Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study

Caries preventive potential of professionally deliverable fluoride-containing agents with incorporated arginine: A scoping review

The scoping review objectives were to: 1) investigate the caries preventive potential of professionally deliverable fluoride (F)-containing agents with incorporated arginine (Arg); and 2) identify the future scope of research on Arg-F interventions for caries prevention. Of 150 identified records, 7 articles (6 in vitro investigations and 1 scoping review) were included for a complete review; with no clinical studies with/without appraisal. Arginine variants (L-Arg/Arg.HCl at 1% to 10% w/v.) were examined for a potential professional application aimed at caries prevention, as reported with in vitro studies. Of the included articles, four in vitro studies explored L-Arg enriched 5% NaF varnish (Duraphat®) as a promising caries preventive agent, while only one considered incorporating L-Arg in MI varnish®/nanohydroxyapatite and one investigated glass ionomer cement for primary/secondary and tertiary caries prevention. The scoping review highlighted the scope for incorporating Arg to professionally deliverable F-containing agents. No clinical data are available to make conclusive recommendations about the caries preventive potential of professionally deliverable F-containing agents with incorporated Arg. With Arg-F varnish being investigated predominantly through in vitro studies, the data so far suggest that Arg was incorporated exclusively in Duraphat®, while the potential of Arg to prevent caries in other F-containing varnishes remains unexplored.

Association of sense of coherence and periodontal disease severity, in two cross-sectional studies

OBJECTIVES

To investigate the association between the individuals' level of sense of coherence (SOC) and periodontal disease severity.

METHODS

The study populations originated from two stratified cross-sectional random samples of residents in a medium-sized Swedish city in 2003 and 2013, respectively. The final samples constituted 491 individuals in 2003 and 538 individuals in 2013. The samples were classified into three groups according to the severity of periodontitis (no/minor, moderate and severe). The 13-item Swedish version of Antonovsky's "Orientation to life" questionnaire, measuring the individual's SOC, was filled out. Descriptive statistics were performed as well as multinomial logistic regression analysis. Dependent variable was the severity of periodontal disease and independent variables, age in years, presently smoking and education at university level.

RESULTS

In the multinomial regression analysis, smoking, age, and total SOC score were significantly associated with severe periodontitis at both examinations. The strongest predictor of severe periodontal disease was smoking. The total SOC score did not differ between the examinations, but there was a statistically significant difference in two of the SOC dimensions, manageability (lower), and comprehensibility (higher), over time.

CONCLUSIONS

Individuals with severe periodontitis had significantly lower SOC compared to subjects periodontally having no/minor periodontal disease. Smoking was the strongest overall predictor of having severe periodontitis.

Adhesive restorations in primary dentition: A retrospective analysis of survival rate and associated factors

BACKGROUND

Several clinical and individual factors may play a role in the survival rate of dental restorations, such as characteristics related to the child's age and oral hygiene, and factors associated with the tooth, such as the type of material and number of surfaces to be restored.

AIM

To analyse the survival rate of adhesive restorations on primary teeth and factors associated with restoration survival.

DESIGN

The study included dental records of children aged 3-12 years having received adhesive restorations on primary teeth at a Brazilian dental school between 2009 and 2019. A Kaplan-Meier survival curve was used to plot survival rates using the log-rank test. A multivariate Cox regression model was run to identify individual and dental factors associated with restoration failure.

RESULTS

The sample comprised 269 restored teeth in 111 children. Survival curves were similar for all materials (p = .20) and types of isolation (p = .05). The annual failure rate was 3.60% for glass ionomer cement, 1.23% for resin-modified glass ionomer cement and 0.40% for composite resin. The following variables were associated with more failures: Class II restoration compared with Class I (HR = 1.96; 95%CI: 1.28-2.99, p < .001), proportion of decayed teeth (HR = 11.89; 95%CI: 2.80-50.57, p < .001) and child's age (HR = 1.17; 95%CI: 1.06-1.29, p < .001).

CONCLUSION

The different materials and types of isolation had similar survival rates. Children with more decayed teeth have an increased risk of restoration failure.

Chemical composition, cytotoxicity, antimicrobial, antibiofilm, and anti-quorum sensing potential of Mentha Piperita essential oil against the oral pathogen Streptococcus mutans

Dental caries is a highly prevalent oral disease affecting billions of individuals globally. The disease occurs chemically as a result of breakdown of the tooth surface attributed to metabolic activity in colonizing biofilm. Biofilms, composed of exopolysaccharides and proteins, protect bacteria like Streptococcus mutans, which is notable for its role in tooth decay due to its acid-producing abilities. While various antimicrobial agents may prevent biofilm formation, these drugs often produce side effects including enamel erosion and taste disturbances. This study aimed to examine utilization of the Mentha piperita essential oil as a potential antibiofilm activity agent against S. mutans. M. piperita oil significantly (1) reduced bacterial biofilm, (2) exhibited a synergistic effect when combined with chlorhexidine, and (3) did not induce cell toxicity. Chemical analysis identified the essential oil with 99.99% certainty, revealing menthol and menthone as the primary components, constituting approximately 42% and 26%, respectively. Further, M. piperita oil eradicated preformed biofilms and inhibited biofilm formation at sub-inhibitory concentrations. M. piperita oil also interfered with bacterial quorum sensing communication and did not produce any apparent cell toxicity in immortalized human keratinocytes (HaCaT). M. piperita represented an alternative substance for combating S. mutans and biofilm formation and a potential combination option with chlorhexidine to minimize side effects. An in-situ performance assessment requires further studies.

Periodontitis impacts on thrombotic diseases: from clinical aspect to future therapeutic approaches

Periodontitis is a chronic inflammatory disease initiated by biofilm microorganisms and mediated by host immune imbalance. Uncontrolled periodontal infections are the leading cause of tooth loss in adults. Thrombotic diseases can lead to partial or complete obstruction of blood flow in the circulatory system, manifesting as organ or tissue ischemia and necrosis in patients with arterial thrombosis, and local edema, pain and circulatory instability in patients with venous thrombosis, which may lead to mortality or fatality in severe case. Recent studies found that periodontitis might enhance thrombosis through bacterial transmission or systemic inflammation by affecting platelet-immune cell interactions, as well as the coagulation, and periodontal therapy could have a prophylactic effect on patients with thrombotic diseases. In this review, we summarized clinical findings on the association between periodontitis and thrombotic diseases and discussed several novel prothrombotic periodontitis-related agents, and presented a perspective to emphasize the necessity of oral health management for people at high risk of thrombosis.

The Association Between Cognitive Function and Oral Health in Home Dwellers and Nursing Home Residents: The HUNT Study

OBJECTIVES

To evaluate the relationships of cognitive function and care dependency with oral health in a Norwegian older adult population.

METHODS

This cross-sectional study included 2623 participants aged 70 and older from the fourth wave of the Trøndelag health study (HUNT4 70+) and the city of Trondheim (Trondheim 70+). Neurocognitive disorders (NCDs) were diagnosed by clinical experts according to the DSM-5 framework. Care dependency referred to nursing home residency. Oral health was assessed by using the Revised Oral Assessment Guide-Jönköping (ROAG-J). Individuals were considered as 'having oral problem' if the score was two or three in at least one of the nine ROAG-J items. Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs).

RESULTS

The prevalence of having oral problems was 19% higher in participants with NCDs than those with normal cognitive function after adjusting for potential confounders (PR 1.19, 95% CI: 1.09-1.29). Further analysis showed a higher prevalence of having oral problems for home dwellers with NCDs (PR 1.23, 95% CI: 1.13-1.33) and nursing home residents (PR 1.32, 95% CI: 1.20-1.45) compared to home dwellers with normal cognitive function.

CONCLUSIONS

NCDs were associated with an increased prevalence of oral problems in this Norwegian older adult population. The study suggests the need for increasing oral care for home dwellers with NCDs and nursing home residents.

The impact of physical activity on the prevalence of edentulism: an analysis of the relationships between active lifestyle and dental health

BACKGROUND

Edentulism is considered the ultimate sign of oral health disease burden. It is a common and frequent clinical disease, mostly seen in the elderly, which has been reported to be closely associated with many diseases. While physical activity is known to benefit many chronic diseases, the relationship between the volume of physical activity and edentulism remains unclear.

MATERIALS AND METHODS

The CHARLS provided the data for this study. A total of 6,480 participants were enrolled in this study, of whom 46.02% were male and 53.98% were female. The edentulism was defined according to self-report and physical activity volume can be represented by metabolic equivalents. Multiple logistic regression, smooth curve fitting, threshold effects analysis, and Cox regression models were used to explore the relationship between physical activity volume and edentulism.

RESULTS

In the fully adjusted model, physically active participants had a 24% lower risk of edentulism compared to those who were physically inactive. Then, we subdivided participants with adequate physical activity into four levels: 600 ≤ PAV < 1200; 1200 ≤ PAV < 1800; 1800 ≤ PAV < 3000; and PAV ≥ 3000. We found that the risk of developing edentulism was lowest and statistically significant at the level of 1,800-3,000 MET-minutes/week physical activity volume (OR = 0.41; 95% CI, 0.24-0.69, p < 0.001). A U-shaped relationship between physical activity volume and edentulism with an inflection point of 2514 (MET-minutes/week) was observed. The results of the longitudinal study also confirm the benefits of physical activity volume with edentulism, participants with adequate physical activity volume had a 21% lower risk of developing edentulism than participants with inadequate physical activity volume (HR = 0.79; 95% CI, 0.67-0.94, p = 0.008).

