Time loss due to dental problems and treatment in the Canadian population: analysis of a nationwide cross-sectional survey

Development and Validation of Chinese Version of Dental Pain Screening Questionnaire

INTRODUCTION

Dental pain is one of the most prevalent oral complaints. This study aimed to establish a Chinese version of Dental Pain Screening Questionnaire (DePaQ) to help classify patients into three groups of dental pain diseases (group 1, reversible pulpitis and dentine hypersensitivity; group 2, acute periapical periodontitis and irreversible pulpitis; and group 3, pericoronitis).

METHODS

The DePaQ was translated from English to Chinese. The clinical subjects (CS, n = 290) and nonclinical subjects (NS, n = 100) with dental pain were collected. The CS were randomly divided into two subsamples: CS1 (n = 203) and CS2 (n = 87). The Fisher discriminant functions of the final 13-item Chinese version of the DePaQ were obtained from the CS1 group, and discriminant validity was further verified in the CS2 and NS groups.

RESULTS

The discriminant functions of the final 13-item DePaQ obtained from the CS1 group were capable of correctly distinguishing 93.1% and 89.0% cases of the CS2 and NS groups, respectively. In the CS2 group, the sensitivity for groups 1, 2, and 3 was 88.0%, 80.0%, and 83.0%, respectively, and the specificity was 95.0%, 95.0%, and 86.0%, respectively. In the NS group, the sensitivity for groups 1, 2, and 3 was 82.0%, 80.0%, and 86.0%, respectively, and the specificity was 91.0%, 97.0%, and 90.0%, respectively.

CONCLUSIONS

The Chinese version of DePaQ could help classify the three groups of dental pain diseases and guide medical treatment.

School-Based Fluoride Mouth-Rinse Programs and Dental Caries Treatment Expenditure: An Ecological Study of the NDB Open Data Japan

OBJECTIVES

The prevalence of dental caries is high in Japan, leading to a huge burden of overall expenditure on dental caries treatment for the population. School-based fluoride mouth-rinse (S-FMR) has been implemented as a public health intervention. However, its cost-effectiveness remains unclear, where universal health insurance covers a broad range of dental treatments at relatively low cost. The aim of the study was to determine whether S-FMR is associated with lower dental caries treatment expenditure in Japan, where the universal health insurance system widely covers dental treatments. In addition, the cost-benefit of S-FMR was estimated.

METHODS

This ecological study examined the association between S-FMR coverage and dental caries treatment expenditure in all 47 prefectures of Japan. Data were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data (NDB Open Data Japan), national survey data on the prevalence of S-FMR, and other census data for each prefecture. The outcome variable was the average annual treatment expenditure of for children aged 5-14 per child. The explanatory variable was the S-FMR coverage of children per prefecture, divided into quartiles: (Q1) 0.0%-0.48%, (Q2) 0.54%-6.9%, (Q3) 7.2%-25.0% and (Q4) 26.9%-80.4%. Linear regression analysis was performed with adjustment for the number of dental clinics per 100 000 individuals, per capita prefectural income, and percentage of the population aged between 5 and 14 years.

RESULTS

The dental caries treatment expenditure was lower in prefectures with higher S-FMR coverage: (Q1) 2378 JPY, (Q2) 2215 JPY, (Q3) 2217 JPY and (Q4) 2065 JPY. Linear regression analysis showed that, compared to the prefectures with the lowest S-FMR coverage, the prefectures with the highest coverage exhibited significantly lower per person dental caries treatment expenditure by 186.0 (95% CI = 96.6, 275.4) JPY. When annual cost of S-FMR per person was lower, 200 JPY, S-FMR would save 0.9 billion JPY if all prefectures change from Q1 to Q4 (approximately 8.2 million USD).

CONCLUSIONS

Although public healthcare insurance in Japan covers most dental treatments at a relatively low cost, the current findings suggest that S-FMR could still be a cost-effective public health intervention.

Meta-analysis of oral microbiome reveals sex-based diversity in biofilms during periodontitis

Sex is an often overlooked, yet compulsory, biological variable when performing biomedical research. Periodontitis is a common yet progressively debilitating chronic inflammatory disorder affecting the tissues supporting teeth that ultimately leads to tooth loss if left untreated. The incidence of periodontitis is sex biased, with increased prevalence in males compared with females but with unknown etiology. We performed a sex-specific meta-analysis using publicly available oral microbiome data from different sampling sites of patients with periodontitis and periodontally healthy controls; sex balance was established for each periodontal health condition. Our results show sex-based diversity in oral biofilms of individuals with periodontitis but not in their saliva, with increased abundance of several periodontal pathogens in subgingival plaques from females compared with males. We devised a quantitative measure, uniquely defined as the Microsexome Index (MSI), which indicates that sexual dimorphism in subgingival bacterial composition is a distinct feature of reduced microbial diversity during periodontitis but not under healthy conditions. In addition, we found that smoking exacerbates microsexome diversity in supragingival biofilms, particularly during periodontitis. Taken together, we provide insights regarding sex-based diversity in periodontitis, a disease with multiorgan associations, and provide the rationale for further mechanistic, diagnostic, and therapeutic studies.

Socio-demographic predictors of not having private dental insurance coverage: machine-learning algorithms may help identify the disadvantaged

BACKGROUND

For accessing dental care in Canada, approximately 62% of the population has employment-based insurance, 6% have some publicly funded coverage, and 32% have to pay out-of pocket. Those with no insurance or public coverage find dental care more unaffordable compared to those with private insurance. To support the development of more comprehensive publicly funded dental care programs, it is important to understand the socio-demographic attributes of all those, who find dental care unaffordable.

