Do dental anxiety and satisfaction with dental professionals modify the association between affordability and dental service use? A population-based longitudinal study of Australian adults

OBJECTIVES

This study aimed to assess the association between affordability in terms of difficulty paying dental bills in Australian dollars and dental service use in the presence of sociodemographic confounders, and to assess the role of dental anxiety and satisfaction with dental professionals as mediators. The second aim was to investigate how dental anxiety and satisfaction with dental professionals modify the association between affordability and use of dental services in Australian adults.

METHODS

Longitudinal data from the Australian National Study of Adult Oral Health (2004-06 and 2017-18) was used. Poisson regression and path analysis were conducted to determine the association between affordability and frequency of use of dental services. Effect measure modification (EMM) analysis was performed by stratification of dental anxiety and satisfaction with dental professionals.

RESULTS

The study included 1698 Australian adults and identified that the prevalence of low frequency of dental visits was 20% more for those who had difficulty paying dental bills. Adults with dental anxiety (prevalence ratio [PR] = 1.14) and those who were dissatisfied with dental professionals (PR = 1.17) had a higher prevalence of low frequency of dental visits in the presence of difficulty paying dental bills. This indicated that dental anxiety and dissatisfaction with dental professionals were effect modifiers on this pathway.

CONCLUSIONS

Adults who experience dental anxiety and dissatisfaction with dental professionals are more likely to avoid dental visits when faced with difficulty paying dental bills. However, it is important to note that these associations do not necessarily imply a causal relationship.

Self-reported oral health status, edentulism and all-cause mortality risk in 12 809 Australian older adults: a prospective cohort study

OBJECTIVE

To investigate the association between oral health status and all-cause mortality in older adults using prospective cohort study design.

SETTING AND PARTICIPANTS

In total, 12 809 adults aged ≥70 years (54.3% females) were participants of the ASPREE Longitudinal Study of Older Persons (ALSOP).

METHODS

Participants self-reported the presence of natural teeth and oral health status. The association of self-reported oral health, edentulism and the integrative measure of the two with all-cause mortality were explored using the Cox-regression models adjusted for age, gender, socio-economic status, health-related behaviours, weight status, aspirin and polypharmacy. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.

RESULTS

In total, 22.2% of participants reported edentulism and 13.8% had fair/poor oral health. After adjustment for confounders, risk of all-cause mortality was higher among those with edentulism (vs. no edentulism) HR (95% CI) 1.43 (1.18, 1.73); and those with edentulism and reporting poor/fair oral health HR (95% CI) 1.69 (1.02, 2.82), or with no edentulism but reporting poor/fair oral health HR (95% CI) 1.46 (1.19-1.80) vs. no edentulism and reporting good/very good/excellent oral health. No association was observed between self-reported oral health alone and all-cause mortality.

CONCLUSIONS

The risk of all-cause mortality was 69% higher among older adults reporting both edentulism and poor/fair oral health compared with those with teeth and more favourable self-reported oral health. © 2023 Australian Dental Association.

The impact of unmet treatment need on oral health related quality of life: a questionnaire survey

BACKGROUND

Based on the present global burden of oral diseases, unmet dental needs affect a more significant population worldwide. It is characterised by the need for dental care but receiving delayed or no care. The contributing factors include lack of knowledge about oral health, its consequences, and the availability of dental services. We need to find out the scale of the problem of unmet dental needs for the south Indian population. Therefore, the objective was to determine the relationship between the presence of oral disease and the quality of life-related to oral health using the OHIP-14 tool.

METHODS

The unmet dental requirements of the south Indian population were determined using a cross-sectional questionnaire survey. Close-ended questions were used to obtain data from two investigators trained to record the answers from the patients. The data was collected using the OHIP-14 questionnaire, which consists of 14 items divided into seven domains with two questions each. Physical pain, psychological impairment, physical disability, psychological disability, social disability, and disability were all considered. An additional analysis of artificial neural network (ANN) was done.

