiliation(s)
- Mona Abdelrehim
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada.
| | - Sonica Singhal
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
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Jiang N, Zhao Y, Mårtensson J, Stensson M. The effects of an integrated supportive programme on oral health in patients with head and neck cancer undergoing radiotherapy: A randomized controlled trial. Int J Dent Hyg 2024. [PMID: 38656048 DOI: 10.1111/idh.12801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/27/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This study determines the effect of an integrated 12-month follow-up support programme on the oral health of patients with head and neck cancer (HNC) who received radiotherapy (RT). METHODS Participants were randomly assigned to an intervention group (n = 47) or a control group (n = 45). The intervention group received usual care and an integrated supportive programme, which included face-to-face education and telephone coaching. The control group received usual care. After a clinical dental examination, the prevalence of caries, gingival inflammation and plaque were registered. Oral health impact profile (OHIP)-14 and the WHO Oral Health Questionnaire for Adults were used to evaluate oral health in both groups. RESULTS A total of 79 participants completed a 12-month follow-up. The intervention group had lower caries increment between baseline and the 12-month follow-up compared with controls, although this was not statistically significant. After 12 months, the intervention group had statistically significant better outcomes in the plaque index (p = 0.038) and the OHIP-14 (p = 0.002) than the control group. No statistically significant differences were found between the two groups concerning gingival index. However, the intervention group reported an overall better state of teeth (p = 0.034) and gums after 12 months (p = 0.042). CONCLUSIONS The integrated supportive programme showed positive effects on improving oral health in patients with HNC regarding plaque control, the state of teeth and gums and oral health-related quality of life during the 12-month follow-up.
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Affiliation(s)
- Nan Jiang
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Jan Mårtensson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Malin Stensson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Abouseta N, Gomaa N, Tassi A, Elzagallaai AA, Rieder MJ, Dixon SJ, Pani SC. Relationships among Cortisol, Perceived Stress, and Dental Caries Experience in Adolescents and Young Adults. Caries Res 2024:1-10. [PMID: 38657570 DOI: 10.1159/000539041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/20/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Stress can impact mental and physical health, especially during adolescence and young adulthood, but the extent of its contribution to dental caries is poorly understood. The present study assessed the association between perceived stress, cortisol levels (in hair and saliva), and overall caries experience of adolescents and young adults aged 15-25 years. METHODS Hair and saliva samples were obtained from 93 participants free of periodontal disease. Cortisol in hair and saliva was determined using a competitive enzyme-linked immunosorbent assay. Participants completed a perceived stress questionnaire and underwent full-mouth oral examination by a calibrated examiner. Dental caries experience was based on the decayed, missing, and filled teeth (DMFT) index. Sociodemographic variables were also recorded. RESULTS There were significantly higher hair cortisol levels and perceived stress scale (PSS) scores in individuals with dental caries experience (DMFT≥1) than in those without (DMFT = 0). However, there was no significant difference in salivary cortisol concentration. A binary logistic regression revealed that higher hair cortisol levels and greater scores on the perceived stress scale were associated with increased odds of having experienced dental caries. In contrast, no significant association was found between salivary cortisol concentration and dental caries. Using multivariable regression models, caries experience was found to be significantly associated with both hair cortisol levels and PSS scores. These associations remained statistically significant even after adjusting for sociodemographic variables. CONCLUSION Hair cortisol levels and perceived stress have a significant association with dental caries experience, whereas salivary cortisol concentrations do not.
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Affiliation(s)
- Naima Abouseta
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Noha Gomaa
- Oral Diagnostic Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Ali Tassi
- Graduate Orthodontics and Dentofacial Orthopaedics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Abdelbaset A Elzagallaai
- Drug Safety Lab, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Michael J Rieder
- Departments of Paediatrics, Physiology and Pharmacology, and Medicine, Schulich Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - S Jeffrey Dixon
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Sharat Chandra Pani
- Schulich Dentistry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
- Pediatric Dentistry, BC Children's Hospital, Vancouver, British Columbia, Canada
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Varzakas T, Antoniadou M. A Holistic Approach for Ethics and Sustainability in the Food Chain: The Gateway to Oral and Systemic Health. Foods 2024; 13:1224. [PMID: 38672896 PMCID: PMC11049237 DOI: 10.3390/foods13081224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Food production is a complex matter, affecting people's lives, organizations' profits, and the well-being of the whole planet, and has multifaceted ethical considerations surrounding its production, distribution, and consumption. This paper addresses the pressing need to confront ethical challenges within the food system, encompassing issues such as environmental sustainability, food security, and individual food choices for better oral and systemic health of all individuals around the globe. From agricultural practices to global trade and food waste, ethical implications are addressed across various domains, highlighting the interconnectedness of ethical decision-making in the food industry. Central themes explored include the ethical dimensions of food production methods, the impact of global trade on food ethics, and the role of individuals in making ethically informed food choices. Additionally, this paper considers the spiritual and physical significance of food, particularly through the lens of oral health as a gateway to holistic well-being. Recognizing the complexity of the food and mouth ecosystem, this paper calls for serious interventions in legislation and economics to promote ethical protocols and techniques for sustainability reasons. It emphasizes the importance of ethical considerations in food safety management systems, regulatory frameworks, and quality standards. Moreover, this paper underlines the need for a comprehensive approach to address ethical dilemmas and moral values inherent in the food industry and oral health policies, adopting the precautionary principle and ethical decision-making frameworks. This article finally aims to serve as a call to action for stakeholders across the food industry and the healthcare sector, to prioritize ethical practices, promote transparency, rearrange economic parameters, and work towards a more sustainable and equitable food system for inner and outer oral and systemic health and human sustainability for all.
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Affiliation(s)
- Theodoros Varzakas
- Department Food Science and Technology, University of the Peloponnese, 24100 Kalamata, Greece
| | - Maria Antoniadou
- Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Certified Systemic Analyst Program in Systemic Management (CSAP), University of Piraeus, 18534 Piraeus, Greece
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Jamieson L, Mejia G, Haag DG, Soares GH, Luzzi L, Ju X. The protective effect of CALD identity in the presence of low income on missing teeth of Australian adults over time. BMC Public Health 2024; 24:1014. [PMID: 38609930 PMCID: PMC11010350 DOI: 10.1186/s12889-023-17272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/20/2023] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND 'Culturally And Linguistically Diverse (CALD)' populations have diverse languages, ethnic backgrounds, societal structures and religions. CALD populations have not experienced the same oral health benefits as non-CALD groups in Australia. However, the socio-demographic profile of Australian CALD populations is changing. This study examined how household income modifies the oral health of CALD and non-CALD adults in Australia. METHODS Data were from two National Surveys of Adult Oral Health (NSAOH) conducted in 2004-06 (NSAOH 2004-06) and 2017-18 (NSAOH 2017-18). The outcome was self-reported number of missing teeth. CALD status was identified based on English not the primary language spoken at home and country of birth not being Australia. Social disadvantage was defined by total annual household income. Effect-measure modification was used to verify differences on effect sizes per strata of CALD status and household income. The presence of modification was indicated by Relative Excess Risk due to Interactions (RERIs). RESULTS A total of 14,123 participants took part in NSAOH 2004-06. The proportion identifying as CALD was 11.7% and 56.7% were in the low-income group, and the mean number of missing teeth was 6.9. A total of 15,731 participants took part in NSAOH 2017-18. The proportion identifying as CALD was 18.5% and 38.0% were in the low-income group, and the mean number of missing teeth was 6.2. In multivariable modelling, the mean ratio (MR) for CALD participants with low household income in 2004-06 was 2% lower than the MR among non-CALD participants with high household income, with the RERI being - 0.23. Non-CALD participants from lower income households had a higher risk of having a higher number of missing teeth than low income CALD individuals (MR = 1.66, 95%CI 1.57-1.74 vs. MR = 1.43 95%CI 1.34-1.52, respectively). In 2017-18, the MR for CALD participants with low household income was 3% lower than the MR among non-CALD participants with high household income, with the RERI being - 0.11. Low income CALD participants had a lower risk of missing teeth compared to their non-CALD counterparts (MR = 1.43, 95% CI 1.34-1.52 vs. MR = 1.57, 95% CI 1.50-1.64). CONCLUSIONS The negative RERI values indicate that the effect-measure modification operates in a negative direction, that is, there is a protective element to being CALD among low income groups with respect to mean number of missing teeth.
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Affiliation(s)
- Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Gloria Mejia
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Dandara G Haag
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Gustavo H Soares
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Liana Luzzi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5005, Australia
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Rødseth SC, Høvik H, Bjertness E, Skudutyte-Rysstad R. Exploring socioeconomic inequality in caries experience in an adult Norwegian population; the HUNT4 Oral Health Study. Community Dent Oral Epidemiol 2024. [PMID: 38566348 DOI: 10.1111/cdoe.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/12/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To investigate socioeconomic inequality in caries experience in an adult Norwegian population. METHODS This population-based study included 4549 dentate participants aged 25-94 years from the cross-sectional HUNT4 Oral Health Study conducted in Central Norway in 2017-2019. Participants were randomly sampled from the larger HUNT4 Survey and answered questionnaires and underwent clinical and radiographic examinations. Caries experience was measured as numbers of decayed, missing and filled teeth (DMFT index) and socioeconomic position was denoted by education and household income. Negative binomial regression models were used to estimate associations between caries experience and socioeconomic position. RESULTS Lower levels of both education and income were associated with higher caries experience, particularly pronounced for missing teeth. Socioeconomic gradients were observed for all outcomes DMFT, DT, MT and FT (p-value linear trends <.001). Gradients were similar for both income and education and were apparent for all age groups but were most evident in middle-aged and older individuals. High level of education was associated with a 50% lower mean number of missing teeth compared with basic level education, whereas high income was associated with a 24% lower mean number of decayed teeth and a 15% higher mean number of filled teeth than low income. CONCLUSIONS There was a socioeconomic gradient for caries experience in the study population that was present from early adulthood and increased with age. The gradient was particularly pronounced for missing teeth. Findings indicate that inequality was more associated with treatment given than with untreated disease.