METHODS

This study is a secondary analysis of the data collected from Ontarians during the latest available cycle of the Canadian Community Health Survey (2017-18), a cross-sectional survey that collects information on health status, health care utilization, and health determinants for the Canadian population. First, bivariate analysis was conducted to determine the characteristics of Ontarians who lack dental insurance. Afterwards, we employed machine learning (ML) to analyze data and identify risk indicators for not having private dental insurance. Specifically, we trained several supervised ML models and utilized Shapley additive explanations (SHAP) to determine the relative feature importance for not having private dental insurance from the best ML model [the gradient boosting (GBM)].

RESULTS

Approximately one-third of Ontarians do not have private insurance coverage for dental care. Individuals with an income below $20,000, those unemployed or working part-time, seniors aged above 70, and those unable to afford to have their own housing are more at risk of not having private dental insurance, leading to financial barriers in accessing dental care.

CONCLUSION

In the future, government-funded programs can incorporate these identified risk indicators when determining eligible populations for publicly funded dental programs. Understanding these attributes is critical for developing targeted and effective interventions, ensuring equitable access to dental care for Canadians.

A Holistic Approach for Ethics and Sustainability in the Food Chain: The Gateway to Oral and Systemic Health

Food production is a complex matter, affecting people's lives, organizations' profits, and the well-being of the whole planet, and has multifaceted ethical considerations surrounding its production, distribution, and consumption. This paper addresses the pressing need to confront ethical challenges within the food system, encompassing issues such as environmental sustainability, food security, and individual food choices for better oral and systemic health of all individuals around the globe. From agricultural practices to global trade and food waste, ethical implications are addressed across various domains, highlighting the interconnectedness of ethical decision-making in the food industry. Central themes explored include the ethical dimensions of food production methods, the impact of global trade on food ethics, and the role of individuals in making ethically informed food choices. Additionally, this paper considers the spiritual and physical significance of food, particularly through the lens of oral health as a gateway to holistic well-being. Recognizing the complexity of the food and mouth ecosystem, this paper calls for serious interventions in legislation and economics to promote ethical protocols and techniques for sustainability reasons. It emphasizes the importance of ethical considerations in food safety management systems, regulatory frameworks, and quality standards. Moreover, this paper underlines the need for a comprehensive approach to address ethical dilemmas and moral values inherent in the food industry and oral health policies, adopting the precautionary principle and ethical decision-making frameworks. This article finally aims to serve as a call to action for stakeholders across the food industry and the healthcare sector, to prioritize ethical practices, promote transparency, rearrange economic parameters, and work towards a more sustainable and equitable food system for inner and outer oral and systemic health and human sustainability for all.

A scoping review of the economic impact of family oral health: Implications for public health, research, and policy

OBJECTIVES

To summarize evidence on the impact of oral health on individual and family economic outcomes, describe trends in the literature, and identify areas for additional research to inform public health research and practice.

METHODS

Searches were conducted within PubMed, CINAHL, EconLit, Cochrane Library, PsycInfo, and Web of Science databases. Article review, selection, abstraction, and reporting processes were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

RESULTS

Of 2758 unduplicated records identified, 52 met inclusion criteria. Study outcomes included indicators of employment/employability (n = 9), earnings/earnings potential (n = 26), parent missed work and family financial impacts of child oral health (n = 19), and financial loss (n = 3). Dental caries-related variables were the most common predictors of poorer economic outcomes. Other oral health problems, such as poorer dental functioning or poorer self-reported oral health status, also were associated with adverse economic outcomes. Significant associations with employment were found among studies that assessed interventions designed to improve oral health. Only one study estimated the impact of oral health on earnings. One-third of studies conducted multivariable analyses, and 14% incorporated race and ethnicity variables.

CONCLUSIONS

Although existing evidence suggests associations between oral health problems and poorer economic outcomes, there is a substantial need for more rigorous research to better understand the extent of economic impact of oral health problems and which populations are most affected. Additional high-quality research is needed to inform which interventions are most likely to improve oral health, reduce adverse economic impacts, and promote health and economic equity.

Diabetes, periodontitis, and cardiovascular disease: towards equity in diabetes care

Type 2 diabetes and its associated cardiovascular risk is an escalating epidemic that represents a significant public health burden due to increased morbidity and mortality, disproportionately affecting disadvantaged communities. Poor glycaemic control exacerbates this burden by increasing retinal, renal, and cardiac damage and raising healthcare costs. This predicament underscores the urgent need for research into cost-effective approaches to preventing diabetes complications. An important but often overlooked strategy to improve metabolic control in diabetic patients is the treatment of periodontitis. Our aim is to assess whether the inclusion of periodontitis treatment in diabetes management strategies can effectively improve metabolic control, and to advocate for its inclusion from an equity perspective. We conducted a comprehensive review of the literature from 2000 to 2023. We analyzed the pathophysiological links between periodontitis, diabetes, and atherosclerotic cardiovascular disease, all of which have inflammation as a central component. We also examined the inequalities in health care spending in this context. Our findings suggest that incorporating routine screening and treatment of periodontitis into national health programs, with coordinated efforts between physicians and dentists, is a cost-effective measure to improve metabolic control, reduce complications and improve the overall quality of life of people with diabetes.

Association of oral health with various work problems: a cross-sectional study of Japanese workers

BACKGROUND

Oral diseases affect quality of life and known to decrease productivity. We examined the impact of oral health status on various types of work problems.

METHODS

This cross-sectional study used data from an internet-based self-report questionnaire survey administered to workers in Japan. Responses to the questionnaire regarding seven types of oral health-related work problems (1. Stress; 2. Lack of focus; 3. Lack of sleep; 4. Lack of energy; 5. Lack of communication due to halitosis; 6. Lack of communication due to appearance; 7. Lack of ability due to dental-related pain) were investigated and statistically analyzed. Explanatory variables were self-reported oral health status, number of teeth, and gum bleeding. To examine the association of oral health with the presence of work problems, logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Age, sex, educational attainment, income, the presence of diabetes, and industrial classifications were used as the covariates.