CONCLUSIONS

This study reveals a U-shaped relationship between physical activity volume and edentulism. Physical activity reduces the risk of developing edentulism in middle-aged and older populations, but it is important to control the appropriate volume of physical activity.

Imbalances in the oral health workforce: a Canadian population-based study

BACKGROUND

In Canada, a new federal public dental insurance plan, being phased in over 2022-2025, may help enhance financial access to dental services. However, as in many other countries, evidence is limited on the supply and distribution of human resources for oral health (HROH) to meet increasing population needs. This national observational study aimed to quantify occupational, geographical, institutional, and gender imbalances in the Canadian dental workforce to help inform benchmarking of HROH capacity for improving service coverage.

METHODS

Sourcing microdata from the 2021 Canadian population census, we described workforce imbalances for three groups of postsecondary-qualified dental professionals: dentists, dental hygienists and therapists, and dental assistants. To assess geographic maldistribution relative to population, we linked the person-level census data to the geocoded Index of Remoteness for all inhabited communities. To assess gender-based inequities in the dental labour market, we performed Blinder-Oaxaca decompositions for examining differences in professional earnings of women and men.

RESULTS

The census data tallied 3.4 active dentists aged 25-54 per 10,000 population, supported by an allied workforce of 1.7 dental hygienists/therapists and 1.6 dental assistants for every dentist. All three professional groups were overrepresented in heavily urbanized communities compared with more rural and remote areas. Almost all dental service providers worked in ambulatory care settings, except for male dental assistants. The dentistry workforce was found to have achieved gender parity numerically, but women dentists still earned 21% less on average than men, adjusting for other characteristics. Despite women representing 97% of dental hygienists/therapists, they earned 26% less on average than men, a significant difference that was largely unexplained in the decomposition analysis.

CONCLUSIONS

Accelerating universal coverage of oral healthcare services is increasingly advocated as an integral, but often neglected, component toward achieving the health-related Sustainable Development Goals. In the Canadian context of universal coverage for medical (but not dentistry) services, the oral health workforce was found to be demarcated by considerable geographic and gendered imbalances. More cross-nationally comparable research is needed to inform innovative approaches for equity-oriented HROH planning and financing, often critically overlooked in public policy for health systems strengthening.

Comparison of three management approaches for dental caries in primary molars: A two-year randomized clinical trial

AIM

to compare two-year clinical success rates of caries management in children (Hall Technique HT, Nonrestorative caries treatment NRCT, Conventional restorations CR), and to evaluate pain perception, behaviour, technique acceptability by patients, parents and dentists.

METHODS

122, 3-8-year-olds were enrolled in 2-year parallel group randomised controlled trial (CR, n = 52, HT, n = 35, NRCT, n = 35). Caries was recorded using Nyvad criteria to measure clinical success/ failure rates. Child's pain perception (Visual Analogue Scale of Faces), child behaviour (Frankl scale), parents' and dentists' treatment opinions (5-point Likert scale) were assessed. Statistical analysis included Chi-square, non-parametric Kruskal-Wallis, Bonferroni-corrected Mann-Whitney U tests (p < 0.05), absolute risk reduction (ARR) and number needed to treat (NNT).

RESULTS

After two years, with 116 participants, clinical success rates were: CR=60.8 % (n = 31), HT=93.8 % (n = 30), NRCT=42.5 % (n = 14) (p < 0.001). Major/minor failure rates differed: CR=17.6 % (n = 9) / 21.6 % (n = 11); HT=6.2 % (n = 2)/ 0 %, NRCT=33.3 % (n = 11)/ 24.2 % (n = 8), (p < 0.05). When comparing HT to CR, ARR = 0.33; NNT= 3 (95 % CI 0.02 -0.58); NRCT to CR, - no observed benefit from NRCT. More than 70 % of children demonstrated "positive/definitely positive" behaviour during treatment. Pain intensity was "very low/low" in 92.3 % of cases for CR, 88.6 % for HT, and 77.1 % for NRCT . NRCT was "very easy" to perform for 82.9 % of participants, compared to 42.3 % for CR and 17.1 % for HT (p < 0.05). CR were reported to take longer than NRCT and HT (p < 0.05).

CONCLUSION

Clinical success rates of HT were superior to CR and NRCT. All treatment techniques were well tolerated by children, CR was more time-consuming and HT - technically more difficult to perform.

CLINICAL SIGNIFICANCE

caries management in primary molars can be successfully performed using minimal intervention, particularly, sealing in caries lesions with Hall technique. NRCT can prevent caries progression when adequate access to mechanical plaque disruption and fluoride is provided. However, occasional fluoride application, and uncontrolled toothbrushing with fluoride toothpaste cannot replace restorative procedures.

The association between interdental cleaning and periodontitis in an urban Thai adult cohort: a cross-sectional study

BACKGROUND

Plaque biofilm is a major etiologic factor of periodontitis, and its effective removal prevents or ameliorates the disease. However, toothbrushing alone does not sufficiently clean the interdental area, and additional interdental cleaning is required to completely remove the plaque from this locale. This cross-sectional study aimed to assess the association of interdental cleaning on the prevalence of periodontitis in a large urban Thai adult cohort.

METHODS

Interdental cleaning data were retrieved from a dental survey of 1,743 employees of the Electricity Generating Authority of Thailand (EGAT) in 2019. The Centers for Disease Control and Prevention/American Association of Periodontology (CDC/AAP) periodontal case definitions were applied. The participants were subdivided into two groups as those with or without periodontitis depending on their oral health status assessed by calibrated professional examiners. The proportion of subjects who performed interdental cleaning was assessed through a self-reported questionnaire by frequency (daily/ ≥ 1 per week/ none) and profile (correct/ incorrect) of interdental cleaning. Then, the association between interdental cleaning and periodontitis was calculated using logistic regression analysis controlling for the common risk factors of periodontitis such as age, sex, education, smoking, and diabetes.

RESULTS

Participants who performed interdental cleaning on a daily basis and ≥ 1 per week were 27.5% (95% CI: 25.4, 29.6) and 29.1% (95% CI: 27.0, 31.3), respectively while the remainder did not practice. Of those who used interdental cleaning, about one-half focused on sites with food impaction. There was a significant 44% lower prevalence of periodontitis (adjusted odds ratio of 0.56 (95%CI: 0.40, 0.79) in the cohort with a frequent and correct group.

CONCLUSIONS

Our data indicate an inverse association between interdental cleaning and periodontitis, particularly in those who routinely adhered to it. Regular interdental cleaning is likely to have a salutary effect on oral health.

TRIAL REGISTRATION

The study was registered retrospectively in Thai Clinical Trials Registry, Registration number: TCTR20240817005, on 17 Aug 2024 ( https://www.thaiclinicaltrials.org ).

Probing the oral-brain connection: oral microbiome patterns in a large community cohort with anxiety, depression, and trauma symptoms, and periodontal outcomes

The role of the oral microbiome in mental health has recently been appreciated within the proposed oral-brain axis. This study examined the structure and composition of the salivary microbiome in a large-scale population-based cohort of individuals reporting mental health symptoms (n = 306) compared to mentally healthy controls (n = 164) using 16S rRNA sequencing. Mental health symptoms were evaluated using validated questionnaires and included depression, anxiety, and posttraumatic stress disorder (PTSD), with accompanying periodontal outcomes. Participants also indicated current or previous diagnoses of anxiety, depression, periodontitis, and gingivitis. Mental and periodontal health variables influenced the overall composition of the oral microbiome. PTSD symptoms correlated with a lower clr-transformed relative abundance of Haemophilus sputorum and a higher clr-transformed relative abundance of Prevotella histicola. The clr-transformed relative abundance of P. histicola was also positively associated with depressive scores and negatively associated with psychological quality of life. Anxiety disorder diagnosis was associated with a lower clr-transformed relative abundance of Neisseria elongate and a higher clr-transformed relative abundance of Oribacterium asaccharolyticum. A higher clr-transformed relative abundance of Shuttleworthia and lower clr-transformed relative abundance of Capnocytophaga were evident in those who reported a clinical periodontitis diagnosis. Higher Eggerthia and lower Haemophilus parainfluenzae clr-transformed relative abundances were associated with reported clinical periodontitis diagnoses and psychotherapeutic efficacy. Functional prediction analysis revealed a potential role for tryptophan metabolism/degradation in the oral-brain axis, which was confirmed by lower plasma serotonin levels across symptomatic groups. This study sheds light on the intricate interplay between oral microbiota, periodontal and mental health outcomes, and a potential role for tryptophan metabolism in the proposed oral-brain axis, emphasizing the need for further exploration to pave the way for novel therapeutic interventions and predicting therapeutic response.

Recommendations on Topical Fluoride Usage for Caries Management in East Asia

Dental caries is a widespread oral health issue in Asia, affecting an estimated 30% to 90% of children and adults. Many caries cases remain untreated, resulting in pain and infection. In response, the Asian Academy of Preventive Dentistry (AAPD) emphasises comprehensive caries management and organised a fluoride workshop at the 15th International Conference of the AAPD in 2023. The AAPD invited a group of experts to form a fluoride working group to review existing literature and develop fluoride recommendations for stakeholders across Asian countries and regions. The working group assessed caries risk and identified commonly used topical fluoride products for home care, professional, and community settings in Asia. The working group concluded that fluoride is a safe and highly effective strategy to reduce caries prevalence and incidence. The working group provided key recommendations based on successful regional caries management practices: (1) use topical fluoride for prevention and control of dental caries; (2) encourage the use of fluoride toothpaste with a concentration of at least 1,000 ppm for effective caries reduction; (3) advise a 0.05% fluoride mouth rinse as soon as children can spit it out to prevent early childhood caries; (4) deliver professionally administered fluoride, such as 5% sodium fluoride varnish, 2% fluoride gel, or 1.23% acidulated phosphate fluoride preparations, to decrease dental caries in at-risk individuals; and (5) apply 38% silver diamine fluoride to arrest cavitated caries. These recommendations aim to help practitioners, health care providers, and parents/caregivers make informed decisions about fluoride use as part of comprehensive oral health care in the region.