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Affiliation(s)
- Siri Christine Rødseth
- Oral Health Centre of Expertise in Eastern Norway, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Hedda Høvik
- Center for Oral Health Services and Research, Mid Norway, Trondheim, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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Oliveira LM, Sfreddo CS, Ardenghi TM, Nascimento GG, Demarco FF, Zanatta FB. The role of differential exposure and susceptibility to heavy drinking linking income inequalities and tooth loss: An investigation of the alcohol harm paradox using a four-way decomposition analysis. Community Dent Oral Epidemiol 2024; 52:239-247. [PMID: 37822131 DOI: 10.1111/cdoe.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/24/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES To examine the extent to which the effect of income inequalities on tooth loss is attributable to differential exposure and susceptibility to heavy drinking in older Brazilian adults. METHODS We conducted a secondary analysis using data from The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015-2016), a nationally representative sample of community-dwelling people aged 50 years and over. Causal mediation analysis based on the counterfactual outcome framework decomposed the effect of income on tooth loss mediated by heavy drinking into four components (four-way decomposition): controlled direct effect (neither mediation nor interaction), reference interaction (interaction only), mediated interaction (both mediation and interaction) and pure indirect effect (mediation only). Proportions of effect attributable to each component were calculated to estimate the differential exposure (the sum of the third and fourth components) and differential susceptibility (the sum of the second and third components) to heavy drinking. RESULTS The analytical sample comprised 8114 participants. After adjusting for covariates, 7.3% (95% CI: 3.8%; 10.9%) and -39.5% (95% CI: -75.8%; -3.3%) of the effects of income on tooth loss were attributable to differential exposure and susceptibility to heavy drinking, respectively, consistent with the alcohol harm paradox. When setting non-functional dentition as outcome, only the effect of differential susceptibility remained (-81.7% [95% CI: -128.2%; -35.2%]). CONCLUSION Our findings suggest that individuals of low-income groups appear to be more susceptible to the effects of heavy drinking on tooth loss.
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Affiliation(s)
- Leandro Machado Oliveira
- Department of Stomatology, Postgraduate Program in Dentistry, Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Camila Silveira Sfreddo
- Department of Semiology and Clinic, Faculty of Dentistry, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Thiago Machado Ardenghi
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Gustavo G Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
- Graduate Program in Epidemiology, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Fabrício Batistin Zanatta
- Department of Stomatology, Postgraduate Program in Dentistry, Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
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Pan S, Yang L, Zhong W, Wang H, Lan Y, Chen Q, Yu S, Yang F, Yan P, Peng H, Liu X, Gao X, Song J. Integrated analyses revealed the potential role and immune link of mitochondrial dysfunction between periodontitis and type 2 diabetes mellitus. Int Immunopharmacol 2024; 130:111796. [PMID: 38452412 DOI: 10.1016/j.intimp.2024.111796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
There is a reciprocal comorbid relationship between periodontitis and type 2 diabetes mellitus (T2DM). Recent studies have suggested that mitochondrial dysfunction (MD) could be the key driver underlying this comorbidity. The aim of this study is to provide novel understandings into the potential molecular mechanisms between MD and the comorbidity, and identify potential therapeutic targets for personalized clinical management. MD-related differentially expressed genes (MDDEGs) were identified. Enrichment analyses and PPI network analysis were then conducted. Six algorithms were used to explore the hub MDDEGs, and these were validated by ROC analysis and qRT-PCR. Co-expression and potential drug targeting analyses were then performed. Potential biomarkers were identified using LASSO regression. The immunocyte infiltration levels in periodontitis and T2DM were evaluated via CIBERSORTx and validated in mouse models. Subsequently, MD-related immune-related genes (MDIRGs) were screened by WGCNA. The in vitro experiment verified that MD was closely associated with this comorbidity. GO and KEGG analyses demonstrated that the connection between periodontitis and T2DM was mainly enriched in immuno-inflammatory pathways. In total, 116 MDDEGs, eight hub MDDEGs, and two biomarkers were identified. qRT-PCR revealed a distinct hub MDDEG expression pattern in the comorbidity group. Altered immunocytes in disease samples were identified, and their correlations were explored. The in vivo examination revealed higher infiltration levels of inflammatory immunocytes. The findings of this study provide insight into the mechanism underlying the gene-mitochondria-immunocyte network and provide a novel reference for future research into the function of mitochondria in periodontitis and T2DM.
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Affiliation(s)
- Shengyuan Pan
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - LanXin Yang
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - Wenjie Zhong
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - He Wang
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - Yuyan Lan
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - Qiyue Chen
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - Simin Yu
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - Fengze Yang
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - Pingping Yan
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - Houli Peng
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - Xuan Liu
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - Xiang Gao
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China.
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Yamamoto T, Kiuchi S, Ishimaru M, Fukuda H, Yokoyama T. Associations between school-based fluoride mouth-rinse program, medical-dental expense subsidy policy, and children's oral health in Japan: an ecological study. BMC Public Health 2024; 24:762. [PMID: 38475804 DOI: 10.1186/s12889-024-18156-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Dental caries are a common non-communicable disease among children. As a public health measure at the prefectural level, school-based fluoride mouth-rinse (S-FMR) program, medical/dental expense subsidy policies, and other factors may reduce the incidence of dental caries and tooth loss. Prefectures focusing on promoting oral health policies may promote both, but the interaction effect of implementing both subsidy policies and S-FMR at the prefectural level on caries prevention has not yet been examined. METHODS We conducted an ecological study using two-wave panel data, prefecture-level aggregated data in Japan for 2016 and 2018. Coefficient and 95% confidence intervals (CI) were calculated for the dependent variables for oral health using mixed-effects linear regression analysis adjusted for possible confounders. Two dependent variables were used; the standardized claim ratio (SCR) of deciduous tooth extraction and 12-year-olds' decayed, missing, or filled permanent teeth (DMFT). Four independent variables were S-FMR, the SCR of dental sealants, prefectural income per person, and subsidy policy in three models: co-payment until children enter elementary school (n = 23), no co-payment until children enter elementary school (n = 7), and co-payment continuing beyond elementary school (n = 17). The effects of six interaction terms, each representing a unique pairing from the four independent variables, were individually calculated. RESULTS S-FMR was negatively associated with the SCR of deciduous tooth extractions and DMFT (coefficient = -0.11, 95% CI -0.20; -0.01 and coefficient = -0.003, 95% CI -0.005; -0.001, respectively). No co-payment until children enter elementary school was positively associated with the SCR of deciduous tooth extraction compared to co-payment until children enter elementary school(coefficient = 11.42, 95% CI 3.29; 19.55). SCR of dental sealants was positively associated with the SCR of deciduous tooth extractions (coefficient = 0.12, 95% CI 0.06; 0.19) but negatively associated with DMFT (coefficient = -0.001, 95% CI -0.003; -0.0001). Per capita prefectural income was positively associated with the SCR of deciduous tooth extractions(coefficient = 0.01, 95% CI 0.001; 0.02). No interaction was found between S-FMR and the subsidy policy at both outcomes. CONCLUSION High S-FMR utilization and no co-payment until children enter elementary school were associated with fewer deciduous tooth extractions. Also, S-FMR and dental sealant were associated with decreased DMFT.
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Affiliation(s)
- Takafumi Yamamoto
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan.
- Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, Miyagi, Japan.
| | - Sakura Kiuchi
- Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, Miyagi, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Miyagi, Japan
| | - Miho Ishimaru
- The Institute of Education, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan
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Ghanem AS, Nagy AC. Oral health's role in diabetes risk: a cross-sectional study with sociodemographic and lifestyle insights. Front Endocrinol (Lausanne) 2024; 15:1342783. [PMID: 38516406 PMCID: PMC10955347 DOI: 10.3389/fendo.2024.1342783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Diabetes, a key chronic non-communicable disease, poses a substantial public health burden. The role of oral health as a determinant in the epidemiology of diabetes mellitus, particularly in the Central Eastern European region, remains underexplored. This research aims to examine the impact of specific oral health parameters, including gum bleeding, active dental caries, tooth mobility, and tooth loss, on diabetes prevalence. Additionally, it seeks to clarify the moderating effects of socio-demographic and lifestyle variables on this relationship. Materials and methods Data were extracted from the 2014 and 2019 datasets of the Hungarian European Health Interview Survey, comprising a combined nationally representative sample of 11,429 participants. Descriptive statistics were presented as weighted proportions and unweighted counts, and weighted Pearson's chi-squared tests were employed for assessing associations and goodness-of-fit. Significant predictors were integrated into weighted multiple logistic regression models for analysis. Sensitivity analysis was then conducted to confirm the robustness of the findings. Results The study identified 'Bad' self-perceived oral health as a diabetes risk (OR=1.35; 95% CI: [1.04-1.75]), with filled teeth being protective (0.65 [0.51-0.84]). Subgroup analysis revealed higher diabetes odds among individuals with primary education (1.41 [1.02-1.96]) and rural residents with tooth loss from decay (3.54 [1.36-9.19]). The bootstrap analysis with 1,000 iterations reaffirmed the model's stability and predictive accuracy for diabetes. Discussion Enhanced oral health is associated with lower risk factors for diabetes. This research highlights the importance of including oral health measures in comprehensive diabetes management approaches.