RESULTS

The response rate was 100 per cent. N = 1029 people replied to the questionnaire about their unmet dental needs. N = 497 (48.3%) were men, whereas N = 532 (51.7%) were women. The average age was 31.7811.72. As their current occupation, most of the included subjects (60.1%) were students. The respondents had no known personal habits and a mixed diet (94.93%). The average BMI was 24.022.59 (14-30.9). OHIP was present in 62.3% of the population. The average OHIP-14 severity score was 10.97. (8.54). The severity and degree of unmet dental need were substantial (p0.01) due to pain in the mouth/teeth/gums, malocclusion, and gum bleeding. The most common OHIP-14 domains affected by unmet oral needs were psychological discomfort, psychological limitation, social limitation, and feeling handicapped. The analysis of ANN revealed that high OHIP scores were primarily attributed to dental caries, poor oral health, and dental aesthetics.

CONCLUSION

The severity and degree of unmet dental needs were significant among the south Indian population. The most common oral health status that impacted OHIP-14 domains were pain, malocclusion, and bleeding gums. These patients were significantly impacted by psychological discomfort and social limitations and felt handicapped.

Prevalence of dental visits in older Japanese adults receiving public assistance

OBJECTIVES

Exemption from paying dental care costs among recipients of public assistance contributes to universal health care coverage. Although this system might reduce the financial barriers to dental care among patients, there are still several other barriers for public assistance recipients. Therefore, this study examined whether receiving public assistance was associated with a higher prevalence of dental visits for any reason, treatment and prevention.

METHODS

Data were obtained from 16 366 respondents from the 2019 wave of a nationwide cohort study on older adults in Japan. Poisson regression analyses with robust error variance were used to examine the associations between receiving public assistance and dental visits, adjusting for number of teeth, dental pain, periodontal conditions, age, sex, number of family members, education, equivalent household income, working status, instrumental activities of daily living, medical conditions, depressive symptoms, instrumental support and geographical variations.

RESULTS

More than half of the non-recipients of public assistance visited a dentist for some reason in the past 6 months. Meanwhile, only 37% of the recipients visited a dentist. In addition, almost half of the non-recipients had treatment visits, while only 34% of the recipients visited. Furthermore, 46% of the non-recipients had dental visits for prevention, while 32% of the recipients had preventive visits. In the fully adjusted models, compared to non-recipients, public assistance recipients were 24% (Prevalence Ratio [PR]: 0.76, 95% Confidence Intervals [CI]: 0.64, 0.90), 23% (PR: 0.77, 95% CI: 0.65, 0.92) and 21% (PR: 0.79, 95% CI: 0.65, 0.95) less likely to have dental visits for any reason, treatment, and prevention, respectively.

CONCLUSIONS

Although recipients were exempted from dental treatment fees, receiving public assistance was associated with a lower prevalence of dental visits for any reason, treatment and prevention. Future studies should identify the barriers to accessing dental care among public assistance recipients to improve dental visits.

Sociodemographic, biological, and timing characteristics of dental caries and fluorosis using mixed-type cluster analysis on 12-year-olds in Ho Chi Minh city, 1989-2019

Objectives

In 1990, Ho Chi Minh City started Community water fluoridation (CWF) at 0.7 ppm F, and in 2000, it was adjusted to 0.5 ppm F. Here, we analyzed dental caries and fluorosis data in Ho Chi Minh City to explore commonalities associated with CWF among 12-year-old children.

Methods

Dental caries and fluorosis data were collected in 1989, 2003, 2012, and 2019 (N = 4773). Trained dentists scored dental caries using the WHO detection criteria and fluorosis using Dean's Fluorosis Index. We used these data and the k-prototypes method by the R package to identify clusters of participants with shared clinical and water fluoride levels.

Results

We used datasets 1 (4773 participants) and 2 (4194 participants, missing fluorosis data in 1989). K-prototypes analysis identified three clusters in each dataset. Cluster 1, with 80 % of the sample at 0.5 ppm F area characterized by low caries and fluorosis scores. Cluster 2 with 60 % of the sample non-fluoridated area had high caries and low fluorosis scores. Cluster 3, with 75 % of the sample in 0.7 ppm area, had low caries but borderline high fluorosis scores.