RESULTS

A total of 3,930 workers (mean age: 43.3 (SD = 11.7), 2,057 males and 1,873 females) were included. Overall, a total of 6.2% of workers reported having at least one oral health-related work problem in the past year, whereas 21.8% of those with poor self-reported oral health reported work problems. Workers with poor self-reported oral health were 3.58 (95% CI (1.70-7.56) times higher odds of reporting work problems than those with excellent self-reported oral health.

CONCLUSIONS

Oral health was found to be associated with various work problems. Oral health promotion policies are needed in the workplace.

The impact of culture on new Asian immigrants' access to oral health care: a scoping review

Background

Immigration has accounted for three-quarters of Canada's population growth since 2016, more than half of which has been from Asian countries. Newcomers from Asia have been reported to experience oral health disparities. The objective of this scoping review was to examine the literature discussing how culture affects access to oral health care for new immigrants from Asia and to identify knowledge gaps.

Methods

The review was conducted from December 2021 to April 2022 following the Arskey and O'Malley approach and PRISMA-ScR guideline. Five databases were searched using the search parameter "Asian+ AND Immigrant+ AND oral care+". Only peer-reviewed articles published in English between 2011 and 2021 were included.

Results

The search strategy yielded 736 articles. Duplicates were removed, titles and abstracts were reviewed, and the full text of 69 articles examined, leaving 26 articles that met eligibility criteria: 18 quantitative studies, 4 qualitative studies, and 4 reviews.

Discussion

Four themes were identified: language barriers, oral health care access and service utilization, oral health beliefs and behaviour, and immigrant children's oral health. Most new immigrants from Asia have limited English proficiency, are of low socioeconomic status, and have difficulty developing trusting relationships with care providers. Immigrant children's oral health is impacted by their parents' beliefs.

Conclusion

More research is needed on cultural barriers to and facilitators of access to oral health care for newcomers from Asia to Canada to aid in the development and implementation of policies and to inform practice and curriculum.

Cross-sectional associations between oral diseases and work productivity loss among regular employees in Japan

The association between oral diseases and work productivity loss remains unclear. This study examined whether dental caries, tooth loss, and poor periodontal status were associated with absenteeism and presenteeism. This cross-sectional study used two independent datasets: 184 employees at a medical university and 435 employees from among the registrants of an online research company. Absenteeism and presenteeism, according to the World Health Organization Health and Work Performance Questionnaire, were dependent variables. The independent variables were the number of decayed and filled teeth (DFT), missing teeth (MT), and self-reported periodontal status. Multivariable linear regression models were developed to estimate unstandardised coefficients with 95% confidence intervals (CIs) for absenteeism and presenteeism. After adjusting for covariates, among the 435 employees enrolled from among the registrants of an online research company, poor periodontal status was significantly associated with a 7.8% (95%CI = -14.5, -1.0) decline in presenteeism but not absenteeism. DFT and MT were not significantly associated with either absenteeism or presenteeism in both populations. Given that periodontal status was potentially associated with a 7.8% decline in work performance, occupational specialists, managers, and dental health professionals should be aware of the impact on work productivity.

Association between place of dental check-ups and work absenteeism among Japanese workers

OBJECTIVES

Dental check-ups at the workplace provide the opportunity for early detection of dental diseases. Dental check-ups during working hours could reduce the number of days of absence from work due to visits to dental clinics outside the workplace. Although health check-ups are provided to workers in Japan, dental check-ups is not mandatory. This study aimed to determine the association between the place of dental check-ups and absenteeism due to visits to the dental clinic.

METHODS

This cross-sectional study used data from an online self-reported worker survey conducted for 2 weeks in March 2017. We applied linear regression analysis with robust variance to determine the association between the place of dental check-ups and absenteeism due to dental clinic visits while adjusting for sociodemographic, health, and oral health covariates.

RESULTS

The average age of the 3930 participants was 43.3 ± 11.7 years, and 52.3% were male. The number of days of absenteeism due to dental clinic visits in the past year for those who received check-ups only at the dental clinic and at the workplace were 0.57 ± 2.67 days and 0.21 ± 1.20 days, respectively. After adjusting for covariates, it was found that those who received dental check-ups at the workplace had 0.35 (95% CI, 0.12-0.58) fewer days of absence than those who received dental check-ups at the dental clinic.

CONCLUSION

Workers who received dental check-ups at the workplace were associated with fewer days of absence due to dental visits than those who received at the dental clinic.

The impact of dental care programs on healthcare system and societal outcomes: a scoping review

BACKGROUND

Dental diseases have detrimental effects on healthcare systems and societies at large. Providing access to dental care can arguably improve health outcomes, reduce healthcare utilization costs, and improve several societal outcomes.

OBJECTIVES

Our objective was to review the literature to assess the impacts of dental care programs on healthcare and societal outcomes. Specifically, to identify the nature of such programs, including the type of services delivered, who was targeted, where services were delivered, and how access to dental care was enabled. Also, what kind of societal and healthcare outcomes have been attempted to be addressed through these programs were identified.

METHODS

We conducted a scoping review by searching four databases, MEDLINE, EMBASE, CINAHL, and Sociological Abstracts. Relevant articles published in English language from January 2000 to February 2022 were screened by four reviewers to determine eligibility for inclusion.

RESULTS

The search resulted in 29,468 original articles, of which 25 were included in the data synthesis. We found minimal evidence that answers our proposed research question. The majority of identified programs have demonstrated effectiveness in reducing medical and dental healthcare utilization (especially for non-preventive services) and avert more invasive treatments, and to a lesser degree, resulting in cost-savings. Moreover, some promising but limited evidence about program impacts on societal outcomes such as reducing homelessness and improving employability was reported.

CONCLUSION

Despite the well-known societal and economic consequences of dental problem, there is a paucity of studies that address the impacts of dental care programs from the societal and healthcare system perspectives.

MESH TERMS

Delivery of Health Care, Dental Care, Outcome assessment, Patient acceptance of Health Care.