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Affiliation(s)
| | - Attila Csaba Nagy
- Department of Health Informatics, Institute of Health Sciences, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
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Kranz AM, Evans LA, Geissler KH. Changes in dental visits and oral health for children by race and ethnicity during the COVID-19 pandemic. J Am Dent Assoc 2024; 155:195-203.e4. [PMID: 38206256 DOI: 10.1016/j.adaj.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The COVID-19 pandemic created new barriers to oral health care, which may worsen oral health and exacerbate disparities. The authors quantified changes in children's dental care receipt and oral health outcomes during the pandemic and examined differences among racial and ethnic groups. METHODS Using the National Survey of Children's Health (163,948 child observations from 2017-2021), the authors used weighted modified Poisson models to examine caregiver-reported receipt of a dental visit (for any reason and for preventive care) and adverse oral health outcomes (teeth in fair or poor condition; difficulty with toothaches, cavities, or bleeding gums) from 2017 through 2019 (prepandemic) compared with 2020 and 2021. The authors examined outcomes within and across racial and ethnic groups. RESULTS Children from all racial and ethnic groups experienced declines in receipt of dental visits, but there were limited changes in adverse oral health outcomes during 2020 and 2021. Prepandemic disparities in receipt of dental visits persisted for Black children and Asian children compared with White children. Hispanic children experienced larger increases in risk of experiencing both adverse oral health outcomes compared with White children in 2020 and in having teeth in fair or poor condition in 2021. CONCLUSIONS The pandemic did not create new disparities in receipt of dental visits or oral health outcomes, but disparities in care persisted, and the oral health of Hispanic children was affected differentially. PRACTICAL IMPLICATIONS Continued monitoring of dental visits and adverse oral health outcomes by race and ethnicity is critical to ensuring all children have access to oral health care. This information can help develop targeted interventions to improve children's oral health, including for minoritized racial and ethnic groups.
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Åstrøm AN, Mastrovito B, Sannevik J, Lie SA. Oral health inequalities in Swedish older adults over 25 years of follow-up. Gerodontology 2024; 41:17-27. [PMID: 36880598 DOI: 10.1111/ger.12680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES The aim of this study was to describe inequalities in tooth loss and dissatisfaction with teeth related to time-invariant and time-variant socio-demographic characteristics and use of dental care across the middle and older life course and to assess whether oral health inequalities remain stable, widen or narrow from age 50 to 75. MATERIALS AND METHODS In 1992, 6346 residents, aged 50, consented to participate in a prospective cohort study including postal questionnaire follow-ups every fifth year until age 75. Tooth loss and dissatisfaction with teeth were assessed at each survey wave in addition to socio-demographic factors and use of dental care. Multivariable logistic regression, generalised estimating equations, GEE, and random intercept logistic mixed models were used for estimation of population-averaged and person-specific odds ratio. Interaction terms of each covariate with the time indicator were added to test whether inequalities changed across time. RESULTS Person-specific OR and 95% CI estimates for tooth loss varied from 1.29 (1.09-1.53) (unmarried vs married) to 9.20 (6.07-13.94) (foreign country vs native). Estimated ORs for tooth dissatisfaction ranged from 1.33 (1.15-1.55) (unmarried vs married) to 2.59 (2.15-3.11) (smoking vs no smoking). Inequalities in tooth loss according to sex, educational level and country of birth were smaller in magnitude in 2017 than in 1992. Inequality estimates in dissatisfaction with teeth according to use of dental care and perceived health were, respectively, smaller and greater at older than at younger age. CONCLUSION Socio-demographic inequalities in oral health persisted from age 50 to 75 and varied in magnitude across time. Both convergence and widening of disparities in oral health occurred towards older ages.
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Affiliation(s)
| | | | - Josefine Sannevik
- Region Örebro län, Tandvårdsenheten, Örebro, Sweden
- Department of Dentistry, Region Örebro, Örebro, Sweden
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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Huang Z, Kawamura K, Yoshimatsu H, Miyake T. Association between tea types and number of teeth: a cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey. BMC Public Health 2024; 24:400. [PMID: 38326794 PMCID: PMC10848561 DOI: 10.1186/s12889-024-17874-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Previous studies have suggested that tea consumption may have a positive impact on oral health. However, the effects of different tea types on oral health remain unclear. Therefore, this study aimed to determine the association between residual teeth and consumption habits of different types of tea (green tea, black tea, oolong tea, and scented tea) in older adults. METHODS We conducted a secondary analysis using data from the Chinese Longitudinal Healthy Longevity Survey in 2018. In a sample of 6,387 older adults, we performed logistic regression analysis to examine the relationship between persistent tea consumption and oral health according to sex and brushing frequency. The indices for particularly healthy oral health and relative health were set at more than 20 teeth and more than 10 teeth, respectively. RESULTS The study included 2,725 males and 3,662 females, both aged 65 and older. Among individuals with more than 20 teeth, drinking green tea significantly improved oral health in men (adjusted odds ratio [ORs]: 1.377; 95% confidence interval [CI]: 1.082-1.752) and drinking black tea significantly improved the oral health of women (ORs: 2.349, 95%CI: 1.028-5.366). In the daily brushing group, green tea had a significant beneficial effect on increasing the number of teeth in men and black tea had a significant beneficial effect in women. Among individuals with more than 10 teeth, drinking green tea significantly improved oral health in men (ORs: 1.539; 95% CI: 1.209-1.959) and drinking green tea and scented tea significantly improved the oral health of women (ORs: 1.447, 95%CI: 1.052-1.991; ORs: 1.948, 95%CI: 1.137-3.340). In the daily brushing group, consumption of green tea and black tea had significant beneficial effects on increasing the number of teeth in men, whereas that of green tea, black tea, and scented tea had significant beneficial effects in women. CONCLUSION Long-term green tea consumption in males and black tea consumption in females were significantly associated with maintaining functional dentition (≥20 teeth). Similarly, long-term green tea consumption in males and green tea and scented tea consumption in females were associated with avoiding severe tooth loss (≥10 teeth). Furthermore, in the daily tooth brushing group, long-term consumption of black tea was associated with avoiding severe tooth loss in both sexes. However, tea consumption alone had no effect on oral health without good brushing habits.
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Affiliation(s)
- Zheqi Huang
- Graduate school of Dentistry, Osaka Dental University, 1-8 Kuzuha Hanazono-cho, Hirakata-shi, Osaka, 573-1121, Japan
| | - Kahori Kawamura
- Department of Preventive and Community Dentistry, Osaka Dental University, 1-8 Kuzuha Hanazono-cho, Hirakata-shi, Osaka, 573-1121, Japan.
| | - Hideki Yoshimatsu
- Department of Preventive and Community Dentistry, Osaka Dental University, 1-8 Kuzuha Hanazono-cho, Hirakata-shi, Osaka, 573-1121, Japan
| | - Tatsuro Miyake
- Department of Preventive and Community Dentistry, Osaka Dental University, 1-8 Kuzuha Hanazono-cho, Hirakata-shi, Osaka, 573-1121, Japan
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Scambler S, Ahmed TA, Aiyere J, Cheng E. Diversifying the dental curriculum: A review of the Bachelor of Dental Surgery degree reading lists in a UK dental school. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:71-78. [PMID: 37147927 DOI: 10.1111/eje.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/04/2023] [Accepted: 04/16/2023] [Indexed: 05/07/2023]
Abstract
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.
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Affiliation(s)
- Sasha Scambler
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Tasnim Aniqa Ahmed
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Jesutomisin Aiyere
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Emily Cheng
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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Habchy P, Tahan L, Moussi C, Barakat MA, Ghanem L, Kattan O, Njeim A, Abou Habib L, El Bitar W, El Asmar B, Chahine MN. Referrals and Determinant Factors of a National School Health Campaign in Lebanon on Children Aged between 3 and 12 Years Old. CHILDREN (BASEL, SWITZERLAND) 2024; 11:175. [PMID: 38397287 PMCID: PMC10886849 DOI: 10.3390/children11020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/20/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
In this extensive study examining the health of 7184 school children aged 3 to 12 in 27 Lebanese schools, screenings involved medical evaluation and interviews, complemented by phone interviews with 3880 parents. Notably, one in two students received a medical referral, revealing prevalent issues such as dental cavities (33%), under-vaccination (25%), undetected vision problems (13%), abnormal growth (6%), underweight (27%), and overweight (33%). Additional concerns encompassed abnormal vital signs (3%), abuse signs (0.6%), infectious skin lesions (1.6%), scoliosis (1.7%), abnormal auscultation (heart 1.1%, lungs 1.2%), ear problems (3.3%), precocious puberty (0.7%), and neurologic signs (0.6%). Mental health challenges affected 20-25% of students. Public schools and Beirut exhibited higher referral rates, with girls, older children, overweight students, those lacking regular pediatrician visits, and children of self-employed or less educated parents facing elevated referral rates. In contrast, children of healthcare workers experienced fewer referrals. Against this backdrop, the study emphasizes the imperative for targeted health initiatives, particularly in marginalized areas and for socioeconomically disadvantaged students. Priority areas include dental care, weight issues, mental health, vaccination compliance, and addressing vision problems to enhance learning outcomes.
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Affiliation(s)
- Peter Habchy
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Léa Tahan
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Charbel Moussi
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Muhammad A. Barakat
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Laura Ghanem
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Ogarite Kattan
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Alain Njeim
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Leila Abou Habib
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
| | - Wassim El Bitar
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Department of Pediatrics, Bellevue Medical Center University Hospital, Mansourieh P.O. Box 295, Lebanon
| | - Béchara El Asmar
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Faculty of Medicine, Saint Joseph University, Beirut P.O. Box 17-5208, Lebanon
- Department of Cardiology, Hotel-Dieu de France Hospital, Achrafieh, Beirut 1100, Lebanon
| | - Mirna N. Chahine
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Basic Sciences Department, Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon
- Foundation-Medical Research Institutes (F-MRI), Achrafieh, Beirut 1100, Lebanon
- Foundation-Medical Research Institutes (F-MRI), 1211 Geneva, Switzerland
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Guo Y, Guo J, Li Y, Zhang P, Zhao YD, Qiao Y, Liu B, Wang G. Rapid detection of non-normal teeth on dental X-ray images using improved Mask R-CNN with attention mechanism. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-023-03047-1. [PMID: 38170416 DOI: 10.1007/s11548-023-03047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Dental health has been getting increased attention. Timely detection of non-normal teeth (caries, residual root, retainer, teeth filling, etc.) is of great importance for people's health, well-being, and quality of life. This work proposes a rapid detection of non-normal teeth based on improved Mask R-CNN, aiming to achieve comprehensive screening of non-normal teeth on dental X-ray images. METHODS An improved Mask R-CNN based on attention mechanism was used to develop a non-normal teeth detection method trained on a high-quality annotated dataset, which can segment the whole mask of each non-normal tooth on the dental X-ray image immediately. RESULTS The average precision (AP) of the proposed non-normal teeth detection was 0.795 with an intersection-over-union of 0.5 and max detections (maxDets) of 32, which was higher than that of the typical Mask R-CNN method (AP = 0.750). In addition, validation experiments showed that the evaluation metrics (AP, recall, precision-recall (P-R) curve) of the proposed method were superior to those of the Mask R-CNN method. Furthermore, the experimental results indicated that proposed method exhibited a high sensitivity (95.65%) in detecting secondary caries. The proposed method took about 0.12 s to segment non-normal teeth on one dental X-ray image using the laptop (8G memory, NVIDIA RTX 3060 graphics processing unit), which was much faster than conventional manual methods. CONCLUSION The proposed method enhances the accuracy and efficiency of abnormal tooth diagnosis for practitioners, while also facilitating early detection and treatment of dental caries to substantially lower patient costs. Additionally, it can enable rapid and objective evaluation of student performance in dental examinations.