Conclusion

Identifying three clusters based on clinical and environmental scores supports the decision to fluoridate the water to prevent caries (0-0.7 ppm) and the shift from 0.7 to 0.5 ppm to keep the caries preventive effect while reducing the risk of fluorosis.

Clinical significance

Our results support the effectiveness of CWF in preventing dental caries and the appropriateness of changing the F concentration to reduce the risk of fluorosis while maintaining its effectiveness.

Time to complete contemporary dental procedures - estimates from a cross-sectional survey of the dental team

BACKGROUND

There are few contemporary studies on the time taken to complete dental procedures, those most heavily relied on in the United Kingdom date back to 1999.

OBJECTIVES

This work aimed to establish how long members of the dental team took to complete specific dental procedures, relevant to their scope of practice.

METHODS

Data were collected via a purposive sample of 96 dentists, dental hygienists/therapists and dental nurses. Via an online survey, participants were asked to state the mean, minimum and maximum time they estimated that they took to complete individual dental procedures.

RESULTS

The mean time taken to complete procedures common to both dentists and dental hygienists/therapists ranged from 3.7 to 4 min respectively for clinical note reading prior to seeing patients to 30.1 and 28 min to undertake root surface debridement. There were no significant differences between the time taken by dentists and dental hygienists/therapists to treat adult patients. However, in all but one procedure, dental hygienists/therapists reported taking longer (p = 0.04) to treat child patients.

CONCLUSIONS

The data provided here represent an up to date assessment of the time taken to complete specific tasks by different members of the dental team. These data will be of value to service planners and commissioners interested in evolving a dental care system that employs a greater degree of skill-mix and preventively oriented care.

Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review

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.

Applications of Nanomaterials in Dentistry: A Review

Aim and Objective

Currently, the major priority in the field of nanotechnology or nanoscience is research and development at the atomic- or molecular-level sciences. Almost every aspects of human health, including pharmaceutical, clinical research and analysis, and supplemental immunological systems, are significantly impacted by it. Diverse dental applications to the realm of nanotechnology, which also reflect developments in material sciences, have given rise to the field of nanodentistry and nanocatalytic drug development, especially in oral nanozyme research and application. This review is aimed to provide readers an in-depth analysis of nanotechnology's characteristics, varied qualities, and applications toward dentistry.

Materials and Methods

A query was carried out in PubMed and Google Scholar databases for the articles published from 2007 to 2022 using the keywords/MESH term nanomaterials, dentistry, nanoenzymes, metals, and antibacterial activity. Data extraction and evidence synthesis have been performed by three researchers individually.

Results

A total of 901 articles have been extracted, out of which 108 have been removed due to repetitions and overlapping. After further screening following exclusion and inclusion criteria, 74 papers were considered to be pertinent and that primarily addressed dental nanotechnology were chosen. Further, the data havebeen extracted and interpreted for the review. The results of the review indicated that the development of multifunctional nanozymes has been continuously assessed in relation to oro-dental illnesses to show the significant impact that nanozymes have on oral health.

Conclusion

As evidenced by the obtained results, with the advent of ongoing breakthroughs in nanotechnology, dental care could be improved with advanced preventive measures.

Dental hesitancy: a qualitative study of culturally and linguistically diverse mothers

BACKGROUND

Oral healthcare is paramount and inextricably linked to well-being. Yet, the evidence indicates that culturally and linguistically diverse (CALD) migrant communities have unequal access to mainstream dental services due to several barriers. The purpose of this study was to investigate the oral healthcare experiences, attitudes and barriers to oral healthcare utilisation in CALD mothers.

METHODS

A qualitative study with semi-structured interviews was conducted within a social constructivism epistemology. CALD mothers who identified as non-English speaking, foreign country born, with a child under 12, were recruited though purposive snowball sampling. Questions probed oral healthcare experiences, barriers, enablers, and attitudes. Verbatim typed transcripts were thematically analysed using grounded methodology.