A qualitative meta-synthesis of carers' perceptions of factors influencing preschool children's oral hygiene practices-A social practices perspective

OBJECTIVES

This study comprises a synthesis of published qualitative studies from developed countries on the perspectives of carers regarding the oral hygiene toothbrushing practices of preschool children, through the lens of social practice theory.

METHODS

A search of the following electronic databases was conducted for all available years: MEDLINE, EMBASE and Global Health using the Ovid platform; Dentistry & Oral Sciences Source (DOSS), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. Included qualitative studies reported primary caregivers' perceptions of oral hygiene practices (focusing on toothbrushing) in preschool children (0-5 years old) in developed countries. A thematic synthesis of the qualitative findings was undertaken for the results of each study.

RESULTS

Eleven articles were included in this meta-synthesis. The focus of this paper was toothbrushing practices. A conceptual map of toothbrushing as a social practice was developed. Key findings included practice elements (meanings, competences, and materials), spatial and temporal aspects, and barriers and facilitators to performance.

CONCLUSIONS

The application of a social practice lens to published qualitative research on the oral hygiene of preschool children provided insights into the meanings and competences related to toothbrushing, as perceived by primary caregivers. However, it also revealed limited information on material, spatial and temporal aspects of toothbrushing practices, indicating the importance of considering social practice theory as a framework in future research to address this gap. Furthermore, exploring toothbrushing in connection with related social practices has the potential to increase understanding of factors influencing oral health in preschool children.

Association between untreated caries and cariogenic bacteria in adolescents in Taiwan

Background/purpose

There is a paucity of research focused on salivary bacteria analyzed through real-time polymerase chain reaction (qPCR) among adolescents. The current study determined the quantity of Streptococcus mutans (SM) and Lactobacillus (LB) in saliva obtained from Taiwanese adolescents and investigated the association between the oral bacteria and untreated dental caries.

Materials and methods

This cross-sectional study recruited Taiwanese students aged 10-18. Saliva was collected using a Salivette kit and then analyzed through qPCR. The relative quantification values of SM and LB were coded based on mean fold ratios, with values > 2 coded as high and other values coded as low. Untreated dental caries was assessed through standard oral examinations. Univariate and multivariate logistic regression models were used to estimate the association between the levels of bacteria in the saliva of the study participants and the presence of untreated caries.

Results

The study involved 421 adolescents. 56 (13.3%) had both SM and LB values of >2 and were coded as having high levels of bacteria, whereas the other 365 (86.7%) students were coded as having low levels. The multivariate logistic regression analysis revealed that adolescents who had high combined salivary SM and LB levels had an odds ratio of having untreated dental caries of 2.05 (95% CI = 1.09, 3.86, P = 0.027) compared with those who had low salivary SM and LB levels.

Conclusion

The results of the present study indicate that salivary SM and LB levels are significantly associated with adolescents having untreated caries.

The combination of arginine and fluoride-containing bioactive glass acted synergistically in inhibiting enamel demineralization in permanent teeth

OBJECTIVES

To evaluate the in-vitro efficacy of inhibiting enamel demineralization using arginine in combination with fluoride-containing bioactive glass (FBG).

METHODS

In this study, the healthy enamel blocks were first demineralized in acetic acid for 24 h, then soaked in anti-demineralization treatment solutions containing either arginine or FBG or both for 96 h.The specimens treated in acetic acid were applied as the control group. The pH, calcium and phosphorus ion concentrations of the solutions were measured before and after treatment. Changes in enamel mineral weight, microhardness, and composition were also analyzed.

RESULTS

The present of arginine facilitated fluorine release from treatment solutions with the presence of FBG. Both arginine and FBG significantly increased the pH of treatment solutions and prevented the further mineral weight loss compared to the control group. All anti-demineralization treatment groups showed significant increases in microhardness, but there was no statistical difference among the treatment groups. The SEM analysis showed enamel restoration in the arginine and FBG groups upon treatment, while the combined groups showing a superior anti-demineralization efficacy. 19F NMR showed the formation of fluorapatite in samples treated with solutions containing FBG.

CONCLUSIONS

Both arginine and FBG could inhibit enamel demineralization to some extent, and their combination demonstrated an enhanced anti-demineralization efficacy. The low-concentration combination group exhibited anti-demineralization effects comparable to those of high-concentration ones.

CLINICAL SIGNIFICANCE

This study introduces a new approach for caries prevention by combining the application of arginine and FBG. The release of fluorine promoted by the presented arginine along with calcium and phosphorus ions from FBG facilitated FAP formation. Additionally, the increment of pH resulting from arginine and FBG degradation further prevents enamel demineralization.

Clinical Effects of Sugar Substitutes on Cariogenic Bacteria: A Systematic Review and Meta-Analysis

BACKGROUND

The use of sugar substitutes in food products has recently increased. Limited information regarding the role of various sugar substitutes in caries prevention was found. This systematic review and meta-analysis was conducted to investigate the effects of sugar substitute consumption on reducing cariogenic bacteria in dental plaque and saliva.

METHODS

We systematically searched PubMed, EMBASE, and Web of Science (inception to July 2023) for prospective controlled trials published in English and investigated the effects of sugar substitute consumption on cariogenic bacteria in dental plaque and saliva. The primary outcome was the changes in cariogenic bacteria. Two independent reviewers screened the papers. Quality was assessed using the Cochrane risk-of-bias tools.

RESULTS

From 977 studies identified, 32 trials were included. Almost half (14/32, 44%) of the included studies had a high risk of bias. Almost all (31/32, 96.88%) were investigations of xylitol and other sugar alcohols (low-intensity sweeteners), such as sorbitol, erythritol, and maltitol. Only one trial investigated stevia, a high-intensity sweetener, whereas no studies on other high-intensity sweeteners, such as sucralose, saccharin, or aspartame, were found. Almost all studies (30/32, 93.75%) showed the consumption of low-intensity sweeteners led to a significant reduction of different types of cariogenic bacteria. The results of the meta-analysis showed that consumption of low-intensity sweeteners led to a significant reduction of cariogenic bacteria in both dental plaque and saliva compared to no treatment.

CONCLUSION

The consumption of low-intensity sweeteners helps reduce cariogenic bacteria in dental plaque and saliva. There is limited clinical evidence regarding the role of high-intensity sweeteners in reducing cariogenic bacteria.

Development of Artificial Intelligence Models for Tooth Numbering and Detection: A Systematic Review

Dental radiography is widely used in dental practices and offers a valuable resource for the development of AI technology. Consequently, many researchers have been drawn to explore its application in different areas. The current systematic review was undertaken to critically appraise developments and performance of artificial intelligence (AI) models designed for tooth numbering and detection using dento-maxillofacial radiographic images. In order to maintain the integrity of their methodology, the authors of this systematic review followed the diagnostic test accuracy criteria outlined in PRISMA-DTA. Electronic search was done by navigating through various databases such as PubMed, Scopus, Embase, Cochrane, Web of Science, Google Scholar, and the Saudi Digital Library for the articles published from 2018 to 2023. Sixteen articles that met the inclusion exclusion criteria were subjected to risk of bias assessment using QUADAS-2 and certainty of evidence was assessed using GRADE approach.AI technology has been mainly applied for automated tooth detection and numbering, to detect teeth in CBCT images, to identify dental treatment patterns and approaches. The AI models utilised in the studies included exhibited a highest precision of 99.4% for tooth detection and 98% for tooth numbering. The use of AI as a supplementary diagnostic tool in the field of dental radiology holds great potential.

Estimating Periodontitis Susceptibility Cases for Epidemiological Studies with Multiple Imputation

KNOWLEDGE TRANSFER STATEMENT

Our proposed estimate of periodontitis susceptibility cases addresses the issue of missing teeth, offering an innovative solution through a generative missing data imputation model. The implications of our findings extend to fostering more robust investigations into the relationships between periodontal health and systemic diseases, thereby offering valuable insights to clinicians for informed decision-making. Moreover, the study's capacity to shape clinical practices and interventions in public health will further fortify health policy strategies.

A randomised clinical trial to arrest caries using silver diamine fluoride therapy with two postoperative instructions

OBJECTIVE

The objective of this study is to investigate the beneficial effect of not rinsing for 30 min in arresting early childhood caries after SDF therapy.

METHODS

This randomised clinical trial recruited 3- to 4-year-old kindergarten children with active (soft) dentine caries. A questionnaire was sent to the parents to collect children's demographic data and oral health-related behaviours. A dentist conducted an oral examination and measured the caries experience using dmft index and oral hygiene using visible plaque index. After 38 % SDF therapy, the children were randomly allocated into two groups. Children in group A were instructed to rinse with water immediately, whereas children in group B were asked to refrain from rinsing, drinking, or eating for 30 min. After six months, the same examiner determined the lesion activity (active/arrest) of the SDF-treated carious tooth surface. Generalized Estimating Equations was used to compare the proportion of caries arrest (caries-arrest rate) between the two groups.