Environmental thiocyanate exposure was associated with oral health-related productivity loss among US adults: results from NHANES

The aim of this study is to examine the environmental exposure to perchlorate, nitrate, and thiocyanate and their associations with oral health-related productivity loss (PL) in general population. A total of 13,554 participants were enrolled from the National Health and Nutrition Examination Survey. Urinary perchlorate, nitrate, and thiocyanate were measured using ion chromatography coupled with electrospray tandem mass spectrometry. Multivariable linear and logistic regressions were performed to explore the associations between urinary perchlorate, nitrate, and thiocyanate with the prevalence of PL. Restricted cubic splines were used to explore the nonlinearity. There are 636 PL cases. There was higher urinary level of thiocyanate in PL group. We found that compared with the lowest quartile, thiocyanate was associated with PL (odds ratio 0.72, 95% confidence interval [0.53, 0.98]; p = 0.039) in the highest quartile. Restricted cubic spines reveled that urinary thiocyanate was L-shaped associated with PL with the infection point of 1.35. Urinary thiocyanate was L-shaped associated with PL with the infection point of 1.35.

Toothache and tooth extraction as reasons for dental visits: an analysis of the 2019 National Health Survey

The aim of this study was to analyze the prevalence of dental visits due to toothache and tooth extraction in Brazil and its association with individual and contextual variables. This two-step cross-sectional study included persons aged 18 years and older in the 2019 National Health Survey who had visited a dentist in the 12 months prior to the interview (n = 40,369). The individual-level outcome was having a dental visit due to toothache or tooth extraction. The ecological-level outcome was the proportion of dental visits for these reasons relative to all dental visits by Brazilian state. Associations with individual - sociodemographic characteristics, number of teeth, and type of health service used - and ecological variables - HDI and dental service coverage - were assessed using Poisson regressions. The prevalence of dental visits due to toothache or extraction was higher among individuals with no formal education, household income < 25% of the minimum wage, of black and brown skin color, living in rural areas, who consulted in the public health system, with 10-19 and 1-9 teeth, and men. The proportion of dental visits due to toothache/extraction in Brazilian states was negatively associated with the HDI and the rate of dental emergency team/100,000 inhabitants and positively associated with primary dental care coverage. The prevalence of dental visits due to toothache/extraction was associated with individual and ecological characteristics, indicating inequities in reasons for dental visits in Brazil. The potential of a well-structured oral health care network to overcome these inequities is suggested and needs to be better explored.

Factors associated with oral pain and oral health-related productivity loss in the USA, National Health and Nutrition Examination Surveys (NHANES), 2015-2018

Background

Our aim was to identify clinical and sociodemographic factors associated with oral pain and oral health-related productivity loss among US adults.

Methods

We included adults aged ≥30 years who completed the dental examination, had at least one natural tooth, and provided an answer about their oral pain experience or oral health-related productivity loss in the 2015–2018 National Health and Nutrition and Examination Survey (NHANES). We performed descriptive analyses and multivariable binary logistic regression analyses on weighted data.

Results

One out of four adults had oral pain and 4% reported oral health-related productivity loss occasionally or often within the last year of the survey. The odds of oral pain were higher among non-Hispanic black (OR = 1.35; 95%CI = 1.08–1.62) and non-Hispanic Asian individuals (OR = 1.38; 95%CI = 1.07–1.78) compared to non-Hispanic white individuals, and individuals with untreated dental caries (OR = 2.06; 95%CI = 1.72–2.47). The odds for oral health-related productivity loss were 13.85 times higher among individuals who reported oral pain (95%CI = 8.07–23.77), and 2.18 times higher among individuals with untreated dental caries (95%CI = 1.65–2.89). The odds of oral pain and reported oral health-related productivity loss decreased as family income increased.

Conclusions

Factors including non-Hispanic black race/ethnicity, lower socio-economic status, and untreated dental caries are associated with oral pain experience, which increases the odds of oral health-related productivity losses. Identifying factors associated with oral pain and productivity loss will enable clinicians, policymakers, and employers to proactively target and prioritize the higher-risk groups in early interventions and policies.

Majority of New Onset of Dental Caries Occurred from Caries-Free Students: A Longitudinal Study in Primary School Students

We examined Rose's axiom that a large number of people exposed to a small risk may generate more cases than a small number exposed to a high risk, using data on caries incidence. This longitudinal study was based on the records of annual dental checks conducted in primary schools in Okinawa, Japan. Participants were students aged 6-11 years at baseline in 2014, and a follow-up survey was conducted after one-year. The outcome variable was the increased number of decayed, missing, and filled teeth (DMFT). The predictor variable was the baseline DMFT score. Gender, grade, and affiliated school variables were adjusted. A negative binomial regression model was used to obtain the estimated increase of DMFT score. Among 1542 students, 1138 (73.8%) were caries-free at baseline. A total of 317 (20.6%) developed new caries during the follow-up. The predicted number of new carious teeth in a caries-free students and students with DMFT = 1 at baseline were 0.26 (95% CI, 0.22-0.31) and 0.45 teeth (95% CI, 0.33-0.56), respectively. However, among the total of 502 newly onset of carious teeth, 300 teeth (59.7%) occurred from the caries-free students at baseline. Hence, prevention strategies should target the low-risk group because they comprise the majority of the population.

Can minimal intervention dentistry help in tackling the global burden of untreated dental caries?

The latest estimates from the Global Burden of Disease study show that dental caries remains a neglected global health issue, with over two billion people suffering the consequences of this highly preventable disease globally. The two main goals of a national health system are to improve population health and reduce health inequalities, which are often achieved through prevention and promotion for everyone, as well as treatment and rehabilitation for the sick. Oral health promotion should be integrated with national policies for the prevention of non-communicable diseases, especially those targeting the intake of free sugars. The ongoing debate on universal health coverage (UHC) offers a unique opportunity to align dental care with essential health services, which all countries are expected to provide. Minimal intervention dentistry (MID) protocols for management of carious lesions, such as the atraumatic restorative technique, silver diamine fluoride and the Hall Technique, could help tackle the global burden of untreated caries as they are cost-effective in the long run. However, the successful implementation in primary dental care and training the new cadre of dentists adequately are pending issues if MID is to facilitate the inclusion of dental care as part of the UHC agenda.