RESULTS

Thirty-three CALD mothers participated; twenty from India, five from Fiji, four from China, two from Nepal and one each from Israel and Macedonia. Languages included Cantonese, Fiji-Hindi, Gujrati, Hebrew, Hindi, Kannada, Mandarin, Maharashtrian, Macedonian, Nepalese, Punjabi, Sanskrit, Telegu and Urdu. Cost was the foremost barrier to oral healthcare services, followed by Confidence in quality care for the provision of services and treatment. Confusion in navigating a public and private healthcare system was highlighted and Competing priorities took precedence. Complacency referred to 'no need' or lack of urgency in dental care. Subsequently, dental hesitancy (superordinate theme) described the patterning of data as comprising the five 'C' factors and was theorised as the dental hesitancy phenomenon to explain the occurrence of delay or avoidance in utilising dental care.

CONCLUSION

Findings highlight the utility of the dental hesitancy phenomenon unearthed within this study. CALD mothers explained five 'C' dimensions: cost, confidence, confusion, competing priorities and complacency as barriers to accessing timely dental care. Multisectoral collaboration between healthcare systems, universal health coverage and primary sector support is required to address dental hesitancy in CALD mothers. Further, this study contributes to the field of behavioural and social sciences in oral health and augments the literature on dental avoidance.

Phenotype Harmonization in the GLIDE2 Oral Health Genomics Consortium

Genetic risk factors play important roles in the etiology of oral, dental, and craniofacial diseases. Identifying the relevant risk loci and understanding their molecular biology could highlight new prevention and management avenues. Our current understanding of oral health genomics suggests that dental caries and periodontitis are polygenic diseases, and very large sample sizes and informative phenotypic measures are required to discover signals and adequately map associations across the human genome. In this article, we introduce the second wave of the Gene-Lifestyle Interactions and Dental Endpoints consortium (GLIDE2) and discuss relevant data analytics challenges, opportunities, and applications. In this phase, the consortium comprises a diverse, multiethnic sample of over 700,000 participants from 21 studies contributing clinical data on dental caries experience and periodontitis. We outline the methodological challenges of combining data from heterogeneous populations, as well as the data reduction problem in resolving detailed clinical examination records into tractable phenotypes, and describe a strategy that addresses this. Specifically, we propose a 3-tiered phenotyping approach aimed at leveraging both the large sample size in the consortium and the detailed clinical information available in some studies, wherein binary, severity-encompassing, and "precision," data-driven clinical traits are employed. As an illustration of the use of data-driven traits across multiple cohorts, we present an application of dental caries experience data harmonization in 8 participating studies (N = 55,143) using previously developed permanent dentition tooth surface-level dental caries pattern traits. We demonstrate that these clinical patterns are transferable across multiple cohorts, have similar relative contributions within each study, and thus are prime targets for genetic interrogation in the expanded and diverse multiethnic sample of GLIDE2. We anticipate that results from GLIDE2 will decisively advance the knowledge base of mechanisms at play in oral, dental, and craniofacial health and disease and further catalyze international collaboration and data and resource sharing in genomics research.

Establishing the research agenda for oral healthcare using the Dialogue Model-patient involvement in a joint research agenda with practitioners

Engagement of patients in the composition of a research agenda is essential to reduce the gap between research and practice and thereby generate more impact. The aim of this study was to develop a research agenda for oral health. Experienced challenges and needs with oral health(care) of practitioners and patients formed the input for the research agenda. We describe the identification of research priorities of patients and the integration of these with previously identified research priorities of practitioners, using a participatory multi‐phase approach for research agenda setting (Dialogue Model). Via focus group discussions, 32 research topics were generated. Next, 1495 patients prioritized these topics in an online survey. In a dialogue meeting, a joint research agenda of eight research topics was agreed upon. Many topics were contributed by patients, but were prioritized by both stakeholder groups. The most important topics concerned behavior change and the relation between general and oral health. Other topics that were prioritized covered affordability and accessibility as well as health system research and organizational issues. By considering different perspectives, this research agenda has uncovered directions for future research that go beyond evident research topics, as many topics are currently underrepresented in oral healthcare research.