RESULTS

This study recruited 298 children with 1,158 decayed tooth surfaces receiving SDF therapy at baseline and evaluated 275 (92 %) children with 1,069 (92 %) SDF-treated tooth-surface at the six-month examination. The demographic background, oral hygiene and caries status of two groups were comparable at baseline (p > 0.05). The caries-arrest rate for group A and group B were 65 % (337/519) and 61 % (338/550), respectively (p = 0.28).

CONCLUSION

This randomised clinical trial found not rinsing for 30 min after SDF therapy is not better than immediate rinsing in arresting early childhood caries.

CLINICAL SIGNIFICANCE

Topical SDF application leaves an unpleasant taste in the mouth, which may affect the acceptance or even rejection of SDF therapy among young children. This study provides clinicians with information to make their decision on postoperative instruction after SDF therapy.

Decomposing Socioeconomic Inequality in Early Childhood Caries Among 3 to 5-Year-Old Children in China

INTRODUCTION AND AIMS

Early childhood caries (ECC) is a widespread oral disease that harms children's health in China. Although previous studies have linked ECC prevalence to socioeconomic status, few have measured the degree of socioeconomic inequality. This study aimed to evaluate the socioeconomic inequality of ECC in children aged 3 to 5 years in China and identify the contributor to the inequality.

METHODS

We extracted data on 3 to 5-year-old children from the fourth National Oral Health Survey. We measured the inequality of ECC by the average household income per capita. We used the average household income per capita to measure the inequality of ECC. To describe inequality both qualitatively and quantitatively, we used the following methods: concentration curve, Erreygers-corrected concentration index, relative index of inequality and slope index of inequality. We also applied a decomposition based on the probit model to identify the factors that contributed to inequality.

RESULTS

The prevalence of ECC in Chinese preschool children was 63.11% (95% CIs: 60.54%, 65.61%). The negative value of the Erreygers-corrected concentration index (-0.0459; 95% CIs: -0.0594, -0.0324), slope index of inequality (-0.0674; 95% CIs: -0.0876, -0.0471) and the positive value of relative index of inequality (0.7484; 95% CIs: 0.6856, 0.8169) all indicated that ECC prevalence was higher among children from low-income families. The main factors contributing to inequality were average household income, parents' educational level and living areas.

CONCLUSION

There is a pro-poor inequality in ECC among 3 to 5-year-old children in China.

CLINICAL RELEVANCE

To improve oral health equality, policymakers should focus more on children from low-income families, with less educated parents and living in rural areas.

Periodontitis: etiology, conventional treatments, and emerging bacteriophage and predatory bacteria therapies

Inflammatory periodontal diseases associated with the accumulation of dental biofilm, such as gingivitis and periodontitis, are very common and pose clinical problems for clinicians and patients. Gingivitis is a mild form of gum disease and when treated quickly and properly is completely reversible. Periodontitis is an advanced and irreversible disease of the periodontium with periods of exacerbations, progressions and remission. Periodontitis is a chronic inflammatory condition that damages the tissues supporting the tooth in its socket, i.e., the gums, periodontal ligaments, root cementum and bone. Periodontal inflammation is most commonly triggered by bacteria present in excessive accumulations of dental plaque (biofilm) on tooth surfaces. This disease is driven by disproportionate host inflammatory immune responses induced by imbalance in the composition of oral bacteria and changes in their metabolic activities. This microbial dysbiosis favors the establishment of inflammatory conditions and ultimately results in the destruction of tooth-supporting tissues. Apart microbial shift and host inflammatory response, environmental factors and genetics are also important in etiology In addition to oral tissues destruction, periodontal diseases can also result in significant systemic complications. Conventional methods of periodontal disease treatment (improving oral hygiene, dental biofilm control, mechanical plaque removal, using local or systemic antimicrobial agents) are not fully effective. All this prompts the search for new methods of therapy. Advanced periodontitis with multiple abscesses is often treated with antibiotics, such as amoxicillin, tetracycline, doxycycline, minocycline, clindamycin, or combined therapy of amoxicillin with metronidazole. However, due to the growing problem of antibiotic resistance, treatment does not always achieve the desired therapeutic effect. This review summarizes pathogenesis, current approaches in treatment, limitations of therapy and the current state of research on the possibility of application of bacteriophages and predatory bacteria to combat bacteria responsible for periodontitis. We present the current landscape of potential applications for alternative therapies for periodontitis based on phages and bacteria, and highlight the gaps in existing knowledge that need to be addressed before clinical trials utilizing these therapeutic strategies can be seriously considered.

Oral diseases and systemic conditions: correlation analyses from the Colombian national health records between 2016 and 2023

Introduction

Prevalence of oral, metabolic, circulatory, and nutritional diseases has tended to increase globally. As these diseases have common contributing factors, such as unhealthy diets, evaluating their epidemiological trends and the relation between them is relevant. In Colombia, the Ministry of Health records the frequency of consultation for these diseases through the Integrated Social Protection Information System. It facilitates the evaluation of their epidemiological behavior at the population level.

Aim

To analyze and correlate the burden of oral diseases (caries and periodontitis) with respect to nutritional, circulatory and metabolic pathologies, as well as their relationships with socioeconomic indices in Colombian regions from 2016 to 2023.

Methods

This study analyzes retrospective data collected between 2016 and 2023 by the National Health Registry in Colombia (SISPRO) according to the ICD-10. Sociodemographic data and the number of disease consultations were extracted. The number of consultations for oral diseases was correlated with systemic pathologies, socioeconomic indices through the Spearman test. Associations were explored via multiple linear regressions. A Principal Component Analyses (PCA) was conducted to identify patterns between socioeconomic, oral and systemic disease variables, as well as to reduce the complexity of the analysis by creating clusters that capture the greatest possible variability in the data.

Results

The average number of consultations per biennium was 24.550.435 being the highest number for 2018-2019. The highest percentage of consultations was related to extensive caries, followed by chronic gingivitis. Moreover, consultations for oral diseases were found to correlate with systemic pathologies. All socioeconomic indices were associated with caries and/or periodontal diseases. This study is the first in Colombia that uses national data on diagnoses assigned to medical and dental consultations. PCA revealed a clustering pattern of pathologies suggesting that they are highly associated one to each other.

Conclusion

Correlations between consultations for oral and systemic diseases stratified by life cycle and socioeconomic indices highlight the importance of conducting epidemiological and public health characterizations and their associations. Identifying these factors is imperative in the prevention and management of both diseases.

Impact of public health and patient-centered prevention strategies on periodontitis and caries as causes of tooth loss in high-income countries

In high-income countries, the oral health of the population is influenced by public health interventions, widespread use of oral care products, dental practice measures, and the cost of dental treatment. We compiled information on changes of the prevalence of proximal and upstream determinants of periodontitis, caries, and tooth loss over the last three decades to outline their potential effects on changes of oral health during this period. Information was retrieved from repeated cross-sectional studies and from published literature. While both the prevalence of edentulism and the number of missing teeth (from the DMF-T index) decreased, the number of sound teeth as well as the total number of teeth increased. The prevalence of severe periodontitis was unchanged, whereas the prevalence of periodontal health and moderate periodontitis may have increased to a minor extent. Concerning oral health risk factors, the proportion of individuals with tertiary education increased, while smoking prevalence declined. More and more people used oral care products. Whether one reimbursement system worked better than another one in terms of tooth retention could not be elucidated. In tooth retention, population-wide use of fluoridated toothpastes had the greatest impact. To some extent, the higher number of teeth present may be related to the more frequent use of interdental cleaning aids and powered toothbrushes. Since there was no decrease in severe periodontitis in most cohorts, periodontal interventions probably contributed little to improved tooth retention.

Prevalence of dentine hypersensitivity, erosive tooth wear, gingival recession and periodontal health in seven European countries

OBJECTIVES

To determine the prevalence and associated risk indicators for dentine hypersensitivity (DH), erosive tooth wear (ETW), gingival recession (GR), and gingival inflammation (bleeding on probing, BOP), with clinical and questionnaire data from seven European countries.

METHODS

A cross-sectional, observational, seven-European country, epidemiological study in systemically healthy adults. Participants completed a questionnaire regarding oral hygiene, diet and lifestyle factors. A clinical examination, by calibrated examiners, measured DH (Schiff; participant yes/no), ETW (basic erosive tooth wear examination, BEWE), GR (mm), and BOP (yes/no).

RESULTS

3551 participants completed the study, mean age 44 ± 17.4, 43.6 % male, 26.1 % rural dwellers. DH (Schiff ≥ 1) was seen in 75.9 % of participants, ETW (BEWE ≥ 1) in 97.6 %, GR (≥1 mm) in 87.9 %. 65.7 % participants had BOP ≥ 10 % sites, 34.3 % BOP<10 % with probing depths ≤3 mm. DH, ETW, GR and BOP increased markedly during young adult life. Thereafter, GR and ETW continued to increase, DH declined after around age 38-47, and BOP plateaued after age 48. DH was significantly associated with ETW (p < 0.001) and GR (p < 0.01); GR was significantly associated with BOP on lingual surfaces (p = 0.017). There were significant associations between increased full mouth BOP ≥ 10 % and reduced brushing duration and exercise frequency (p < 0.001); increased DH and heartburn (p < 0.001); decreased DH (p < 0.001), ETW (p < 0.001) and BOP ≥ 10 % (p = 0.002) with powered toothbrush use.