Oral health interventions for people living with mental disorders: protocol for a realist systematic review

BACKGROUND

The increasing number of people who experience mental disorders is a global problem. People with mental disorders have high rates of co-morbidity and significantly poorer oral health outcomes than the general public. However, their oral health remains largely a hidden and neglected issue. A complex range of factors impact the oral health of this group. These include anxiety and dental phobia, dietary habits, including the heavy consumption of sugary drinks, substance misuse of tobacco, alcohol, and/or psychostimulants, the adverse orofacial side effects of anti-psychotic and anti-depression medications, and financial, geographic, and social barriers to accessing oral health care.

METHODS

The aim of this realist systematic review is to (a) identify and synthesise evidence that explores oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal, contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level. Using a five-step process, that incorporates primary data collection from key stakeholders, a beginning theoretical framework will be developed to describe contextual and mechanistic factors and how they might impact on the success or failure of oral health interventions for people with mental disorders. Key database searches will be conducted, with data extraction focused on the factors that might have impacted on intervention implementation and outcomes. Quality appraisal of studies will occur, and the theoretical framework will be populated with extracted data. Stakeholder input will support the development and refinement of a theory on oral health interventions for people with mental disorders.

DISCUSSION

This will be the first review to take a realist approach to explore the broad scope of causal factors that impact on the success or failure of oral health interventions for people with mental disorders. The approach includes extensive stakeholder engagement and will advance realist systematic review methodology. Review outcomes will be important in guiding policy and practice to ensure oral health interventions better meet the needs of people with mental disorders.Systematic review registration This review protocol is registered with PROSPERO (Number) 155969.

Impact of sugar-sweetened beverage tax on dental caries: a simulation analysis

Background

The tiered sugar-sweetened beverage (SSB) tax was implemented in Thailand to encourage industries to reduce sugar content in beverages, and consequently reduce sugar consumption in the population. The aim of the study is to explore the expected impact of the new SSB tax policy in Thailand, a middle-income country in Asia, and other alternative policies on oral health outcomes as measured by the prevalence and severity of dental caries among the Thai population.

Methods

A qualitative system dynamics model that captures the complex interrelationships among SSB tax, sugar consumption and dental caries, was elicited through participatory stakeholder engagement. Based on the qualitative model, a quantitative system dynamics model was developed to simulate the SSB tax policy and other alternative scenarios in order to evaluate their impact on dental caries among Thai adults from 2010 to 2040.

Results

Under the base-case scenario, the dental caries prevalence among the Thai population 15 years and older, is projected to increase from 61.3% in 2010 to 74.9% by 2040. Implementation of SSB tax policy is expected to decrease the prevalence of dental caries by only 1% by 2040, whereas the aggressive policy is projected to decrease prevalence of dental caries by 21% by 2040.

Conclusions

In countries where a majority of the sugar consumed is from non-tax sugary food and beverages, especially Asian countries where street food culture is ubiquitous and contributes disproportionately to sugar intake, SSB tax alone is unlikely to have meaningful impact on oral health unless it is accompanied with a comprehensive public health policy that aims to reduce total sugar intake from non-SSB sources.

Effort-reward imbalance at work and tooth loss: a cross-sectional study from the J-SHINE project

Oral diseases produce enormous productivity loss. However, epidemiological evidence of work stress and tooth loss is scarce. The aim of this study was to examine the association of work stress, according to effort-reward imbalance (ERI), with tooth loss. We conducted a cross-sectional study using data obtained between 2010 and 2011 in Japan. This study included 1,195 employees aged 25-50 years old (response rate=32%). The dependent variable was self-reported tooth loss (having or not). The independent variable was a dichotomized ERI ratio (>1.4 and ≤1.4). Age, sex, sociodemographic variables, work-related factors, and health-related variables were adjusted. Psychological distress was used as a potential mediator. We also examined an additive interaction between support from supervisors and ERI. The median age was 37, and 48% were women. After adjusting for the covariates, ERI was still associated with tooth loss (prevalence ratio=1.20 [95% confidence interval=1.01, 1.42] from Poisson regression models with a robust error variance). Psychological distress partially explained the association, and support from supervisors significantly attenuated the association. In conclusion, high ERI ratio was still associated with an increased risk of tooth loss among working adults.

System dynamics analysis of dental caries status among Thai adults and elderly

Purpose

The purpose of this paper is to estimate the changes of dental caries status among Thai adults and elderly under the different policy options using system dynamics modeling.

Design/methodology/approach

A multi-sector system dynamics model was developed to capture the dynamic interrelationship between dental caries status changes and oral health behavior – including self-care, dental care utilization and sugar consumption. Data used to populate the model was obtained from the Thai national oral health survey in 2000, 2006, 2012 and Thailand Official Statistics Registration. Three policy scenarios were experimented in the model: health promotion policy, dental personnel policy and affordable dental care service policy.

Findings

Dental caries experiences among Thai adults and elderly were projected to increase from now to 2040, as the elderly population increases. Among all policies experimented herein, the combined policies of health promotion, increased affordability and capacity of dental health service were found to produce the highest improvement in dental caries status with 3.7 percent reduction of population with high decayed, missing and filled teeth (DMFT) and 5.2 percent increase in population with very low DMFT.

Originality/value

This study is the first comprehensive simulation model that attempts to explore the dynamic interrelationship among dental caries experiences and behavioral factors that impact on oral health outcomes. In addition, the simulation model herein offers a framework for policy experimentation that provides policymakers with additional insights to inform health policy planning.