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Affiliation(s)
- Yanbin Guo
- Hubei Bioinformatics and Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Jing Guo
- Department of Dental General and Emergency, The Affiliated Stomatological Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, 330038, Jiangxi Province, China
| | - Yong Li
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Peng Zhang
- Department of Dental General and Emergency, The Affiliated Stomatological Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, 330038, Jiangxi Province, China
| | - Yuan-Di Zhao
- Hubei Bioinformatics and Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yundi Qiao
- Department of Dental General and Emergency, The Affiliated Stomatological Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, 330038, Jiangxi Province, China
| | - Benyuan Liu
- Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, USA.
| | - Guoping Wang
- Hubei Bioinformatics and Molecular Imaging Key Laboratory, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, China.
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Tahani B, Baghban AA, Kazemian A. Determinants of oral health status: an ecological study in Iran. BMC Oral Health 2023; 23:910. [PMID: 37993816 PMCID: PMC10666374 DOI: 10.1186/s12903-023-03557-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/19/2023] [Indexed: 11/24/2023] Open
Abstract
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.
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Affiliation(s)
- Bahareh Tahani
- Department of Oral Public Health, Dental Research Center, Dental Research Institute, Dental School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kazemian
- Department of Community Oral Health, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
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Drumond VZ, de Arruda JAA, Bernabé E, Mesquita RA, Abreu LG. Burden of dental caries in individuals experiencing food insecurity: a systematic review and meta-analysis. Nutr Rev 2023; 81:1525-1555. [PMID: 37040617 DOI: 10.1093/nutrit/nuad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
CONTEXT Food insecurity affects approximately 2.37 billion people worldwide. Individuals experiencing food insecurity are more likely to exhibit poor health-related endpoints. Dental caries, a highly prevalent noncommunicable disease, is modulated by an interplay between biological, behavioral, and environmental factors. OBJECTIVE This systematic review and meta-analysis aimed to assess whether individuals experiencing food insecurity were more likely to exhibit dental caries than individuals facing food security. DATA SOURCES The Web of Science, PubMed, Scopus, Embase, Ovid, CINAHL, LILACS, and APA PsycINFO databases were checked from inception to November 2021. Grey literature and Google Scholar were also examined. An updated search was conducted in August 2022. Observational studies were included if they evaluated the association between dental caries and food insecurity status. DATA EXTRACTION Data extraction was performed by two reviewers. DATA ANALYSIS Random-effects meta-analyses were conducted using R language. In total, 514 references were retrieved from databases, of which 14 articles were included in qualitative synthesis and 7 were merged into meta-analysis. The results of an inverse-variance meta-analysis (OR = 1.62; 95%CI, 1.01-2.60) and a meta-analysis of binary data (OR = 1.66; 95%CI, 1.36-2.02) demonstrated that food-insecure individuals were more likely to exhibit dental caries than food-secure individuals. Inverse-variance meta-analyses appraising multiple strata of food security also showed that individuals experiencing marginal food security (OR = 1.48; 95%CI, 1.28-1.72), individuals experiencing low food security (OR = 1.26; 95%CI, 1.01-1.57), and those experiencing very low food security (OR = 1.33; 95%CI, 1.04-1.71) were more likely to exhibit dental caries than individuals experiencing full food security. CONCLUSION Dental caries is associated with food insecurity. Individuals living with food insecurity are more likely to exhibit dental caries than those who have food security. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42021268582.
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Affiliation(s)
| | - José Alcides A de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Eduardo Bernabé
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Ricardo A Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas G Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Li R, Wang H. Re: Association between periodontal disease and oral squamous cell carcinoma: A systematic review and meta-analysis. Br J Oral Maxillofac Surg 2023; 61:641. [PMID: 37806940 DOI: 10.1016/j.bjoms.2023.08.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Rui Li
- Department of Periodontology, School of Stomatology, China Medical University, Nanjing North Street 117, Shenyang, China.
| | - Hongyan Wang
- Department of Periodontology, School of Stomatology, China Medical University, Nanjing North Street 117, Shenyang, China.
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Ghanem AS, Móré M, Nagy AC. Assessing the impact of sociodemographic and lifestyle factors on oral health: a cross-sectional study in the Hungarian population. Front Public Health 2023; 11:1276758. [PMID: 37927886 PMCID: PMC10623121 DOI: 10.3389/fpubh.2023.1276758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Oral health, a critical aspect of overall well-being, is influenced by various sociodemographic and lifestyle factors, with poor oral health associated with systemic diseases and diminished quality of life. Methods This cross-sectional study leverages data from the Hungarian European Health Interview Survey (EHIS) representative of the Hungarian population, to conduct a comprehensive examination of the intersection between these factors and oral health, aiming to identify potential risk factors and contribute to the development of targeted interventions. The research examined associations between sociodemographic/lifestyle factors and oral health. Statistical techniques included Pearson's Chi-square test, multivariate and ordinal logistic regression analyses. Weighting was applied to assure the representativeness of the population and enhance the validity of the survey results. Results The study identifies gender, age, education, financial status, smoking, and self-perceived oral health as key factors influencing oral health outcomes. Notably, regular dental visits significantly reduced the risk of poor oral health and caries. Females, non-smokers, university graduates, high-income individuals, and those with good self-perceived health had fewer missing teeth and better self-perceived oral health. Teeth extractions due to decay, especially when not replaced, significantly increased the perception of poor oral health, while regular dental visits improved it. Discussion The study highlights the need for personalized oral health interventions considering the different sociodemographic and lifestyle factors, along with promotion of healthy lifestyle, more frequent dental office visits and equitable dental care access. The findings offer the potential to inform regional oral health policies and prevention strategies, improving oral health and overall wellbeing.
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Affiliation(s)
- Amr Sayed Ghanem
- Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Marianna Móré
- Institute of Social and Sociological Sciences, Faculty of Health Sciences, University of Debrecen, Nyíregyháza, Hungary
| | - Attila Csaba Nagy
- Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
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McKay FH, Bennett R, Dunn M. How, why and for whom does a basic income contribute to health and wellbeing: a systematic review. Health Promot Int 2023; 38:daad119. [PMID: 37804514 DOI: 10.1093/heapro/daad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2023] Open
Abstract
Ensuring that people have a sufficient income to meet their basic needs and that it keeps pace with costs of living are important when considering ways to reduce health inequities. Many have argued that providing a basic income is one way to do this. The aim of this review is to provide an overview of the existing peer reviewed evidence on the health and wellbeing impacts of basic income interventions. A systematic search of ten electronic databases was conducted in June 2022. Eligible publications examined any effect on health and wellbeing from unconditional cash transfers. All study designs were included, and no limitations were placed on duration of cash transfer trials, location of study, study population or on amount of money provided through the cash transfer. Ten studies were included in this review. Studies employed a range of methods. All studies reported on a trial of Universal Basic Income in either a region or a town. Studies explored a range of health and wellbeing related outcomes including crime, quality of life, employment, subjective wellbeing, tuberculosis and hospitalization. Basic income programs can mitigate poverty in a time of economic upheaval and have the potential to become a powerful policy tool to act upon the determinants of health and reduce health inequality. This review found a small number of trials indicating a positive impact on health and wellbeing. More trials which track recipients over a longer period are needed to provide more robust evidence for the impact of basic income programs.
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Affiliation(s)
- Fiona H McKay
- School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Rebecca Bennett
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Matthew Dunn
- School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
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Hill CM, Chi DL, Mancl LA, Jones-Smith JC, Chan N, Saelens BE, McKinney CM. Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state. PLoS One 2023; 18:e0290287. [PMID: 37699013 PMCID: PMC10497152 DOI: 10.1371/journal.pone.0290287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity-tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity-tooth decay relationship for lower-income children. MATERIALS AND METHODS Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects. RESULTS Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity-tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33). CONCLUSIONS Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.
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Affiliation(s)
- Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Lloyd A. Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Jessica C. Jones-Smith
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Nadine Chan
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Public Health-Seattle & King County, Assessment, Policy, Development and Evaluation Division, Seattle, WA, United States of America
| | - Brian E. Saelens
- Seattle Children’s Research Institute, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| | - Christy M. McKinney
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Seattle Children’s Research Institute, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
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Mannaa AI. Knowledge and Attitude Toward Esthetic Dentistry and Smile Perception. Cureus 2023; 15:e46043. [PMID: 37900474 PMCID: PMC10603367 DOI: 10.7759/cureus.46043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION A smile is important in human communication and is increasingly valued in modern society. The perception of smile attractiveness is subjective and depends on many factors. AIM This study aimed to evaluate and compare knowledge and attitude related to esthetic dentistry in dental students versus dental interns, general dentists, and dental specialists, examine the self-perception of their smile, and identify parameters that influence smile perception. METHODS This cross-sectional study was conducted at King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. Participants included dental students, interns, general practitioners, and specialists. They completed an electronic questionnaire covering demographics, knowledge about esthetic dentistry, attitudes toward smile perception, and previous dental treatments. Data analysis involved descriptive statistics, bivariate analysis, and chi-square tests. RESULTS A total of 275 individuals participated in our study. The study found that dental students' exposure and awareness of esthetic dentistry topics increased with academic progression. Gender, age, and marital status influenced self-perception and smile evaluation. More females perceived gender as an influencing factor in smile evaluation, while more males believed in the existence of an ideal smile. A substantial portion of the sample had undergone dental treatments, with no significant income-related disparities observed. CONCLUSION This study highlights differences in knowledge and attitudes among dental students and professionals. Dental education appears to impact students' exposure to esthetic dentistry concepts. Moreover, gender, age, and marital status influence self-perception and evaluation of others' smiles.