CONCLUSIONS

Prevalence of oral conditions assessed was high, greater than in the majority of the GR, DH and ETW literature. Periodontal health was seen in a third of sampled individuals. All these conditions varied markedly by country and age.

CLINICAL SIGNIFICANCE

Oral diseases and conditions were highly prevalent throughout the seven European countries investigated. For the majority, these conditions are eminently preventable and treatable by changing behaviours. Upstream policy changes are needed to address these health challenges, to raise awareness and to empower individuals with oral health education and support.

Vitamin D, periodontitis and tooth loss in older Irish adults

The aim of this study is to investigate whether 25-hydroxyvitamin D (25(OH)D) is associated with periodontitis and tooth loss in older adults. A total of 2346 adults underwent a detailed dental examination as part of the health assessment of a national population study - The Irish Longitudinal Study of Ageing. 25(OH)D analysis was performed on frozen non-fasting total plasma using LC-MS. The analysis included both multiple logistic regression and multinominal logistic regression to investigate associations between 25(OH)D concentration, periodontitis and tooth loss, adjusting for a range of potential confounders. Results of the analysis found the mean age of participants was 65·3 years (sd 8·2) and 55·3 % of the group were female. Based on the quintile of 25(OH)D concentration, participants in the lowest v. highest quintile had an OR of 1·57 (95 % CI 1·16, 2·13; P < 0·01) of having periodontitis in the fully adjusted model. For tooth loss, participants in the lowest v. highest quintile of 25(OH)D had a RRR of 1·55 (95 % CI 1·12, 2·13; P < 0·01) to have 1-19 teeth and a RRR of 1·96 (95 % CI 1·20, 3·21; P < 0·01) to be edentulous, relative to those with ≥ 20 teeth in the fully adjusted models. These findings demonstrate that in this cross-sectional study of older men and women from Ireland, 25(OH)D concentration was associated with both periodontitis and tooth loss, independent of other risk factors.

Prevalence and Association of Caries and Enamel Hypomineralisation/Molar-Incisor Hypomineralisation in 8- to 10-Year-Old Children from Bavaria, Germany

INTRODUCTION

The aim of this cross-sectional epidemiological study was to record caries and enamel hypomineralisation (EH), including molar-incisor hypomineralisation (MIH), and assess associations between both entities in 8- to 10-year-olds from Bavaria, Germany.

METHODS

A total of 5,418 children (mean age 9.8 years; 2,726 females, 2,692 males) were examined using the dmft/DMFT index with additional inclusion of initial or non-cavitated carious lesions (it/IT). EHs were recorded in the primary (eh) and permanent dentition (EH), and individuals with different EH phenotypes were determined as follows: at least one EH, at least one hypomineralised second primary molar (HSPM), at least one hypomineralised first permanent molar (MIH), and at least one hypomineralised first permanent molar and incisor (M+IH). Multiple logistic regression models were constructed to assess association between caries and EH.

RESULTS

The percentage of children without caries in the permanent dentition (DMF = 0) was 88.9%. When data regarding initial carious lesions were included (IDMF = 0), the prevalence decreased to 75.7%. The caries experience was idmf/t = 1.6 and the IDMF/T = 0.6. The mean number of carious teeth in subjects with no eh/EH was higher than that in subjects with HSPM, MIH, or M+IH. The presence of HSPM, MIH, and M+IH was associated with a significantly lower probability of caries in the permanent dentition; the corresponding adjusted odds ratios were 0.55 (95% CI: 0.41-0.75), 0.67 (95% CI: 0.56-0.81), and 0.54 (95% CI: 0.41-0.72), respectively.

CONCLUSIONS

Caries and EH are prevalent conditions in 8- to 10-year-old Bavarian schoolchildren; both dental diseases were negatively associated with each other.

PANoptosis: a new insight for oral diseases

PANoptosis, a burgeoning area of research, is a unique type of programmed cell death typified by pyroptosis, apoptosis, and necroptosis, yet it defies singular classification by any one mode of death. The assembly and activation of PANoptosomes are pivotal processes in PANoptosis, with several PANoptosomes already identified. Linkages between PANoptosis and the pathophysiology of various systemic illnesses are established, with increasing recognition of its association with oral ailments. This paper aims to deepen understanding by conducting a comprehensive analysis of the molecular pathways driving PANoptosis and exploring its potential implications in oral diseases.

Integrative microbiome and metabolome profiles reveal the impacts of periodontitis via oral-gut axis in first-trimester pregnant women

BACKGROUND

Periodontitis results from host-microbe dysbiosis and the resultant dysregulated immunoinflammatory response. Importantly, it closely links to numerous systemic comorbidities, and perplexingly contributes to adverse pregnancy outcomes (APOs). Currently, there are limited studies on the distal consequences of periodontitis via oral-gut axis in pregnant women. This study investigated the integrative microbiome-metabolome profiles through multi-omics approaches in first-trimester pregnant women and explored the translational potentials.

METHODS

We collected samples of subgingival plaques, saliva, sera and stool from 54 Chinese pregnant women at the first trimester, including 31 maternal periodontitis (Perio) subjects and 23 Non-Perio controls. By integrating 16S rRNA sequencing, untargeted metabolomics and clinical traits, we explored the oral-gut microbial and metabolic connection resulting from periodontitis among early pregnant women.

RESULTS

We demonstrated a novel bacterial distinguisher Coprococcus from feces of periodontitis subjects in association with subgingival periodontopathogens, being different from other fecal genera in Lachnospiraceae family. The ratio of fecal Coprococcus to Lachnoclostridium could discriminate between Perio and Non-Perio groups as the ratio of subgingival Porphyromonas to Rothia did. Furthermore, there were differentially abundant fecal metabolic features pivotally enriched in periodontitis subjects like L-urobilin and kynurenic acid. We revealed a periodontitis-oriented integrative network cluster, which was centered with fecal Coprococcus and L-urobilin as well as serum triglyceride.

CONCLUSIONS

The current findings about the notable influence of periodontitis on fecal microbiota and metabolites in first-trimester pregnant women via oral-gut axis signify the importance and translational implications of preconceptional oral/periodontal healthcare for enhancing maternal wellbeing.

Validation of an Artificial Intelligence-Based Model for Early Childhood Caries Detection in Dental Photographs

Background/Objectives: Early childhood caries (ECC) is a widespread and severe oral health problem that potentially affects the general health of children. Visual-tactile examination remains the diagnostic method of choice to diagnose ECC, although visual examination could be automated by artificial intelligence (AI) tools in the future. The aim of this study was the external validation of a recently published and freely accessible AI-based model for detecting ECC and classifying carious lesions in dental photographs. Methods: A total of 143 anonymised photographs of anterior deciduous teeth (ECC = 107, controls = 36) were visually evaluated by the dental study group (reference test) and analysed using the AI-based model (test method). Diagnostic performance was determined statistically. Results: ECC detection accuracy was 97.2%. Diagnostic performance varied between carious lesion classes (noncavitated lesions, greyish translucency/microcavity, cavitation, destructed tooth), with accuracies ranging from 88.9% to 98.1%, sensitivities ranging from 68.8% to 98.5% and specificities ranging from 86.1% to 99.4%. The area under the curve ranged from 0.834 to 0.964. Conclusions: The performance of the AI-based model is similar to that reported for the internal dataset used by developers. Further studies with independent image samples are required to comprehensively gauge the performance of the model.

Prevalence of dental caries among children and adolescents with intellectual disability in India: A scoping review

BACKGROUND

Children with intellectual and developmental disabilities are at a higher risk of developing dental caries. Few scoping reviews have been conducted in India to understand their issues. We aimed to summarise the distribution and risk factors of dental caries among children and adolescents with intellectual disabilities in India.

METHODS

A scoping review was conducted based on the Arksey O Malley framework. Quality assessment of studies, descriptive and thematic analyses were also conducted.

RESULTS

We charted, collated, and summarised from four databases. Thirty-one studies met the study criteria consisting of children and adolescents with intellectual disabilities. Median caries prevalence was 70%, decayed missing and fIlled permenant teeth (DMFT) was 2.4, decayed missing and filled decidous teeth (dmft) was 2.36, and DMFS was 3.7. Major determinants were the severity of disability, socioeconomic status and parents' education. Oral care and dental visits were inadequate.

CONCLUSION

Further exploration is required to improve access and reduce caries experience and prevalence among children with intellectual and developmental disabilities in India.

A policy option towards improving efficiencies in Victorian public oral healthcare

BACKGROUND

International oral health policy directions led by the World Health Organisation call for the inclusion of oral health within universal health coverage. The aim of this study is to perform a budget impact analysis of a policy option for a more cost-efficient oral health workforce skill-mix (dentists and oral health therapists) to provide public oral healthcare in Victoria, Australia.

METHODS

Two hypothetical standard care pathways were developed. A dynamic population Markov model in TreeAge software, with a time horizon of 6 years. Two scenarios were modelled to determine: (1) base-case scenario: the threshold the dentist workforce could reduce per year, while achieving the same service delivery outputs, and (2) alternative scenario: the potential cost-savings for utilising an optimally cost-efficient oral health workforce skill-mix.

RESULTS

The threshold analysis showed a minimum reduction of 13% of the dentist workforce being replaced with oral health therapists can occur without having any impact on the same service delivery outputs. Under the alternative scenario, the potential cost-savings would be AUD$1,425,037 (standard deviation 58,954).

CONCLUSIONS

Governments and policy-decision makers should consider strategies in training, attracting, and retaining oral health therapists to achieve an optimally cost-efficient oral health workforce skill-mix when delivering public oral healthcare.