Oral health in the context of prevention of absenteeism and presenteeism in the workplace

BACKGROUND

Oral health is an important factor of human morbidity worldwide. Yet is often neglected in occupational health despite its direct impact on the quality of life and health of workers.

OBJECTIVE

To discuss the role of oral health in sickness absence and presenteeism, as well as in development and work efficiency improvement processes involving governments, companies and the workers themselves.

METHODS

Review of full-text articles on oral health, occupational health, sickness absence and presenteeism published in English or Portuguese in the last 10 years and included in scientific databases.

RESULTS

Oral problems accounted for 9 to 27% cases of sickness absence and 28 to 50% of presenteeism, with toothache and temporomandibular joint pain as the most frequent reasons. About 50% of workers prefer company-provided dental care, while 40% visit public and 10% other types of facilities. Despite high, the prevalence of oral diseases and orofacial pain was not associated with high rates of absenteeism, but mainly with presenteeism, this is to say, workers do not tend to miss work days, but their performance is reduced and become susceptible to more serious health problems in the future.

CONCLUSION

Oral health is not dissociated from general and occupational health, and as such it must be enhanced and duly promoted in an integrated manner. Effective and comprehensive oral health promotion and prevention public policies and private sector actions in the workplace can enhance the quality of life of workers.

Oral diseases: a global public health challenge

Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.

The association of the Bolsa Familia Program with children's oral health in Brazil

Background

Several studies have demonstrated that Conditional Cash Transfer (CCT) programs reduce poverty/inequity and childhood mortality. However, none of these studies investigated the link between CCT programs and children’s oral health. This study examines the association between receiving the Brazilian conditional cash transfer, Bolsa Familia Program (BFP), and the oral health of five-year-old children in the Northeast of Brazil.

Methods

We conducted a cross-sectional study with 230 caregivers/children randomly selected in primary health care clinics in the city of Fortaleza in 2016. Interviews and oral health examinations were performed. Descriptive statistics and multiple logistic regression analyses were conducted to identify factors associated with dental caries among five-year-old children enrolled in the BFP.

Results

Around 40% of children enrolled in the BFP had dental caries. However, those who received Bolsa Familia (BF) for a period up to two years (OR = 0.13, 95% CI 0.05–0.35) had substantially lower adjusted odds of having dental caries than those who had never received BF. In addition, the association of BF and dental caries was more prominent among extremely poor families (OR = 0.05, 95% CI 0.01–0.28).

Conclusions

Although initial enrolment in the BFP predicted low dental caries among five-year-old children, the prevalence of dental caries in this population is still high, thus, public health programs should target BF children’s oral health. An ongoing effort should be made to reduce oral health inequalities among children in Brazil.

Time expended on managing molar incisor hypomineralization in a pediatric dental clinic in Nigeria

This study assessed the difference in the number of visits made to a dental care clinic and the time spent providing specific dental treatment for children with and without molar incisor hypomineralization (MIH). Children aged 8 to 16 years who presented at the Pediatric Dental Unit of the Obafemi Awolowo University Teaching Hospital Complex, in Ile-Ife, Nigeria, were eligible for the study. A comprehensive medical and dental history was taken, and each child was clinically examined, diagnosed, and treated according to a drawn-up plan. The time taken to establish a diagnosis and to provide specific treatments (scaling and polishing, restoration, pulpectomy, extraction, and placement of stainless steel crowns) and the number of visits made to complete the treatment plan were recorded for each child. Differences in the number of visits, time expended to make a diagnosis and to treat children with and without MIH were analyzed. The average time for diagnosis (p = 0.001) and the average time for placing amalgam restorations (p = 0.008) were significantly longer in children with MIH than in those without it. Children with MIH made more visits to the clinic (p < 0.001).There was no significant difference in the average time for scaling and polishing (p = 0.08), glass ionomer cement restorations (p = 0.99), composite restorations (p = 0.26), pulpectomy (p = 0.42), tooth extraction (p = 0.06), and placement of a stainless steel crown (p = 0.83) in children with and without MIH. In conclusion, children with MIH required more time for oral health care. Placing amalgam restorations took significantly longer than placing tooth bonding restorative materials in children with MIH than in those without it.

Risk Determinants of Dental Caries and Oral Hygiene Status in 3-15 Year-Old Recent Immigrant and Refugee Children in Saskatchewan, Canada: A Pilot Study

This study aimed to identify the risk determinants of caries and record oral hygiene status in recent immigrant and refugee children residing in Saskatoon and Regina, Saskatchewan, Canada. Convenience samples of 133, 3-15 year-old recent immigrant and refugee children, and 86 adult guardians were recruited. Clinical examination of children and survey of their guardians explored the presence of at least one decayed tooth in the child's mouth; and the knowledge, attitudes, behaviors, among other aspects in adult participants. Refugee children had statistically significant higher decayed, missing, filled teeth (DMFT) scores (mean dmft/DMFT score 5.80 ± 4.24) than immigrant children (mean dmft/DMFT score 3.52 ± 3.78 (p < 0.001). Adult immigrants had significantly higher proficiency in English language, knowledge about preventive components like fluoride and dental floss compared to refugee adults. The results of this study confirm the poorer state of oral health among refugee and immigrant children compared to Canadian children.

Hours Lost to Planned and Unplanned Dental Visits Among US Adults

INTRODUCTION

Poor oral health is associated with lost hours at work or school, which may affect a person's productivity. The objective of our study was to estimate work or school hours lost to dental visits among adults aged 18 and older by the types of visits (emergency or unplanned; routine, planned, or orthodontic; or cosmetic) and to determine the factors associated with hours lost.

METHODS

We used the most recent Oral Health Supplement data, from the 2008 National Health Interview Survey (NHIS), to estimate the total hours lost at work or school for dental visits among adults in the United States. The associations of the hours lost in unplanned and planned dental visits with socioeconomic characteristics, oral health status, and affordability were calculated. We used χ2 tests and logistic regression to determine associations at P < .05.