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Affiliation(s)
- Alaa I Mannaa
- Restorative Dentistry, King Abdulaziz University, Jeddah, SAU
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Galvão MHR, Roncalli AG. Explaining public dental service utilization: A theoretical model. PLoS One 2023; 18:e0290992. [PMID: 37656715 PMCID: PMC10473501 DOI: 10.1371/journal.pone.0290992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVES Constructing and validating a theoretical model of relationships between dental services use and socioeconomic characteristics, oral health status, primary care coverage, and public dental services. METHODS The first stage of the study consisted of developing a theoretical-conceptual model to demonstrate the expected relationships between variables based on the literature. In the second stage, we tested the proposed theoretical model using the Partial Least Squares Structural Equation Modeling (PLS-SEM) technique, using data from the Brazilian National Health Survey conducted in 2019 with a sample of 41,664 individuals aged 15 or older. RESULTS This study successfully defined a theoretical model that explains the systematic relationships involving public dental services utilization. Socioeconomic status was negatively associated with oral health status (β = -0.376), enrollment in primary care facilities (β = -0.254), and the use of public dental consultations (β = -0.251). Being black, indigenous, or living in a rural area was directly associated with lower socioeconomic status and greater use of public dental services. CONCLUSIONS The identified relationships, establishing a theoretical basis for further investigations, also provide evidence of a public access policy's effect on oral health services on equity, supporting the construction of more effective and equitable public policies.
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Affiliation(s)
- Maria Helena Rodrigues Galvão
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Academic Center of Vitória, Federal University of Pernambuco, Vitória de Santo Antão, Pernambuco, Brazil
| | - Angelo Giuseppe Roncalli
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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AlHaj MAK, Baseer MA, AlSaffan AD, Ingle NA. Comparative Assessment of Oral Health Attitudes and Behaviors of First-Time and Previous Dental Patients Undergoing Exodontia Treatment During the COVID-19 Pandemic in Private Dental Clinics in Riyadh City, Saudi Arabia. Risk Manag Healthc Policy 2023; 16:1679-1691. [PMID: 37667746 PMCID: PMC10475302 DOI: 10.2147/rmhp.s420859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
Background The COVID-19 lockdown affected oral health behaviors. This study aims to assess and compare the oral health attitudes and behaviors of first-time and previous patients undergoing dental extractions during the COVID-19 pandemic at private dental clinics in Riyadh City, Saudi Arabia. Methods This cross-sectional study was conducted among patients aged 18-65 years undergoing dental extractions at private dental clinics in Riyadh City, Saudi Arabia. Four hundred and eighty patients were selected using a convenient sampling methodology. A structured, close-ended questionnaire investigated demographic information, tooth extraction attendance, and oral health attitudes and behaviors using 20 items Hiroshima University Dental Behavioral Inventory (HUDBI). Results A total of 480 exodontia patients [282 (58.8%) males and 198 (41.2%) females] participated in this study. All patients used a stiff-bristled toothbrush and were concerned about their teeth' color and bad breath. Similarly, all the participants did not feel brushed unless they used strong strokes, and the dentist told them to brush very well. An overall mean HUDBI score of 6.34±1.12 was observed. Patients with a primary education (5.61±0.79), income ≤5000 SAR (6.00±0.92), residing in rural areas (5.84±0.93), and government employees (5.62±0.96) exhibited lower HU-DBI scores compared to their counterparts. The study revealed a significant variation in HUDBI scores across different demographic factors, including education, income, residence, occupation, and reason for extraction (p<0.001). The HUDBI score of first-time attendees to dental extraction (5.88±1.03) was found to be significantly poorer than to those of previous attendees (6.63±1.09), (p<0.001). Conclusion Patients who underwent dental extractions at private dental clinics in Riyadh City, Saudi Arabia, during the post-lockdown COVID-19 pandemic exhibited average oral health attitudes and behaviors. Oral health attitudes and behaviors differed by socioeconomic status. Patients undergoing dental extractions for reasons other than dental caries and periodontal diseases and first-time attendees demonstrated poor oral health attitudes and behaviors.
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Affiliation(s)
| | - Mohammad Abdul Baseer
- Preventive Dentistry Department, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | | | - Navin Anand Ingle
- Preventive Dentistry Department, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
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Choufani A, Barakat R. The Knowledge, Attitude, and Practice of Lebanese Mothers Toward Their Children's Oral Health: A Cross-Sectional Survey. Cureus 2023; 15:e42903. [PMID: 37664336 PMCID: PMC10474875 DOI: 10.7759/cureus.42903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES This study aims to assess the knowledge, attitude, and practice of Lebanese mothers toward their children's oral health, examine the association between the three variables, and identify their predictors. METHODS A cross-sectional online survey was administered to Lebanese mothers residing in Lebanon with children aged six months to 12 years between April and May 2022. The survey was administered to mothers from various geographical areas who presented to academic medical centers, private clinics, and dispensaries. The survey gathered sociodemographic data as well as assessed the knowledge, attitude, and practice of the participating mothers toward their children's oral health. RESULTS A total of 357 responses were included in the final analysis. The mean age of mothers was 32.67 years +/- 6.35. The majority of mothers had one or two children (35.8% and 37.5%, respectively). More than two-thirds of the mothers were unemployed. Only 13% of the mothers followed best practices for their children's dental health, while 48.6.2% possessed above-average knowledge and 88.9% had great attitudes. Mothers with a university education had higher knowledge, better attitudes, and practice scores than those with school-level education (elementary, high school). Employed mothers had a significantly better knowledge score (p=0.036) and practice score (p=0.043) than unemployed mothers. The decrease in the number of children was associated with an increase in the maternal knowledge score. An increase in the mother's age was associated with a higher knowledge score. CONCLUSION The findings of this study suggest the need for targeted oral health education programs for Lebanese mothers to enhance their attitudes and practices toward their children's oral health. It highlights the importance of early oral health interventions and emphasizes the significant role of mothers in promoting good oral health practices for their children. Further research is needed on a larger scale to comprehensively understand these variables and inform the development of appropriate national oral health programs for children in Lebanon.
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Affiliation(s)
- Antoine Choufani
- Pediatric and Public Health Dentistry, Lebanese University, Beirut, LBN
| | - Rasseel Barakat
- Pediatric Dentistry and Public Health, Private Practice, Windsor, CAN
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Aida J, Ishimaru M, Kino S. Reconsidering economic interventions to reduce oral health inequalities. Community Dent Oral Epidemiol 2023; 51:600-605. [PMID: 37282745 DOI: 10.1111/cdoe.12883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023]
Abstract
Despite the general recognition of economic factors as fundamental upstream social determinants of health inequalities, interventions to improve health and reduce inequalities tend to focus on proximal health determinants. However, recent socioeconomic crises have increased the focus on economic factors. Health-related approaches to address economic factors can be divided into two categories: (1) indirect approaches, such as financial support for obtaining dental care and fiscal policies targeting unhealthy commodities and (2) direct approaches, such as cash transfers or provision of a universal basic income. For indirect approaches, policies reducing out-of-pocket payments for dental care appear to improve access to services and reduce oral health inequalities. Price policies targeting tobacco and sugar through taxation are associated with declines in periodontal disease and caries, and sugar taxation appears to reduce oral health inequalities. As regards direct approaches, studies on cash transfers to low-income individuals have found no positive impact on dental visits, while results in relation to caries prevention were inconclusive. No dental studies examined the effect of a population approach to income security, such as basic income. Research on economic interventions for oral health inequalities is scarce, and studies using causal inference methods and natural experiments are urgently needed.
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Affiliation(s)
- Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miho Ishimaru
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shiho Kino
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Madera M, Delgado-Angulo EK, Bashir NZ, Bernabe E. The intersections of socioeconomic position, gender, race/ethnicity and nationality in relation to oral conditions among American adults. Community Dent Oral Epidemiol 2023; 51:644-652. [PMID: 36786413 DOI: 10.1111/cdoe.12845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE The objective of the study was to evaluate how gender, socioeconomic position (SEP), race/ethnicity and nationality intersect to structure social inequalities in adult oral health among American adults. METHODS Data from adults aged 20 years or over who participated in the National Health and Nutrition Examination Survey (NHANES) 2009-2018 were analysed. The outcomes were poor self-rated oral health and edentulism among all adults (n = 24 541 and 21 446 participants, respectively) and untreated caries and periodontitis among dentate adults (n = 16 483 and 9829 participants, respectively). A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted for each outcome, by nesting individuals within 48 intersectional strata defined as combinations of gender, SEP, race/ethnicity and nationality. Intersectional measures included the variance partition coefficient (VPC), the proportional change in variance (PCV) and predicted excess probability due to interaction. RESULTS Substantial social inequalities in the prevalence of oral conditions among adults were found, which were characterized by high between-stratum heterogeneity and outcome specificity. The VPCs of the simple intersectional model showed that 9.4%-12.7% of the total variance in the presentation of oral conditions was attributed to between-stratum differences. In addition, the PCVs from the simple intersectional model to the intersectional interaction model showed that 84.1%-97.1% of the stratum-level variance in the presentation of oral conditions was attributed to the additive effects of gender, SEP, race/ethnicity and nationality. The point estimates of the predictions for some intersectional strata were suggestive of an intersectional interaction effect. However, the 95% credible intervals were very wide and the estimations inconclusive. CONCLUSIONS This analysis highlights the value of the intersectionality framework to understand heterogeneity in social inequalities in oral health. These inequalities were mainly due to the additive effect of the social identities defining the intersectional strata, with no evidence of interaction effects.