Crossing the Innovation Chasm: Identifying Facilitators and Barriers to Early Adoption of the Global Health Starter Kit Curriculum

Purpose:

The Global Health Starter Kit (GHSK) is an interdisciplinary, competency-based, open access global health curriculum covering global disease and demographic trends, Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), the connection between oral health and overall health, social determinants of health, and concepts of sustainable and ethical global health programs. In this study, we evaluate and describe barriers to and facilitators for using and implementing the GHSK curriculum across a variety of new users.

Methods:

This two-phase study uses the Roger’s Adoption Curve concept to standardize this evaluation and inform a strategic plan for continuing to move the curriculum across the chasm from early adopters to an early majority of global oral health educators and learners. We utilized a theoretical adoption framework to identify facilitators and barriers under the domains of innovation and curricular, educator and learner, and institutional and structural factors. Under qualitative Phase 1, five early adopter institutions were interviewed to elicit understanding of factors that contribute to adoption of the GHSK curriculum. Common themes identified were next used to create a Phase 2 quantitative survey for early majority subscribers of the GHSK (N = 27).

Results:

These qualitative and quantitative results showed an overall high satisfaction with the quality of the GHSK materials, but also effectively identified barriers to its adoption, including inexperience of faculty in teaching global oral health, a lack of awareness and marketing, and absence of global health accrediting requirements.

Conclusions:

By identifying the barriers and facilitators of GHSK curriculum integration, this study provides concrete and specific opportunities to improve its format, relevance, content, and delivery. This study outlines next steps to creating a standardized approach to successfully adopting competency-based global oral health teaching and learning.

Beneficial effects of a mouthwash containing an antiviral phthalocyanine derivative on the length of hospital stay for COVID-19: randomised trial

The risk of contamination and dissemination by SARS-CoV-2 has a strong link with nasal, oral and pharyngeal cavities. Recently, our research group observed the promising performance of an anionic phthalocyanine derivative (APD) used in a mouthwash protocol without photoexcitation; this protocol improved the general clinical condition of patients infected with SARS-CoV-2. The present two-arm study evaluated in vitro the antiviral activity and cytotoxicity of APD. Additionally, a triple-blind randomized controlled trial was conducted with 41 hospitalized patients who tested positive for COVID-19. All the included patients received World Health Organization standard care hospital treatment (non-intensive care) plus active mouthwash (experimental group AM/n = 20) or nonactive mouthwash (control group NAM/n = 21). The adjunct mouthwash intervention protocol used in both groups consisted one-minute gargling/rinsing / 5 times/day until hospital discharge. Groups were compared considering age, number of comorbidities, duration of symptoms prior admission and length of hospital stay (LOS). The associations between group and sex, age range, presence of comorbidities, admission to Intensive care unit (ICU) and death were also evaluated. The in vitro evaluation demonstrated that APD compound was highly effective for reduction of SARS-CoV-2 viral load in the 1.0 mg/mL (99.96%) to 0.125 mg/mL (92.65%) range without causing cytotoxicity. Regarding the clinical trial, the median LOS of the AM group was significantly shortened (4 days) compared with that of the NAM group (7 days) (p = 0.0314). Additionally, gargling/rinsing with APD was very helpful in reducing the severity of symptoms (no ICU care was needed) compared to not gargling/rinsing with APD (28.6% of the patients in the NAM group needed ICU care, and 50% of this ICU subgroup passed way, p = 0.0207). This study indicated that the mechanical action of the protocol involving mouthwash containing a compound with antiviral effects against SARS-CoV-2 may reduce the symptoms of the patients and the spread of infection. The use of APD in a mouthwash as an adjuvant the hospital COVID-19 treatment presented no contraindication and reduced the hospital stay period.

Trial registration: The clinical study was registered at REBEC—Brazilian Clinical Trial Register (RBR-58ftdj).