RESULTS

An average of 320.8 million work or school hours were lost annually for dental care in the United States, of which 92.4 million hours were for emergency (unplanned) care (0.99 h/adult), 159.8 million for routine (planned) care or orthodontic care (1.71 h/adult), and 68.6 million for cosmetic care (0.73 h/adult). Adults with poor oral health were more likely to lose one or more hours in unplanned dental visits (OR = 5.60; 95% confidence interval [CI], 3.25-9.63) than those who reported very good oral health. Not being able to afford dental care was positively associated with more work hours lost in unplanned care (odds ratio [OR] = 2.56; 95% CI, 1.76-3.73). Compared with Hispanic adults, non-Hispanic white adults (OR = 2.09; 95% CI, 1.40-3.11) and non-Hispanic Asian adults and adults of other races/ethnicities (OR =1.91; 95% CI, 1.06-3.47) were more likely to lose any hours for planned care. Consistently, those with more than a high school education were more likely to lose any hours in planned care (OR = 1.39; 95% CI, 1.06-1.83) than those with a high school education or less.

CONCLUSIONS

Dental problems result in hours lost from work and may adversely affect a person's productivity. There is disparity in lost hours at work by race/ethnicity and dental care affordability.

Dental public health capacity worldwide: Results of a global survey

The World Federation of Public Health Associations' Oral Health Working Group (WFPHA OHWG) carried out a survey to establish the extent of global dental public health (DPH) capacity. Senior stakeholders in DPH completed 124 surveys, covering 73 countries and all WHO regions. The survey evaluated DPH workforce within the country, funding, education, current services, and integration between public health and DPH in countries across the world. In 62 per cent of countries, DPH is only partially integrated in the public health system, while in 25 per cent of countries it has not yet been formally integrated. DPH programs at Masters level are available in 44 per cent of countries. Over half of countries have 0 to 10 trained DPH professionals. Because both poor oral and general health share several common risk factors, DPH must be integrated into national health systems and budgets, with an emphasis on having trained DPH specialists available in every country to collaborate in healthcare policy and provision.

[The potential financial impact of oral health problems in the families of preschool children]

The aim of the study was to evaluate the perception of parents/caregivers regarding the financial impact of oral health problems on the families of preschool children. A preschool-based, cross-sectional study was conducted with 834 preschool children in Campina Grande, Brazil. Parents/caregivers answered the Early Childhood Oral Health Impact Scale. "Financial impact" was the dependent variable. Questionnaires addressing socio-demographic variables, history of toothache and health perceptions were administered. Clinical exams were performed by three dentists previously calibrated (Kappa: 0.85-0.90). Descriptive statistics were performed, followed by logistic regression for complex samples (α = 5%). The frequency of financial impact due to oral health problems in preschool children was 7.7%. The following variables were significantly associated with financial impact: parental perception of child's oral health as poor, the interaction between history of toothache and absence of dental caries and the interaction between history of toothache and presence of dental caries. It is concluded that often parents/caregivers reported experiencing a financial impact due to seeking treatment late, mainly by the presence of toothache and complications of the clinical condition.

Basic income guarantee: a review of implications for oral health

OBJECTIVES

To: a) Familiarize readers with the concept of a basic income guarantee (BIG) and its different forms; b) Consider how BIG could improve oral health and decrease oral health disparities; c) Motivate readers to advocate for the evaluation of oral health outcomes in BIG experiments.

METHODS

Published articles and book chapters that have analyzed and reviewed data from past BIG pilot projects were examined for their findings on health and socioeconomic outcomes.

RESULTS

Our findings suggest various areas and mechanisms whereby BIG can influence oral health-related outcomes, whether through impacts on work, illness and injury, education, a social multiplier effect, expenditure behavior, and/or mental illness and other health outcomes.

CONCLUSION

Our findings illustrate the importance of assessing oral health-related outcomes in future BIG pilot projects.

Exploratory scoping of the literature on factors that influence oral health workforce planning and management in developing countries

OBJECTIVES

The purpose of this study was to scope the literature that exists about factors influencing oral health workforce planning and management in developing countries (DCs).

METHODS

The Arksey and O'Malley method for conducting a scoping review was used. A replicable search strategy was applied, using three databases. Factors influencing oral health workforce planning and management in DCs identified in the eligible articles were charted.

FINDINGS

Four thousand citations were identified; 41 papers were included for review. Most included papers were situational analyses. Factors identified were as follows: lack of data, focus on the restorative rather than preventive care in practitioner education, recent increase in number of dental schools (mostly private) and dentistry students, privatization of dental care services which has little impact on care maldistribution, and debates about skill mix and scope of practice. Oral health workforce management in the eligible studies has a bias towards dentist-led systems. Due to a lack of country-specific oral health related data in developing or least developed countries (LDCs), oral health workforce planning often relies on data and modelling from other countries.

DISCUSSION AND CONCLUSION

Approaches to oral health workforce management and planning in developing or LDCs are often characterized by approaches to increase numbers of dentists, thus not ameliorating maldistribution of service accessibility. Governments appear to be reducing support for public and preventative oral healthcare, favouring growth in privatized dental services. Changes to professional education are necessary to trigger a paradigm shift to the preventive approach and to improve relationships between different oral healthcare provider roles. This needs to be premised on greater appreciation of preventive care in health systems and funding models.

Work absenteeism by parents because of oral conditions in preschool children

OBJECTIVE

The aim of the present study was to evaluate the influence of oral conditions in preschool children and associated factors on work absenteeism experienced by parents or guardians.

METHODS

A preschool-based, cross-sectional study was conducted of 837 children, 3-5 years of age, in Campina Grande, Brazil. Parents or guardians answered the Brazilian version of the Early Childhood Oral Health Impact Scale. The item 'taken time off work' was the dependent variable. Questionnaires addressing sociodemographic variables, history of toothache and health perceptions (general and oral) were also administered. Clinical examinations for dental caries and traumatic dental injury (TDI) were performed by three dentists who had undergone training and calibration exercises. Cohen's kappa (κ) was 0.83-0.88 for interexaminer agreement and 0.85-0.90 for intra-examiner agreement. Descriptive, analytical statistics were conducted, followed by logistic regression for complex samples (α = 5%).