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Affiliation(s)
- Meisser Madera
- Faculty of Dentistry, University of Cartagena, Cartagena, Colombia
| | - Elsa Karina Delgado-Angulo
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nasir Zeeshan Bashir
- School of Dentistry, University of Leeds, Leeds, UK
- School of Mathematics and Statistics, The University of Sheffield, Sheffield, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- DentStat Consulting Ltd, Cardiff, Wales, UK
| | - Eduardo Bernabe
- Institute of Dentistry, Queen Mary University of London, London, UK
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Colvara BC, Ritzel IF, Aguiar VR, Hilgert JB, Celeste RK. [Coverage of the Brazilian Income Transfer Program and factors associated with the performance of dental procedures in Brazil, from 2007 to 2011: an ecological study]. CAD SAUDE PUBLICA 2023; 39:e00200622. [PMID: 37466555 PMCID: PMC10494671 DOI: 10.1590/0102-311xpt200622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 07/20/2023] Open
Abstract
In Brazil, there has been an expansion of the coverage of dental services in primary health care (PHC), and the focus of the services has changed to include more efforts in prevention and diagnosis. However, little is known about the influence of the coverage of the Brazilian Income Transfer program on the use of dental services. Our study evaluates the association between municipal coverage of the Brazilian Income Transfer Program and the use of dental services. This ecological study conducted with data from the 5,570 Brazilian municipalities estimates, via logistic regressions, the impact of the coverage of the Brazilian Income Transfer program, the Family Health Strategies (FHS), and the oral health teams on the number of restoration, colective, prevention, and dental extraction procedures performed by the Brazilian Unified National Health System (SUS) between the periods 2007/2008 and 2010/2011. The percentage of municipalities that increased the rates of prevention, colective, restoration, and extraction procedures was 46%, 59.8%, 52.5%, and 44.2%, respectively. In the adjusted model, municipalities with increased coverage of Brazilian Income Transfer program were less likely to increase colective (OR = 0.91; 95%CI: 0.79-1.04) and prevention (OR = 0.92; 95%CI: 0.80-1.05) procedures, and they were more likely to increase rates of restoration (OR = 1.11; 95%CI: 0.97-1.28) and dental extraction (OR = 1,10; 95%CI: 0.95-1.27) procedures. The increase in the coverage rate of the oral health teams was significantly associated with a higher chance of an increase in prevention, restoration, and extraction procedures. We conclude that the coverage of oral health teams was the main variable associated with the increase in dental procedures performed in the public service.
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Nguyen TM, Bridge G, Hall M, Theodore K, Lin C, Scully B, Heredia R, Le LKD, Mihalopoulos C, Calache H. Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study. J Public Health Policy 2023; 44:310-324. [PMID: 37142745 PMCID: PMC10232653 DOI: 10.1057/s41271-023-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/06/2023]
Abstract
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.
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Affiliation(s)
- Tan M Nguyen
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia.
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Gemma Bridge
- Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Martin Hall
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Katy Theodore
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Clare Lin
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne Dental School, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ben Scully
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Ruth Heredia
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Hanny Calache
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
- La Trobe University, Bendigo, VIC, 3552, Australia
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Oshima K. Regular Dental Check-Ups Are Associated with Choosing Uninsured Dental Restoration/Prosthesis Treatment in Japan. Healthcare (Basel) 2023; 11:healthcare11111582. [PMID: 37297722 DOI: 10.3390/healthcare11111582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Since Japan has implemented Universal Health Coverage (UHC), most dental treatments are covered by public health insurance. Therefore, when receiving fixed dental restoration/prosthesis (FDRP) treatment, such as inlays, crowns, and bridges, the patient can choose whether or not it is covered by insurance. This study aimed to evaluate whether those who receive dental check-ups regularly chose uninsured FDRP treatment. Data were collected from 2088 participants, who had undergone FDRP treatment, via a web-based survey and analyzed. Among them, 1233 (59.1%) had received regular dental check-ups (RDC group) and 855 (40.9%) had not (non-RDC group). The multivariate logistic regression model showed that compared to the non-RDC group, those in the RDC group were statistically significantly associated with higher rates of good oral health behaviors (brushing teeth ≥ 3 times daily, odds ratios (OR):1.46; practiced interdental cleaning habitually, OR: 2.22) and received uninsured FDRP treatment more often (OR: 1.59), adjusted for socioeconomic factors. These results suggest that health policy interventions to promote access to RDC among individuals may improve the oral health of people and reduce the financial burden on the public health insurance system.
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Affiliation(s)
- Katsuo Oshima
- Department of Dental Technology, The Nippon Dental University College, Tokyo 102-8159, Japan
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Nakai Y, Mori-Suzuki Y. Cross-Cultural Validity of a Dietary Questionnaire for Studying Dental Caries in Japanese Children. Healthcare (Basel) 2023; 11:healthcare11071036. [PMID: 37046963 PMCID: PMC10093983 DOI: 10.3390/healthcare11071036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/18/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023] Open
Abstract
This study examines the cross-cultural validity of the Japanese version of the Food Frequency Questionnaire (FFQ), designed for studies on dental caries to assess dietary intake in Japanese children. Parent-reported dietary data were collected (274 children, 3-6 years old) using the 38-item FFQ, whose reliability and validity have been demonstrated in adults. Factor analysis was used to determine dimensionality. Dietary cariogenicity scores were compared with the levels of plaque mutans streptococci, and the decayed, missing, and filled teeth (dmft) index to evaluate the criterion validity using Pearson's correlation coefficient (r) and the Kruskal-Wallis test. The FFQ showed good criterion validity, assessed through its relationship with the dmft index (r = 0.119; p = 0.05) and Dentocult SM score (r = 0.124; p = 0.04). Factor analysis revealed six questionnaire subscales. Internal consistency was from low to acceptable (Cronbach's alpha = 0.64 for the total scale, 0.39-0.53 for each subscale). Children with a higher SM score were more likely to have higher dietary cariogenicity scores (p = 0.01; Kruskal-Wallis test). These results confirm the validity of the Japanese version of the FFQ for children, which can be used to track dietary structure dynamics regarding cariogenicity from childhood to adulthood.
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Affiliation(s)
- Yukie Nakai
- Department of Dental Hygiene, University of Shizuoka Junior College, Shizuoka 422-8021, Japan
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Miranda G, Bernabé E, Delgado-Angulo EK. Is social origin, destination or mobility what matters to adult self-rated oral health? Community Dent Oral Epidemiol 2023; 51:211-218. [PMID: 35084747 DOI: 10.1111/cdoe.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the independent contributions of parental socioeconomic position (SEP), own SEP and social mobility to explain adult self-rated oral health. METHODS Data from 6633 participants in the 1970 British Cohort Study were analysed. Parental SEP at the age of 10 years (social origin) and own SEP at the age of 46 years (social destination) were indicated by the 7-class National Statistics Socioeconomic Classification (NS-SEC). The study outcome was self-rated oral health (SROH) at the age of 46 years. Diagonal reference models (DRMs) were used to parse out the effects of parental SEP, own SEP and intergenerational mobility from childhood to middle adulthood, after adjusting for demographic characteristics (sex, ethnicity, country and area of residence). RESULTS Overall, 23.1% of participants reported poor SROH. A baseline DRM, with no indicators of social mobility, showed that the contribution of own SEP to explain variations in SROH was higher than that of parental SEP. However, they became almost equal after indicators of social mobility were introduced. Downward mobility was associated with poor SROH (odds ratio: 1.24, 95% CI: 1.01-1.51), but upward mobility was not (1.01, 95% CI: 0.83-1.23). Also, short-range downward mobility and long-range downward mobility (moving 1 and 2+ social classes down in NS-SEC, respectively) were associated with poor SROH (1.26, 95% CI: 1.01-1.58 and 1.39, 95% CI: 1.06-1.83, respectively) whilst short-range upward mobility (1.04, 95% CI: 0.84-1.28) and long-range upward mobility (0.88, 95% CI: 0.67-1.14) were not. CONCLUSIONS The contributions of parental and own SEP were similar once social mobility was accounted for. Only downward mobility was associated with poor SROH, with new evidence that long-range mobility was more strongly associated with poor SROH than short-range mobility.
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Affiliation(s)
- Gabriela Miranda
- Dental Public Health Group, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Eduardo Bernabé
- Dental Public Health Group, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Elsa Karina Delgado-Angulo
- Dental Public Health Group, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Perú
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Fernando C, Ha DH, Do LG, Tadakamadla SK. Socioeconomic Status and Toothbrushing in Indigenous and Non-Indigenous Australian Children. JDR Clin Trans Res 2023; 8:139-147. [PMID: 35360957 DOI: 10.1177/23800844221086205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Dental caries in children is a multifactorial and complex condition. Toothbrushing helps maintain good oral hygiene and delivers fluoride. However, determinants of toothbrushing could vary based on Indigenous status. OBJECTIVE This study aimed to assess the association between socioeconomic status and adequate toothbrushing practice (brushing twice or more a day) in Indigenous and non-Indigenous Australian children. METHODS Data were acquired from the National Child Oral Health Survey (NCOHS) 2012 to 2014. NCOHS administered questionnaires to parents of a representative sample of 24,215 Australian children aged 5 to 14 y recruited using a complex sampling method. Data on the frequency of toothbrushing and socioeconomic status were collected through the questionnaires. Statistical analysis was conducted progressively from bivariate to multivariable regression modeling, stratified by Indigenous status. RESULTS Just over half of Indigenous children and over two-thirds of non-Indigenous children reported adequate toothbrushing. The prevalence of adequate brushing (twice or more a day) was 42% (95% confidence interval [CI], 1.10-1.84) higher among children with an overseas-born parent than those with Australian-born parents. Among non-Indigenous children, sex and age, parents' country of birth, number of children in the family, and other family socioeconomic indicators (education, income, private health insurance) were associated with adequate toothbrushing. The prevalence of adequate brushing was 1.09 (95% CI, 1.03-1.15) and 1.15 (95% CI, 1.10-1.21) times higher when their parent possessed vocational training and tertiary education, respectively, compared to those children whose parents had school-level education. CONCLUSIONS There were differences in patterns of socioeconomic disparities for toothbrushing practices between Indigenous and non-Indigenous Australian children. KNOWLEDGE TRANSFER STATEMENT To promote positive toothbrushing practices in children, dental clinicians and public health professionals must be aware of the determinants of toothbrushing practices. Socioeconomic disparities in toothbrushing frequency were more apparent in non-Indigenous children. These results will help develop population-specific interventions that tackle the determinants to help improve oral hygiene behavior in Indigenous and non-Indigenous children.