Association between LTF/MMP20/CA6/TAS1R2 polymorphisms and susceptibility to dental caries

OBJECTIVES

The aim was to assess the associations between the LTF, MMP20, CA6, and TAS1R2 polymorphisms and caries in the Zhuang population and explore the underlying mechanism of the impact of lactoferrin on caries susceptibility.

METHODS

A case-control study of 315 adolescents was conducted in Guangxi, China, from May-November 2022. Data were collected through oral examinations and questionnaires. Buccal mucosa cells and DNA samples were collected using the SNPscan technique. Saliva and supragingival plaque samples were taken from 69 subjects with various LTF rs10865941 genotypes. The relationships among the LTF rs10865941 polymorphism, lactoferrin, Streptococcus mutans, and caries were investigated by using the ELISA and qRT-PCR, along with logistic regression analysis.

RESULTS

The genotype distribution of the LTF gene were significantly different between the case and control groups (p = 0.018). The case group had lower C allele and greater T allele frequencies than the control group (p = 0.006). The LTF rs10865941 polymorphism was associated with caries in the codominant, dominant, and additive models (p < 0.05). MMP20 rs1784418, CA6 rs2274328, and TAS1R2 rs35874116 were not significantly different between the two groups (p > 0.05). A greater quantity of S. mutans. in the supragingival plaque was found in the case group (p = 0.03). There were significant differences between the two groups in both the codominant model and the dominant model (p < 0.05).

CONCLUSIONS

The LTF rs10865941 polymorphism may be associated with caries susceptibility in the Zhuang population of China. The LTF rs10865941 T allele may be a potential risk factor for dental caries.

Oral Diseases as a Manifestation of Inborn Errors of Immunity

Oral findings such as inflammation, ulcerations, or lesions can indicate serious systemic diseases and should prompt suspicion of acquired chronic conditions or inborn errors of immunity (IEIs). Currently, there are approximately 500 disease entities classified as IEIs, with the list expanding annually. The awareness of the existence of such conditions is of paramount importance, as patients with these disorders frequently necessitate the utilization of enhanced diagnostic techniques. This is exemplified by patients with impaired antibody production, in whom conventional serological methods may prove to be undiagnostic. Patients with IEI may require distinct therapeutic approaches or antimicrobial prophylaxis throughout their lives. An accurate diagnosis and, more importantly, early identification of patients with immune deficiencies is crucial to ensure the quality and longevity of their lives. It is important to note that the failure to establish a proper diagnosis or to provide adequate treatment could also have legal implications for medical professionals. The article presents IEIs, which may manifest in the oral cavity, and their diagnosis alongside therapeutic procedures.

Association between periodontitis and cardiovascular risk in Spanish employed adults-The Workers' Oral Health study

AIMS

Periodontitis and cardiovascular diseases (CVD) are highly prevalent non-communicable diseases, sharing an inflammatory pathogenesis and common risk factors. The objective of the present research is to assess the association between periodontitis and cardiovascular disease risk in a representative sample of the Spanish-employed population.

METHODS

Cross-sectional data were obtained between 2008 and 2011 in the Workers' Oral Health (WORALTH) epidemiological study. Periodontal examinations were based on the evaluation of clinical attachment loss (CAL) and community periodontal index (CPI). Participants also underwent a medical check-up and answered a comprehensive health questionnaire. With this information, participants were categorized into three levels of CVD risk using the systemic coronary risk estimation (SCORE) algorithm for low-risk European countries. Crude and adjusted odds ratios (ORs) were determined with multiple logistic regression models for the association between periodontal status and CVD risk.

RESULTS

Data from 4224 individuals were analyzed. The overall prevalence of high CVD risk (SCORE ≥ 5%) was 5.1%. The prevalence of SCORE ≥ 5% was 3.4%, 9.4%, and 15.2% for CAL 0-3 mm, 4-5 mm, and ≥6 mm, respectively (p < .001), and 6.2%, 6.5%, and 14.6% for CPI ≤2, 3, and 4, respectively (p < .001). Individuals with CPI = 4 presented an OR of 1.50 (95% confidence interval, CI [1.04; 2.17]) for high SCORE values, after adjusting for confounders (age, sex, and smoking habit).

CONCLUSIONS

Periodontitis, defined by the presence of deep periodontal pockets (≥6 mm), was significantly associated with high CVD risk (SCORE ≥ 5%) in a representative sample of the employed population in Spain.

Assessing oral health knowledge among public school children in Saudi Arabian subpopulation

INTRODUCTION

Oral hygiene is paramount for maintaining optimal oral and physical health, especially among children who are particularly susceptible to dental caries and issues due to dietary habits and inadequate hygiene practices. This study aimed to evaluate the awareness and knowledge of oral health among public school children, analyse their oral hygiene habits, educate parents on the importance of oral health for their children, and implement an oral hygiene educational program in Al-Kharj City, Saudi Arabia.

METHODS

Four public elementary schools were selected for the study, with a sample size of 200 school-going children participating. A structured questionnaire was used to assess awareness and knowledge of oral health among the participants. SPSS software version 26 was used for data analysis. Multiple regression analysis and correlation tests was employed to explore the relationships between the different variables measured in the study.

RESULTS

The findings revealed a significant lack of awareness regarding oral health among school children. Oral hygiene habits were found to be inadequate in many participants. Overall, the findings highlight the need for targeted interventions aimed at promoting regular dental visits, addressing dental fear, and fostering positive oral hygiene practices among school-going children to improve oral health outcomes in the studied population.

CONCLUSION

The study highlighted a critical gap in oral health awareness among school children, underscoring the need for targeted interventions. While the oral hygiene educational program has been implemented and future data will shed light on its effectiveness, preliminary observations suggest that such programs could potentially improve oral health outcomes and overall engagement among students.

Estimated economic costs of dental implants among older South Korean adults, 2015-2018

OBJECTIVE

Dental implants are a considerable financial burden for elderly people and their caregivers. This study aimed to calculate the estimated economic costs of dental implants on the Korean older population.

MATERIALS AND METHODS

The economic costs of dental implants for adults aged 75 years and older were estimated from a societal perspective, considering both direct and indirect expenditures. We used data from the Korean National Health Insurance Service for the period 2015-2018 to estimate the medical costs. Noninsured medical costs were estimated from research on medical expenses by the National Health Insurance Review and Assessment Service. Indirect costs related to transportation fees and time loss were obtained. The Cochran Armitage trend test was performed to examine the trend of the economic burden of dental implants.

RESULTS

The estimated economic costs showed from 2015 to 2018 (total costs: $26.54-55.66 million, total costs after discount: $17.11-39.56 million). Direct costs, including insured and noninsured medical costs, represented from $25.81 to $47.03 million. Indirect costs, including transportation and time costs, ranged from $0.73 to $1.63 million. The impact of the total dental implant costs was 0.0018%-0.0034% of the Korean annual gross domestic product and 1.03%-1.59% of the annual total costs of dental care benefits.

CONCLUSIONS

The estimated economic burden of dental implants significantly increased from 2015 to 2018 in older South Korean adults. These results will provide a foundation and guidance for further health economic studies on the burden of dental implants in the elderly population.

Supra-Alveolar Bone Regeneration: Progress, Challenges, and Future Perspectives

Periodontitis is a highly prevalent disease that damages the supporting tissues of a tooth, including the alveolar bone. Alveolar bone loss owing to periodontitis is broadly categorized as supra-alveolar and intra-alveolar bone loss. In intra-alveolar bone loss, the defect has an angular or oblique orientation to the long axis of the tooth in an apical direction. In contrast, the defect is perpendicular to the long axis of the tooth in supra-alveolar bone loss. Unlike intra-alveolar bone defects, supra-alveolar bone defects lack supporting adjacent space, which makes supra-alveolar bone regeneration more challenging. In addition, the limited availability of resources in terms of vascularity and underlying tissues is another obstacle to supra-alveolar bone regeneration. Currently, supra-alveolar bone loss is the least predictable periodontal defect type in regenerative periodontal therapy. In addition, supra-alveolar bone loss is much more common than other alveolar bone loss. Despite its prevalence, research on supra-alveolar bone regeneration remains sparse, indicating an unmet need for significant research efforts in this area. This review summarize recent advances, obstacles, and future directions in the field of supra-alveolar bone regeneration. We discuss the biomaterials, bioactive molecules, and cells that have been tested for supra-alveolar bone regeneration, followed by pre-clinical and clinical approaches employed in this field. Additionally, we highlight obstacles and present future directions that will propel supra-alveolar bone research forward.

Global Trial Representation and Availability of Tyrosine Kinase Inhibitors for Treatment of Chronic Myeloid Leukemia

Background: Evaluating clinical trial representation for countries with different socio-demographic index (SDI) and tyrosine kinase inhibitor (TKI) availability for chronic myeloid leukemia (CML). Methods: CML incidence rates (IRs) and disability-adjusted life years (DALYs) (1999-2019) from the Institute of Health Metrics and Evaluation were analyzed. Trials investigating TKI use in CML were obtained from ClinicalTrials.gov. Site data for eligible trials (N = 30) and DALYs were analyzed. TKI approvals, DALYs, and IRs were summarized by SDI. Results: North America (NA) had significant decreases in annual percent change (APC) in DALYs and incidence rates from 1999 to 2004. IRs were highest in Europe and Central Asia (ECA) and NA, while DALYs were highest in South Asia (SAsia) and Sub-Saharan Africa (SSA). Countries in the high-SDI quintile were likely to have lower DALYs than lower-SDI quintiles. Differences in regional DALYs vs. sites in TKI trials were significant for SAsia, SSA, and ECA. High-SDI countries were included in all 30 trials, and TKI approvals were prominent in high-SDI (142) vs. low-SDI (14) countries. Conclusions: The inclusion of disproportionately affected countries during the design of and recruitment into clinical trials should occur, as should TKI availability. The lack of representation demonstrates healthcare disparities.