[Global oral health in the international health policy spotlight-challenges and new opportunities for sustainable improvement]

Orale Erkrankungen sind ein signifikantes globales Gesundheitsproblem über alle Länder und Bevölkerungsgruppen hinweg. Mit fast 3,5 Mrd. Erkrankungsfällen (2017) sind so viele Menschen betroffen wie von keiner anderen Krankheitsgruppe. Die Haupterkrankungen sind unbehandelte Karies der bleibenden oder der Milchzähne, fortgeschrittene Parodontopathien, Zahnlosigkeit sowie Karzinome der Mundhöhle und Lippen. Bei weitgehend unverändert hoher globaler Prävalenz erhöhen durch Bevölkerungswachstum bedingte stark steigende Fallzahlen den Druck auf schwache oder überlastete Gesundheitssysteme, insbesondere in Ländern der unteren und mittleren Einkommensgruppen.

Dennoch wird der Mundgesundheit in vielen Ländern nur unzureichende Priorität eingeräumt und sie erhält als wichtiges Thema im gesundheitspolitischen Diskurs der deutschen und globalen Akteure nach wie vor wenig Aufmerksamkeit. Eine der fundamentalen Herausforderungen ist dabei die Gewährleistung eines allgemeinen und fairen Zugangs zu adäquater universeller Basisgesundheitsversorgung für alle Menschen ohne Verursachung von finanziellen Härten (Universal Health Coverage).

Dieser Beitrag gibt einen einführenden Überblick über die globalen Trends der weltweiten Krankheitslast der oralen Haupterkrankungen, die von starken Ungleichheiten geprägt sind. Verbesserungsansätze aus der bevölkerungsweiten Risikoreduktion und Prävention, der Versorgungsplanung sowie gesundheitspolitische Lösungen werden kurz vorgestellt. Dabei werden die im internationalen Diskurs wichtigen Themen angesprochen und die im Rahmen einer Lancet-Artikelserie zur globalen Mundgesundheit aus dem Jahr 2019 entwickelten Reformbereiche besprochen. Schließlich werden neue Initiativen diskutiert sowie Empfehlungen für die deutsche und internationale gesundheitliche Entwicklungspolitik gegeben, die in den kommenden Jahren die Situation der globalen Mundgesundheit entscheidend verbessern könnten.

Oral health academics' conceptualisation of health promotion and perceived barriers and opportunities in dental practice: a qualitative study

BACKGROUND

Oral diseases place a significant burden on individual and population health. These diseases are largely preventable; health promotion initiatives have been shown to decrease the disease rates. However, there is limited implementation of health promotion in dentistry, this could be due to a number of factors; the ethos and philosophy of dentistry is focused on a curative, individualised approach to oral diseases, confusion around health promotion as a concept. Oral health academics are well placed to implement health promotion, training of these professionals needs to include prevention, as training influences dental practice. However, there is a little understanding about how oral health academics (dental professionals who educate dental and oral health students) view health promotion. The aim of this exploratory study is to understand how oral health academics conceptualise health promotion and perceive the barriers and possible opportunities for health promotion implementation in dental practice.

METHODS

Nominal group technique (NGT), a highly structured face-to-face meeting, was conducted with 24 oral health academics to explore how they conceptualize health promotion and the barriers and opportunities for health promotion in practice. An additional 4 questions were emailed to oral health educators after the NGT meeting to gather additional data, 6 oral health academics were involved. The data was analyzed using thematic analysis.

RESULTS

Three board themes were identified: "Knowledge, ideas and concepts of health promotion", "Challenges to health promotion", "Opportunities for health promotion practice". The oral health academics in this study discussed health promotion in a holistic way, however, health education and behaviour change were mentioned more than other aspects of health promotion. The structure of dental practice specifically the curative approach that underpins dentistry and the lack of funding, and value placed on health promotion could act as a challenge to health promotion being implemented in practice. There has been a shift towards prevention in dentistry, however the participants acknowledge there needs to be a change in the curative culture of the profession. Collaboration with other health professionals and using a common risk factor approach were the identified opportunities for health promotion practice.