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Affiliation(s)
- C Fernando
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - D H Ha
- School of Dentistry, The University of Queensland, Brisbane, Australia
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - L G Do
- School of Dentistry, The University of Queensland, Brisbane, Australia
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - S K Tadakamadla
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Karam SA, Costa FDS, Peres KG, Peres MA, Barros FC, Bertoldi AD, Santos IS, Tovo L, Matijasevich A, B Menezes AM, Gonçalves H, Correa MB, Demarco FF. Two decades of socioeconomic inequalities in the prevalence of untreated dental caries in early childhood: Results from three birth cohorts in southern Brazil. Community Dent Oral Epidemiol 2023; 51:355-363. [PMID: 35362631 DOI: 10.1111/cdoe.12747] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil. METHODS The socioeconomic data to this study were collected at the 48-month follow-up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality-SII and Concentration Index-CIX) were used. RESULTS The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro-poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data. CONCLUSIONS Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children.
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Affiliation(s)
- Sarah Arangurem Karam
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Karen G Peres
- National Dental Research Institute Singapore, National Dental Center Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Marco A Peres
- National Dental Research Institute Singapore, National Dental Center Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Fernando C Barros
- Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
| | | | - Iná S Santos
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luciana Tovo
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Faculty of Medicine, Department of Preventive Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Ana M B Menezes
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Helen Gonçalves
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Flávio Fernando Demarco
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
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Monsalves MJ, Espinoza I, Moya P, Aubert J, Durán D, Arteaga O, Kaufman JS, Bangdiwala SI. Structural determinants explain caries differences among preschool children in Chile's Metropolitan Region. BMC Oral Health 2023; 23:136. [PMID: 36894931 PMCID: PMC9996898 DOI: 10.1186/s12903-023-02778-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To estimate the association between Social Determinants of Health (structural and intermediate) and caries indicators in Chile's Metropolitan Region preschool children. METHODS A multilevel cross-sectional study of Social Determinants of Health (SDH) and caries in children aged 1 to 6 years in Chile's Metropolitan Region was conducted in 2014-2015, with three levels: district, school and child. Caries were assessed by the dmft-index and the prevalence of untreated caries. The structural determinants analyzed were Community Human Development Index (CHDI), urban/rural location, school type, caregiver's education and family income. Poisson multilevel regression models were fit. RESULTS The sample size was 2,275 children from 40 schools in 13 districts. While the highest CHDI district had an untreated caries prevalence of 17.1% (12.3-22.7%), in the most disadvantaged district it was 53.9% (95% CI 46.0-61.6%). As family income increased, the probability of untreated caries prevalence decreased (PR = 0.9 95% CI 0.8-1.0). Rural districts had an average dmft-index of 7.3 (95% CI 7.2-7.4), while in urban districts, it was 4.4 (95% CI 4.3-4.5). Higher probabilities of untreated caries prevalence (PR = 3.0 95% CI 2.3-3.9) were observed in rural children. Greater probabilities of untreated caries prevalence (PR = 1.3 95% CI 1.1-1.6) and prevalence of caries experience (PR = 1.3 95% CI 1.1-1.5) were observed in children whose caregivers had a secondary educational level. CONCLUSIONS A strong association was observed between the social determinants of health, specifically the structural ones, and the caries indicators studied in children of the Metropolitan Region of Chile. There were notable differences in caries between districts according to social advantage. Rurality and caregiver's education were the most consistent predictors.
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Affiliation(s)
- María José Monsalves
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Lota 2465, 7510157, Santiago, Chile.
| | - Iris Espinoza
- Departamento de Patología y Medicina Oral y Centro de Epidemiología y Vigilancia de Enfermedades Orales (CEVEO), Facultad de Odontología, Universidad de Chile, 380544, Santiago, Chile
| | - Patricia Moya
- Facultad de Odontología, Universidad Finis Terrae, 7501015, Santiago, Chile
| | - Josefina Aubert
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Lota 2465, 7510157, Santiago, Chile
| | - Doris Durán
- Instituto de Investigación en Ciencias Odontológicas (ICOD), Facultad de Odontología, Universidad de Chile, 380544, Santiago, Chile.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, H3A1G1, Canada
| | - Oscar Arteaga
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, 8380453, Santiago, Chile
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, H3A1G1, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton, ON, L8L2X2, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8N 3Z5, Canada
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Costa ACS, Mesquita CM, Vieira WA, Sponchiado-Júnior EC, de-Jesus-Soares A, Blumenberg C, Paranhos LR. Critical appraisal of confounding factors of observational studies on the association between dentofacial features and dental trauma in a Brazilian population. Evid Based Dent 2023; 24:44. [PMID: 36890251 DOI: 10.1038/s41432-023-00854-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/09/2023] [Indexed: 03/10/2023]
Abstract
AIMS/OBJECTIVES Dental trauma is a highly prevalent dental emergency. Children and adolescents without inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of traumatic dental injuries. Observational studies do not allow the inference of causality, one of the reasons being: the potential confounding factors. Therefore, this review aimed to critically appraise the confounding factors considered in epidemiological studies that associate dentofacial features with the occurrence of dental trauma in Brazilian children and adolescents. METHODS Studies included in the qualitative synthesis of a recently published comprehensive systematic review and meta-analysis on the topic were screened. Studies that only mentioned the performance of bivariate analyzes or that did not mention the performance of multivariate analyzes were excluded. Evaluation of control statements for possible confounders and bias consideration was performed for each selected study. Confounding factors in these studies were also identified and categorized according to their domains. RESULTS Fifty-five observational studies were screened, of which 11 were excluded due to the mention of only bivariate analyzes or the lack of multivariate analyses. The remaining 44 studies were critically appraised. Of these, 9 studies specifically mentioned the term confounding, and 12 studies mentioned the term bias. However, only 14 studies mentioned limitations on confounding factors in their findings. Among the 99 different variables identified, the most used were type of trauma, followed by sex and age. CONCLUSION Most studies did not acknowledge the control for possible confounding factors and rarely stressed the need for caution in interpreting their results. Cross-sectional studies do not allow inferring a cause-and-effect relationship between dentofacial features and dental trauma.
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Affiliation(s)
- Ana Carla Souza Costa
- Universidade CEUMA, Faculdade de Odontologia, Programa de Pós-Graduação em Odontologia, São Luiz, MA, Brasil
| | - Caio Melo Mesquita
- Universidade Federal de Uberlândia, Faculdade de Odontologia, Uberlândia, MG, Brasil
| | - Walbert A Vieira
- Departamento de Odontologia Restauradora, Divisão de Endodontia, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, SP, Brasil
| | | | - Adriana de-Jesus-Soares
- Departamento de Odontologia Restauradora, Divisão de Endodontia, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, SP, Brasil
| | | | - Luiz Renato Paranhos
- Universidade Federal de Uberlândia, Faculdade de Odontologia, Departamento de Odontologia Social e Preventiva, Uberlândia, MG, Brasil.
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Tuan WJ, Leinbach LI, Gill SA. Assessing Risks of Early Childhood Caries in Primary Care Practice Using Electronic Health Records and Neighborhood Data. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:178-185. [PMID: 36126220 PMCID: PMC9897270 DOI: 10.1097/phh.0000000000001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
CONTEXT Early childhood caries (ECC) is a persistent public health challenge, affecting more than 56% of US toddlers and preschool-aged children. Despite this, ECC is largely preventable with routine oral hygiene practices, diet, and application of topical fluoride. OBJECTIVE This study assessed the utilization of preventive oral health care in primary care practices and evaluated the variation in patient characteristic and geographic disparities. DESIGN We conducted a retrospective study using electronic health records (EHRs) over a 2-year period. Patients' home addresses were geocoded and linked to census-based neighborhood statistics and fluoridated water accessibility. Multiple logistic regression modeling was used to assess the risk of ECC in patients with fluoride preventive care, controlled for demographics, comorbid conditions, and neighborhood risk factors. PARTICIPANTS Patients aged 6 to 71 months who had primary care providers at family medicine and general pediatric clinics in a large academic medical center. MAIN OUTCOME MEASURE The presence of dental caries based on diagnoses in EHRs. RESULTS The study consisted of 10 836 patients: 17% treated with topical fluoride varnish (TFV), 12% prescribed oral fluoride supplement, 6.1% with both TFV and supplement, and 64% without fluoride treatment. Patients with fluoride treatment were 24% to 53% less likely to have ECC. Children living in rural and nonfluoridated water communities had 1.7 to 1.8 times greater risk of developing ECC. Minority, under/uninsured, and low-income patients also were at an increased risk of ECC. CONCLUSION Despite continuing efforts to improve access to dental care for vulnerable populations, substantial disparities remain among socioeconomically disadvantaged children. To address dental care shortage, primary care clinicians should serve as the safety net to care for vulnerable and underserved children who have no or limited access to oral health services. Future research into the collaboration between primary care and dental providers at the level of both practice and professional education should be considered.