The association between dental caries and serum crp in the us adult population: evidence from NHANES 2015-2018

BACKGROUND

Dental caries remains one of the most prevalent diseases worldwide, affecting 29.4% of the global population. Despite numerous efforts to diagnose, predict, and prevent dental caries, the incidence continues to rise. Salivary biomarkers provide a non-invasive means for early detection of various oral conditions. C-reactive protein (CRP) is a key marker, elevated in both oral and general inflammatory conditions such as diabetes, periodontitis and oral squamous cell carcinoma. Considering the emerging connection between oral and systemic health, it is worth exploring the various factors associated with this widespread disease. This study investigates the association between CRP levels and dental caries in the United States population, utilizing data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

The study analyzed data from the 2015-2018 NHANES cycles, focusing on a nationally representative sample of individuals aged 30 years and above. Weighted multivariable negative binomial and logistic regression analyses were employed to explore the relationship between dental caries and CRP levels, adjusting for age, gender, race, education level, diabetes status, and gum disease.

RESULTS

The results of the negative binomial regression analysis demonstrated a positive association between higher CRP levels and an increased mean number of dental caries (Adjusted Mean Ratio [AMR] = 1.7; 95% CI: 1.3 - 2; P: < 0.001). The logistic regression analysis showed that individuals with higher CRP levels have a 50% increase in the odds of developing dental caries (AOR: 1.5, CI: 1.2 - 1.9; P: < 0.01).

CONCLUSION

The results of this cross-sectional study of the U.S. population highlight the positive association between high CRP levels and increased dental caries. These findings contribute to the growing body of evidence supporting the integration of oral and systemic health care. Further research is necessary to deepen our understanding of the mechanistic relationship between CRP levels and dental caries.

Oral health status of Dutch Armed Forces recruits in the years 2000, 2010 and 2020, a retrospective repeated cross-sectional study

BACKGROUND

Studies on oral health status of adults are sparse and rarely include data on endodontic treatment and trauma. In the military, those data are available because recruits are routinely assessed with a clinical and radiological examination at the start of their career. This study aimed to identify differences in oral health status of Dutch Armed Forces recruits between cohorts, departments, sex, age and rank, with DMF-T, endodontic treatment and dental trauma as outcome measures.

METHODS

Data from Electronic Patient Files from all recruits enlisted in 2000, 2010 and 2020 were used for analysis in a hurdle model resulting in the estimated cohort effect, controlled for the demographic variables. The total number of recruits was 5,764. Due to the retrospective character of the study a proxy was used to compose D-T and dental trauma.

RESULTS

The mean DMF-T number in recruits decreases from 5.3 in cohort 2000 to 4.13 in cohort 2010 and 3.41 in cohort 2020. The percentage of endodontically treated teeth increases from 6% in cohort 2000 to respectively 9% in 2010 and 8% in 2020. The percentage of recruits showing signs of dental trauma did not change significantly between cohort 2000 (3.1%) and cohort 2010 and 2020 (both 2.7%).

CONCLUSIONS

Oral health in Armed Forces recruits is improving over the years, following a similar trend as the general population in the Netherlands. Lower SES represented by enlisted rank showed substantial lower oral health status.

Assessment of treatment needs, barriers, and self-perception regarding oral health among female university students: a cross-sectional study

BACKGROUND

The study aimed to compare the self-perceived oral health status measured through a self-administered questionnaire with clinically determined oral health status measured by decayed-missing-filled teeth (DMFT) and community periodontal index of treatment need (CPITN) indices in university going females. In addition, access barriers to treatment related to oral healthcare were also determined.

METHODS

A 3-month analytical cross-sectional study was designed for consenting university going females (aged 18-22 years) in Islamabad, Pakistan. The self-perceived oral health was recorded through a questionnaire requesting information regarding socio-demographics, self-perception of oral health, frequency of dental visits and barriers to seeking oral health. Seven independent examiners performed intraoral clinical examination and assessed the oral health status using globally standardized oral health assessment indices (DMFT and CPITN).

RESULTS

A total of 400 students were included in the final sample. The study revealed a significant disparity between self-perceived oral health and clinical assessment. Although perceived oral health was considered "good" by 80.0% of the respondents, clinical examination revealed moderate DMFT scores (mean 2.95 ± 1.41) and periodontal disease requiring treatment in 89.5% of the individuals. The most common barriers in seeking dental care were lack of knowledge, dental phobia, affordability issue and false self-perception.

CONCLUSION

The present study demonstrated a notable discrepancy between self-perception of oral health and clinically assessed oral health. These results emphasize the importance of focused educational programs and community outreach programs, especially directed towards this demographic. Prioritizing such initiatives will help individuals to recognize their actual oral health condition thus encouraging positive oral health behaviors and outcomes.

Socioenvironmental sugar promotion and geographical inequalities in dental health of 5-year-old children in England

OBJECTIVES

To investigate the relationship between socioenvironmental sugar promotion and geographical inequalities in the prevalence of dental caries amongst 5-year-olds living across small areas within England.

METHODS

Ecological data from the National Dental Epidemiology Programme (NDEP) 2018-2019, comprising information on the percentage of 5-year-olds with tooth decay (≥1 teeth that are decayed into dentine, missing due to decay, or filled), and untreated tooth decay (≥1 decayed but untreated teeth), in lower-tier local authorities (LAs) of England. These were analysed for association with a newly developed Index of Sugar-Promoting Environments Affecting Child Dental Health (ISPE-ACDH). The index quantifies sugar-promoting determinants within a child's environment and provides standardized scores for the index, and its component domains that is, neighbourhood-, school- and family-environment, with the highest scores representing the highest levels of sugar promotion in lower-tier LAs (N = 317) of England. Linear regressions, including unadjusted models separately using index and each domain, and models adjusted for domains were built for each dental outcome.

RESULTS

Participants lived across 272 of 317 lower-tier LAs measured within the index. The average percentage of children with tooth decay and untreated tooth decay was 22.5 (SD: 8.5) and 19.6 (SD: 8.3), respectively. The mean index score was (0.1 [SD: 1.01]). Mean domain scores were: neighbourhood (0.02 [SD: 1.03]), school (0.1 [SD: 1.0]), and family (0.1 [SD: 0.9]). Unadjusted linear regressions indicated that the LA-level percentage of children with tooth decay increased by 5.04, 3.71, 4.78 and 5.24 with increased scores of the index, and neighbourhood, school and family domains, respectively. An additional model, adjusted for domains, showed that this increased percentage predicted by neighbourhood domain attenuated to 1.37, and by family domain it increased to 6.33. Furthermore, unadjusted models indicated that the LA-level percentage of children with untreated tooth decay increased by 4.72, 3.42, 4.45 and 4.97 with increased scores of the index, and neighbourhood, school, and family domains, respectively. The model, adjusted for domains, showed that this increased percentage predicted by neighbourhood domain attenuated to 1.24 and by family domain rose to 6.47. School-domain was not significantly associated with either outcome in adjusted models.

CONCLUSIONS

This study reveals that socioenvironmental sugar promotion, particularly within neighbourhood- and family-environments, may contribute to geographical inequalities in dental caries in children. Further research involving data on individual-level dental outcomes and confounders is required.

Validity of self-reported oral conditions among Brazilian older women: Do socio-economic factors matter?

OBJECTIVE

To validate the level of agreement between self-report and clinical examination for oral conditions and evaluate the effect of sociodemographic conditions on the validity of self-report among women aged 60 and older.

METHODS

A cross-sectional study was conducted in a social community center for seniors in Southern Brazil. Sociodemographic data (age, level of education, and income) were measured. Participants were interviewed and clinically examined for the number of teeth (DMF-T index) and the use of dental prostheses. The self-reported number of teeth in each arch and the use of dental prostheses were gathered through interviews. The level of agreement was estimated using the observed agreement, Kappa statistics, sensitivity/specificity (edentulism/prostheses) and Lin's concordance correlation coefficient, and related tests (number of teeth). The validity of the oral conditions was estimated according to sociodemographic information.

RESULTS

Ninety-nine women participated in the study. High levels of agreement were observed for edentulism (97.8%; 95%CI 92.8;99.7; Kappa 0.947) and the use of dental prostheses (97.0%; 95%CI 91.3;99.4; Kappa 0.922). In both conditions, despite achieving similar concordance correlation coefficients (ranging from weak to moderate), the mean number of upper teeth was lower in clinical examination (7.1 ± 5.2) compared with self-reported (8.6 ± 3.6), while the opposite was observed for lower teeth (clinical examination: 9.1 ± 3.4; self-reported: 6.6 ± 5.3). Larger differences were found among women of low income and educational levels.

CONCLUSIONS

Our findings suggest that the participants' socio-economic position might influence their self-reported number of teeth.

Dental caries and associated factors among Turkish children and adults: Findings from the 3rd National Oral Health Survey

BACKGROUND

Information on the current status of oral health and related risk factors is lacking in Turkiye. This study aimed to evaluate dental caries and associated factors among the Turkish population using the findings of the third national oral health survey.