CONCLUSIONS

Oral health academics have a holistic understanding of health promotion, but still focus more on behavioural approaches which is common within dentistry. For a change to occur in health promotion practice a change in the structure, curative approach and funding model of dentistry is required. Collaboration with other health professionals is an opportunity to be capitalised on. Training of future dental professionals is the perfect place to start to implement the changes and opportunities for health promotion presented in this paper.

Nanozymes go oral: nanocatalytic medicine facilitates dental health

Nanozymes are multi-functional nanomaterials with enzyme-like activity, which rapidly won a place in biomedicine due to their number of nanocatalytic materials types and applications. Yan and Gao first discovered horseradish peroxidase-like activity in ferromagnetic nanoparticles in 2007. With the joint efforts of many scientists, a new concept-nanocatalytic medicine-is emerging. Nanozymes overcome the inherent disadvantages of natural enzymes, such as poor environmental stability, high production costs, difficult storage and so on. Their progress in dentistry is following the advancement of materials science. The oral research and application of nanozymes is becoming a new branch of nanocatalytic medicine. In order to highlight the great contribution of nanozymes facilitating dental health, we first review the overall research progress of multi-functional nanozymes in oral related diseases, including treating dental caries, dental pulp diseases, oral ulcers and peri-implantitis; the monitoring of oral cancer, oral bacteria and ions; and the regeneration of soft and hard tissue. Additionally, we also propose the challenges remaining for nanozymes in terms of their research and application, and mention future concerns. We believe that the new catalytic nanomaterials will play important roles in dentistry in the future.

Theoretical evidence explaining the relationship between socio-demographic and psychosocial barriers on access to oral health care among adults: A scoping review

OBJECTIVES

Current global models for oral health care are outdated. Out of pocket payments and exclusion from most national health systems has created a gap for access of services by socio-economically vulnerable adults. Our objective is to understand barriers to access and the causal associations between barriers to care.

DATA

All study designs with a theoretical/conceptual framework to explain access and barriers among adults were included.

SOURCES

6 electronic databases (PubMed, Medline (EBSCO), CINAHL, Embase, Web of Science) including grey literature searches (ProQuest) and expert consultation. The identified studies were then analysed using narrative synthesis and NVivo.

STUDY SELECTION/RESULTS

40 studies using a theoretical framework to explain access among adults were identified. Andersen's behavioural model was most used. Cost was the primary causal factor that perpetuated the effect of other barriers. Associations were found between age and education level, cost and need, cost and dental anxiety. Study design and analysis used to identify these associations had limitations in determining causality.

CONCLUSION

Oral health access research is based in theory, leading to the identification of socio-demographic and psychosocial barriers and their relationships. However, a lack of explanation of causal associations persists. This review recognises the importance of understanding the cause of barriers in addition to their nature. Appropriate study designs and analysis considering the impact of time varying factors on access is required. Empirical analysis needs to focus on the role of confounders and mediators to determine causality successfully. To achieve this a theory driven causal model has been proposed.

Age-Period-Cohort Analysis of Toothbrushing Frequency in Finnish Adults: Results From Annual National Cross-Sectional Surveys From 1978 to 2014

Objectives

No previous study has analysed age-, period-, and cohort-related long-term trends in toothbrushing frequency among adults using a nationally representative data set. Our aim was to study age, period, and cohort effects on toothbrushing among 15- to 64-year-olds in Finland from 1978 to 2014.

Methods

Data were gathered by nationally representative random cross-sectional samples of 15- to 64-year-old Finns annually from 1978 to 2014, during which response rates decreased from 84% to 53%. The final pooled sample size was 119,665. An age-period-cohort model was used to separate the effects of age, period, and cohort on trends in men's and women's toothbrushing frequency.