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Affiliation(s)
- Wen-Jan Tuan
- Departments of Family and Community Medicine (Drs Tuan and Gill), Public Health Sciences (Drs Tuan and Leinbach), and Surgery (Dr Leinbach), College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Leah I. Leinbach
- Departments of Family and Community Medicine (Drs Tuan and Gill), Public Health Sciences (Drs Tuan and Leinbach), and Surgery (Dr Leinbach), College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Stephanie A. Gill
- Departments of Family and Community Medicine (Drs Tuan and Gill), Public Health Sciences (Drs Tuan and Leinbach), and Surgery (Dr Leinbach), College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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Felgner S, Henschke C. Patients' preferences in dental care: A discrete-choice experiment and an analysis of willingness-to-pay. PLoS One 2023; 18:e0280441. [PMID: 36848356 PMCID: PMC9970100 DOI: 10.1371/journal.pone.0280441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/31/2022] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION Dental diseases are a major problem worldwide. Costs are a burden on healthcare systems and patients. Missed treatments can have health and financial consequences. Compared to other health services, dental treatments are only covered in parts by statutory health insurance (SHI). Using the example of dental crowns for a cost-intensive treatment, our study aims to investigate whether (1) certain treatment attributes determine patients' treatment choice, and (2) out-of-pocket payments represent a barrier to access dental care. METHODS We conducted a discrete-choice-experiment by mailing questionnaires to 10,752 people in Germany. In presented scenarios the participants could choose between treatment options (A, B, or none) composed of treatment attribute levels (e.g., color of teeth) for posterior (PT) and anterior teeth (AT). Considering interaction effects, we used a D-efficient fractional factorial design. Choice analysis was performed using different models. Furthermore, we analyzed willingness-to-pay (WTP), preference of choosing no and SHI standard care treatment, and influence of socioeconomic characteristics on individual WTP. RESULTS Out of n = 762 returned questionnaires (response rate of r = 7.1), n = 380 were included in the analysis. Most of the participants are in age group "50 to 59 years" (n = 103, 27.1%) and female (n = 249, 65.5%). The participants' benefit allocations varied across treatment attributes. Aesthetics and durability of dental crowns play most important roles in decision-making. WTP regarding natural color teeth is higher than standard SHI out-of-pocket payment. Estimations for AT dominate. For both tooth areas, "no treatment" was a frequent choice (PT: 25.7%, AT: 37.2%). Especially for AT, treatment beyond SHI standard care was often chosen (49.8%, PT: 31.3%). Age, gender, and incentive measures (bonus booklet) influenced WTP per participant. CONCLUSION This study provides important insights into patient preferences for dental crown treatment in Germany. For our participants, aesthetic for AT and PT as well as out-of-pocket payments for PT play an important role in decision-making. Overall, they are willing to pay more than the current out-of-pockt payments for what they consider to be better crown treatments. Findings may be valuable for policy makers in developing measures that better match patient preferences.
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Affiliation(s)
- Susanne Felgner
- Department of Health Care Management, Berlin Centre of Health Economics Research (BerlinHECOR), Technische Universität Berlin, Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Berlin Centre of Health Economics Research (BerlinHECOR), Technische Universität Berlin, Berlin, Germany
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Oshima K. People's Willingness to Pay for Dental Checkups and the Associated Individual Characteristics: A Nationwide Web-Based Survey among Japanese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4145. [PMID: 36901149 PMCID: PMC10001831 DOI: 10.3390/ijerph20054145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to determine the willingness-to-pay (WTP) values for dental checkups and analyze the association between the values and individual characteristics. This cross-sectional study was conducted using a nationwide web-based survey, and 3336 participants were allocated into groups that received regular dental checkups (RDC; n = 1785) and those who did not (non-RDC; n = 1551). There was a statistically significant difference in the WTP value for dental checkups between the RDC (median: 3000 yen [22.51 USD]) and non-RDC groups (2000 yen [15.01 USD]). In the RDC group, age 50-59 years, household income <2 million yen, homemaker and part-time worker employment status, and having children were significantly associated with decreased WTP values; male sex, household incomes ≥8 million yen, and tooth brushing ≥3 times daily were associated with increased WTP values. In the non-RDC group, age ≥30 years, household incomes <4 million yen, and having ≥28 teeth were significantly associated with decreased WTP values; household income ≥8 million yen was associated with increased WTP values. Conclusively, WTP values for dental checkups were lower in the non-RDC group than in the RDC group; in the non-RDC group, those with lower household income aged ≥30 years were more likely to propose lower WTP values, suggesting the need for policy intervention to improve access to RDC.
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Affiliation(s)
- Katsuo Oshima
- Department of Dental Technology, The Nippon Dental University College, Tokyo 102-8159, Japan
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Rodriguez JL, Thakkar-Samtani M, Heaton LJ, Tranby EP, Tiwari T. Caries risk and social determinants of health: A big data report. J Am Dent Assoc 2023; 154:113-121. [PMID: 36503669 DOI: 10.1016/j.adaj.2022.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/30/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral health is influenced by social determinants of health (SDH), predisposing people and communities to greater risk of developing caries. This study evaluated the association between caries risk in adults and SDH such as ZIP Codes, systemic diseases, payment methods, and race or ethnicity. METHODS The BigMouth Dental Data Repository (n = 57,211) was used to extract clinical and SDH data from patients' dental electronic health records for 2019. Caries risk categories were used as ZIP Code data was merged with the Social Deprivation Index, a composite measure of area-level deprivation based on 7 demographic characteristics collected in the American Community Survey. RESULTS The results showed that the odds of being in the high caries risk group were higher for people in the 49- to 64-year age group (adjusted odds ratio [aOR], 2.24; 95% CI, 2.08 to 2.40; P ≤ .001), men (aOR, 1.19; 95% CI, 1.13 to 1.25; P ≤ .001), people who had comorbidities (diabetes: aOR, 1.16; 95% CI, 1.08 to 1.24; P ≤ .001; cardiovascular disease: aOR, 1.40; 95% CI, 1.32 to 1.50), and people with an Social Deprivation Index score above the 75th percentile (aOR, 2.39; 95% CI, 2.21 to 2.58; P ≤ .001). In addition, Hispanic and Black people had higher odds of being at high caries risk than other races or ethnicities (Hispanic: aOR, 3.05; 95% CI, 2.32 to 4.00; Black: aOR, 2.05; 95% CI, 1.02 to 4.01). CONCLUSIONS This study shows the association of caries risk with higher social deprivation, reinforcing the role of structural and upstream factors in oral health. This study is unique in using recorded ZIP Code information and assessing caries risk levels for those regions. PRACTICAL IMPLICATIONS The physical and structural environment should be considered contributors to caries risk in people.
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Income-related inequalities in the association of smoking with periodontitis: a cross-sectional analysis in Tokyo Metropolitan Districts. Clin Oral Investig 2023; 27:519-528. [PMID: 36241924 DOI: 10.1007/s00784-022-04747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/02/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Socio-economic status (SES) and smoking are risk factors for periodontitis; however, their interaction has not been determined. We investigated the effect of modification of SES and smoking with periodontal conditions. MATERIALS AND METHODS Data on the social background, smoking status, and dental examination of 1033 individuals residing in the Tokyo Metropolitan District were analyzed. The outcomes were the number of remaining teeth and the proportion of teeth with probing pocket depth (PPD) ≥ 4 mm and ≥ 6 mm. Multilevel linear and Poisson regression analyses were performed after adjusting for possible confounding factors, including SES, assessed by the average income of the residential area. RESULTS The mean number of remaining teeth was 24.6 ± 4.8, and the proportion of teeth with PPD ≥ 4 mm and ≥ 6 mm was 31.2 ± 28.5% and 12.2 ± 18.1%, respectively. After adjusting for confounding factors, the lowest-income population had significantly lesser teeth (coefficient: - 0.46, 95% CI - 0.89, 0.02, p = 0.039) and a higher proportion of teeth with PPD ≥ 4 mm than the highest-income population (ratio of means: 1.22, 95% CI 1.03-1.44, p = 0.013). Significant interactions were observed; income inequalities in periodontitis were significant only among current smokers. CONCLUSION Inequality in socio-economic status is associated with oral health inequalities. The adverse effects of smoking on periodontitis might be greater in the low-income population. CLINICAL RELEVANCE The low-income population, especially current smokers, had significantly more compromised oral health than the high-income population. In addition to the emphasis on smoking cessation, the promotion of universal health coverage for dental care is necessary to reduce oral health inequalities.
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Amaral Júnior OLD, Fagundes MLB, Bastos LF, Menegazzo GR, Hugo FN, Abreu LG, Iser BPM, Hilgert JB, Giordani JMDA. Dental visits and depression mediating the association of socioeconomic status with oral health behaviors. Braz Oral Res 2023; 36:e094. [PMID: 36651385 DOI: 10.1590/1807-3107bor-2022.vol36.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/07/2022] [Indexed: 01/18/2023] Open
Abstract
Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the "Patient Health Questionnaire-9") and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.
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Affiliation(s)
- Orlando Luiz do Amaral Júnior
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stoatology, Santa Maria, RS, Brazil.,Centro Universitário FAI - UCEF, School of Dentistry, Department of Oral Health, Itapiranga, SC, Brazil
| | | | - Lucelen Fontoura Bastos
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil
| | - Gabriele Rissotto Menegazzo
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stoatology, Santa Maria, RS, Brazil
| | - Fernando Neves Hugo
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil
| | - Lucas Guimarães Abreu
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Child and Adolescent Oral Health, Belo Horizonte. MG, Brazil
| | - Betine Pinto Moehlecke Iser
- Universidade do Sul de Santa Catarina - Unisul, Post-Graduate Program in Health Sciences, Tubarão, SC, Brazil
| | - Juliana Balbinot Hilgert
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil
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Nguyen TM, Tonmukayakul U, Le LKD, Calache H, Mihalopoulos C. Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:53-70. [PMID: 36089630 PMCID: PMC9834378 DOI: 10.1007/s40258-022-00758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia.
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | - Long Khanh-Dao Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
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