METHODS

This cross-sectional epidemiological survey was carried out between March and September in 2018 including five index ages and age groups (5-, 12-, 15-year-olds, 35-44 and 65-74 age groups). A multistage cluster sampling design was used to obtain a national representative sample of these age groups. Participants were interviewed face-to-face using a structured questionnaire, and oral examinations were performed based on the methods and criteria suggested by the World Health Organization. The adjusted prevalence ratio for dental caries was estimated considering sociodemographic and behavioural characteristics by using log-binomial and robust Poisson regression analysis in R and SAS software.

RESULTS

After data cleaning, a total of 11 091 participants remained. The prevalence of dental caries was 76.5% (95% confidence interval: 75.4%-77.7%) and determined to be associated with age, dental visit, and pain or discomfort history during the previous year among the Turkish population. Prevalence was also associated with the mother's education level among 5-, 12- and 15-year-olds. For the 35-44 age group, individuals living in urban areas had lower dental caries than those living in rural areas. For 65-74 age group, none of the factors were significantly associated with dental caries.

CONCLUSION

A high prevalence of dental caries was observed in Turkish children and adults. Therefore, it is necessary to strengthen current preventive oral health programs. Regular disease surveillance should be maintained. National oral health targets should be formulated in accordance with Turkiye's needs, resources and structure.

Global trends in incidence of caries in permanent teeth of children aged 5 through 14 years, 1990 through 2019

BACKGROUND

School-aged children are in the stage of permanent tooth eruption to replace primary teeth and this can be reached at a life stage when their health habits are being formed due to a large amount of time in school. However, data on the global trend in incidence of caries in permanent teeth in school-aged children are sparse. This study aimed to assess the trends in incidence of caries in permanent teeth in children aged 5 through 14 years from 1990 through 2019 at the global, regional, and national levels.

METHODS

The authors collected data on incidence of caries in permanent teeth in children aged 5 through 14 years from 1990 through 2019 from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to assess trends at the global, regional, and national levels.

RESULTS

Globally, incident cases of caries in permanent teeth in children aged 5 through 14 years increased by 15.25% from 1990 through 2019, and the incidence rate remained stable during this period, with incidence rates of 34.04% in 1990 and 33.93% in 2019. The incidence rate increased at an average annual percentage change of 0.08% (95% CI, 0.06% to 0.10%) and 0.07% (95% CI, 0.05% to 0.09%) from 1990 through 2019 in low and low-middle sociodemographic index regions, respectively. An increasing trend also was observed in nearly one-half of GBD regions and more than one-half of the world's countries from 1990 through 2019 (P < .05).

CONCLUSIONS

Global incidence of caries in permanent teeth remained stable at a high level in children aged 5 through 14 years, but there was a trend toward increasing rates in nearly one-half of sociodemographic index or GBD regions and more than one-half of the world's countries and territories from 1990 through 2019. These findings suggest that caries in permanent teeth is a priority health issue in school-aged children worldwide.

PRACTICAL IMPLICATIONS

Reducing free sugar intake and implementing school-based effective caries prevention programs, such as school water fluoridation, provision of fluoride tablets at school, and school dental sealant programs, are needed for school-aged children.

Global and regional trends in prevalence of untreated caries in permanent teeth: Age-period-cohort analysis from 1990 to 2019 and projections until 2049

OBJECTIVES

This study aims to update the relevant epidemiological information of untreated caries in permanent teeth.

METHODS

Data were derived from the Global Burden of Disease (GBD) study 2019. We described temporal trends in age-standardized prevalence rate (ASPR) of untreated caries in permanent teeth by gender and region from 1990 to 2019. Age-period-cohort (APC) model was utilized to analyze age, period and cohort effects on prevalence, and we used the Bayesian age-period-cohort (BAPC) model to make projections of prevalence between 2020 and 2049.

RESULTS

The global ASPR of untreated caries in permanent teeth presented a decreasing trend from 1990 to 2019 (26593.58/105 vs. 25625.53/105), with females exceeding males annually. Negative correlation was observed between ASPR and Socio-demographic Index (SDI) levels. APC analyses showed that net drift was -0.16 % globally and generally below 0 across all SDI regions. The overall global peak in prevalence occurred in the 20-24 years group (36319.99/105), and there was a decrease trend in the overall global period rate ratio (RR). Compared to younger birth cohorts, prior birth cohorts had higher prevalence risks globally and across all SDI regions. Significant upward trends was predicted in the global ASPR of untreated caries in permanent teeth for both genders from 2020 to 2049.

CONCLUSIONS

Age-period-cohort effects exerted a significant impact on the prevalence of untreated caries in permanent teeth during the study period.

CLINICAL SIGNIFICANCE

The ASPR of untreated caries in permanent teeth may increase in the next 30 years by projections. And the disease burden of untreated caries in permanent teeth may be affected by population ageing. It is essential to implement targeted prevention and control policies to disadvantaged groups and attempt to reduce caries inequalities.

Enhancing Esthetics in Direct Dental Resin Composite: Investigating Surface Roughness and Color Stability

Dental restorations must replicate the natural appearance of teeth while ensuring biocompatibility and durability. This study evaluated the surface characteristics and color stability of three dental composites-Herculite Ultra XRV, G-ænial A'CHORD, and Omnichroma-exposed to acidic beverages (red wine, black coffee, and Coca-Cola). Sixty disk-shaped specimens were prepared, polished, and immersed in these beverages. Surface roughness was assessed using profilometry and SEM analysis, hydrophobicity via contact angle analysis, and surface charge through streaming potential measurements. Color stability was evaluated using a spectrophotometer, and the pH levels of the solutions were recorded. Results showed that Herculite Ultra XRV had the highest mean contact angle (79.46° ± 6.52), indicating superior hydrophobicity, while Omnichroma had the lowest (64.94° ± 3.08), indicating more hydrophilicity. Significant color changes were observed, especially in black coffee, with ∆E values indicating notable discoloration. The acidic pH of the solutions increased surface roughness and color changes. Statistical analyses confirmed significant increases in surface roughness and color change for all composites, with the nanohybrid resin composite showing the greatest variability. These findings highlight the need for dental restorative materials with enhanced resistance to acidic environments to improve the longevity and esthetics of dental treatments.

Impact of smoking on cost-effectiveness of 10-48 years of periodontal care

The study aims were (1) to explore whether "periodontal treatment" consisting of surgical therapy (flap, resective, or regenerative) or scaling and root planing treatment with long-term periodontal maintenance treatment, is cost-effective in terms of preventing periodontitis-attributable tooth extraction and replacement by implant-supported crowns ("extraction/replacement"); (2) to assess the effect of cigarette smoking on this cost-effectiveness. Data for this observational retrospective study were collected from dental charts of patients who had received periodontal therapy and at least annual follow-up visits for >10 years were analyzed by linear regression generalized estimating equations and generalized linear models. Among 399 adults (199 males, 200 females), those with the least mean annual treatment cost experienced the greatest mean annual costs for extraction/replacement, indicating general cost-effectiveness. Cigarette smoking adversely impacted this cost-effectiveness, with current heavy smokers experiencing no cost-effectiveness. Former smokers with Grade C periodontitis benefitted most, whereas smoking did not influence cost-effectiveness for Grade B periodontitis. Assessed by mean annual costs of "extraction/replacement," periodontal treatment was cost-effective, which decreased in a dose-response manner by former and current smoking intensity. Cigarette smoking should be factored into treatment planning and cost-effective analyses of periodontal treatment. Smoking cessation should be encouraged.

Oral health inequalities in immigrant populations worldwide: a scoping review of dental caries and periodontal disease prevalence

BACKGROUND

Inequalities in immigrants' oral health are often masked in population-level data. Therefore, this paper was planned to assess the prevalence data on oral health diseases, namely dental caries, and periodontitis, among immigrants worldwide.

METHODS

Following a systematic search in Scopus, Embase, and PubMed for studies published between 2011 and 2023, 1342 records were identified. Following title and abstract screening, 76 studies remained for full-text eligibility-screening based on predefined inclusion criteria. Thirty-two studies were included in the review.

RESULTS

Dental caries figures were higher in immigrant populations compared to the local population, regardless of host countries, age, gender, or nationality. In children, the overall mean and standard deviation (SD) for decayed, missing, and filled teeth in the primary dentition (d3mft) was 3.63(2.47), and for D3MFT (permanent dentition), it was 1.7(1.2). Upon comparing overall mean caries counts in children and adults with their control groups in the included studies, untreated dental caries (D3T and d3t) constituted the dominant share of caries experience (D3MFT and d3mft) in immigrant children. For the local population, the highest proportion of caries experience was attributed to filled teeth (FT and ft). Dentin caries prevalence among immigrants ranged from 22% to 88.7% in the primary dentition and 5.6% to 90.9% in the permanent dentition. Gingivitis ranged from 5.1% to 100%. Oral health varied greatly between studies. Regarding oral health accessibility, 52% to 88% of immigrant children had never been to a dentist, suggesting a very limited level of accessibility to dental health services.

CONCLUSION

It is imperative to develop interventions and policies that have been customized to address the oral health disparities experienced by immigrant populations. Additionally, host countries should actively implement measures aimed at enhancing the accessibility of oral health care services for these individuals. The utilization of available data is crucial in establishing a hierarchy of objectives aimed at enhancing the oral health of immigrant populations.

TRIAL REGISTRATION

The Scoping review protocol was registered at OSF Registries with registration number ( https://doi.org/10.17605/OSF.IO/MYXS4 ).