RESULTS

The prevalence of parents' or guardians' work absenteeism because of the oral conditions of their children was 9.2%. The following variables were significantly associated with work absenteeism: mother's low schooling [odds ratio (OR) = 2.31; 95% confidence interval (95% CI): 1.31-4.07]; history of toothache (OR = 6.33; 95% CI: 3.18-12.61); and avulsion or luxation types of TDI (OR = 8.54; 95% CI: 1.80-40.53).

CONCLUSION

Other oral conditions that do not generally cause pain, such as dental caries with a low degree of severity or inactive dental caries and uncomplicated TDI, were not associated with parents' or guardians' work absenteeism of preschool children. It is concluded that toothache, avulsion, luxation and a low degree of mother's schooling are associated with work absenteeism.

Global Economic Impact of Dental Diseases

Reporting the economic burden of oral diseases is important to evaluate the societal relevance of preventing and addressing oral diseases. In addition to treatment costs, there are indirect costs to consider, mainly in terms of productivity losses due to absenteeism from work. The purpose of the present study was to estimate the direct and indirect costs of dental diseases worldwide to approximate the global economic impact. Estimation of direct treatment costs was based on a systematic approach. For estimation of indirect costs, an approach suggested by the World Health Organization's Commission on Macroeconomics and Health was employed, which factored in 2010 values of gross domestic product per capita as provided by the International Monetary Fund and oral burden of disease estimates from the 2010 Global Burden of Disease Study. Direct treatment costs due to dental diseases worldwide were estimated at US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure. Indirect costs due to dental diseases worldwide amounted to US$144 billion yearly, corresponding to economic losses within the range of the 10 most frequent global causes of death. Within the limitations of currently available data sources and methodologies, these findings suggest that the global economic impact of dental diseases amounted to US$442 billion in 2010. Improvements in population oral health may imply substantial economic benefits not only in terms of reduced treatment costs but also because of fewer productivity losses in the labor market.

Safety Net Care and Midlevel Dental Practitioners: A Case Study of the Portion of Care That Might Be Performed Under Various Setting and Scope-of-Practice Assumptions

OBJECTIVES

We sought to determine the proportion of dental care provided at safety net-type clinics that might be performed by midlevel practitioners.

METHODS

Data were obtained on 157,328 procedures performed in 2012 at the clinics associated with a Midwestern dental school. Based on procedure codes, we determined the overall proportion, as well as the proportion of visits and patients' care, that could have been performed by 3 types of practitioners.

RESULTS

Overall, 48% to 66% of all procedures could have been performed by a midlevel dental practitioner. Nearly half of all visits, and roughly a third of all patients, could have been entirely cared for by a practitioner trained in prophylaxis and with evaluation capabilities. Such practitioners could handle roughly 80% of the visits at the community-based clinic and more than half of the visits at the hospital-based clinic.

CONCLUSIONS

A midlevel practitioner with training in prophylaxis has the potential to alleviate much of the burden on the dental safety net because much of the need among vulnerable populations falls well within their scope of practice.

Self-reported racism and experience of toothache among pregnant Aboriginal Australians: the role of perceived stress, sense of control, and social support

OBJECTIVES

We hypothesized that the psychosocial factors perceived stress and sense of personal control mediated the relationship between self-reported racism and experience of toothache. We hypothesized that social support moderated this relationship.

METHODS

Data from 365 pregnant Aboriginal Australian women were used to evaluate experience of toothache, socio-demographic factors, psychosocial factors, general health, risk behaviors, and self-reported racism exposure. Hierarchical logistic regression models estimated odds ratios (ORs) and 95 percent confidence intervals (CIs) for experience of toothache. Perceived stress and sense of personal control were examined as mediators of the association between self-reported racism and experience of toothache. Social support was examined as a moderator.

RESULTS

Self-reported racism persisted as a risk indicator for experience of toothache (OR 1.99, 95 percent CI 1.07-3.72) after controlling for age, level of education, and difficulty paying a $100 dental bill. The relationship between self-reported racism and experience of toothache was mediated by sense of control. The direct effect of self-reported racism on experience of toothache became only marginally significant, and the indirect effect was significant (β coefficient=0.04, bias-corrected 95 percent CI 0.004-0.105, 21.2 percent of effect mediated). Stress was insignificant as a mediator. Social support was insignificant as a moderator.

CONCLUSIONS

The findings indicate that high levels of self-reported racism were associated with experience of toothache and that sense of control, but not perceived stress, mediated the association between self-reported racism and experience of toothache among this sample of pregnant Aboriginal Australian women. Social support did not moderate the association between self-reported racism and experience of toothache.

The potential oral health impact of cost barriers to dental care: findings from a Canadian population-based study

Background

Prior to the 2007/09 Canadian Health Measures Survey, there was no nationally representative clinical data on the oral health of Canadians experiencing cost barriers to dental care. The aim of this study was to determine the oral health status and dental treatment needs of Canadians reporting cost barriers to dental care.

Methods

A secondary data analysis of the 2007/09 Canadian Health Measures Survey was undertaken using a sample of 5,586 Canadians aged 6 to 79. Chi square tests were conducted to test the association between reporting cost barriers to care and oral health outcomes. Logistic regressions were conducted to identify predictors of reporting cost barriers.

Results

Individuals who reported cost barriers to dental care had poorer oral health and more treatment needs compared to their counterparts.

Conclusions

Avoiding dental care and/or foregoing recommended treatment because of cost may contribute to poor oral health. This study substantiates the potential likelihood of progressive dental problems caused by an inability to treat existing conditions due to financial barriers.