Results

From 1978 to 2014, the proportion of respondents who brushed at least twice a day or once a day increased from 42% to 66% and from 83% to 95%, respectively. The proportion of respondents who brushed at least twice a day increased from 27% to 53% among men and from 60% to 75% among women. Increases in at least once-a-day toothbrushing were smaller in both sexes, and in women the increase was minimal over the study years. The increase in toothbrushing frequency occurred particularly among those older than 40 years of age. In men, toothbrushing frequency increased steadily cohort by cohort (cohort effect) and within a single cohort as men in the cohort got older (longitudinal age trend). Instead, in women the cohort effect and longitudinal age trend in toothbrushing were smaller at both frequency thresholds.

Conclusions

On the population level, favourable changes in toothbrushing habits occurred among adult Finns from 1978 to 2014, especially in men.

Wider Dental Care Coverage Associated with Lower Oral Health Inequalities: A Comparison Study between Japan and England

Countries with different oral health care systems may have different levels of oral health related inequalities. We compared the socioeconomic inequalities in oral health among older adults in Japan and England. We used the data for adults aged 65 years or over from Japan (N = 79,707) and England (N = 5115) and estimated absolute inequality (the Slope Index of Inequality, SII) and relative inequality (the Relative Index of Inequality, RII) for edentulism (the condition of having no natural teeth) by educational attainment and income. All analyses were adjusted for sex and age. Overall, 14% of the Japanese subjects and 21% of the English were edentulous. In both Japan and England, lower income and educational attainment were significantly associated with a higher risk of being edentulous. Education-based SII in Japan and England were 9.9% and 26.7%, respectively, and RII were 2.5 and 4.8, respectively. Income-based SII in Japan and England were 9.2% and 14.4%, respectively, and RII were 2.1 and 1.9, respectively. Social inequalities in edentulous individuals exist in both these high-income countries, but Japan, with wider coverage for dental care, had lower levels of inequality than England.

Did expanded access to denture services improve chewing ability in the Korean older population? Results of a regression discontinuity analysis

The Korean National Health Insurance expanded the dental insurance in 2012 to cover denture services for older adults. We analyzed whether the new policy improved of chewing ability in the eligible population. We used regression discontinuity (RD), a quasi-experimental design, to analyze the effects of the expanded dental insurance. We analyzed data from the Korea National Health and Nutrition Examination Survey conducted in 2010 and 2015. The study population consisted of two groups: the treatment group, aged 65 and above who were eligible; and the control group, under 65 years of age who were not eligible for the dental insurance benefit. The main outcome evaluated was self-reported chewing difficulty. The RD analysis showed that in 2015, the chewing difficulty in aged above 65 was 2.2% lower than in those aged under 65. However, the difference was not statistically significant (P = 0.76). The results from the falsification testing of predetermined covariates, placebo cut-offs, and bandwidths validated our main conclusion. The expansion of dental insurance benefits to include dentures for the older adults did not improve the chewing ability in the eligible population. Future studies should evaluate long-term outcomes of oral health as well as the social impacts on the elderly.

Did Expanded Dental Insurance Improve Chewing Ability in the Older Korean Population? Results of an Interrupted Time-series Analysis

Background

In 2012, the Korean National Health Insurance extended its coverage to include denture services for older adults. We examined whether the new policy resulted in improved chewing ability in the eligible population.

Methods

We used interrupted time-series (ITS) analysis, a quasi-experimental design, to analyze the effect of the policy. We used data from the Korea National Health and Nutrition Examination Survey conducted from 2007 to 2016–2018. The study population consisted of two groups: the treatment group, aged 65 years or older and eligible for the dental insurance benefit; and the control group, those younger than 65 years and ineligible. The main evaluated outcome was self-reported chewing difficulty.

Results

The ITS analysis showed that chewing difficulty decreased annually by 0.93% (95% CI, −1.30 to −0.55%) and 0.38% (95% CI, −0.59 to −0.16%) after the policy extension in the older than 65 and younger than 65 groups, respectively. However, we could not conclude that the insurance extension affected chewing difficulty because there was a decrease in the control group as well.

Conclusion

Chewing ability improved in both older and younger adults regardless of dental insurance coverage for older adults. Other exogenous factors probably led to the improvements in chewing ability as well as dental insurance benefits.