The ethical imperative of addressing oral health disparities: a unifying framework

Oral health care use characteristics in a limited sample of Medicare Advantage beneficiaries, Medicare Advantage Encounter data 2021

BACKGROUND

In contrast to the limited dental benefits available through traditional Medicare, most Medicare Advantage (MA) plans offer dental care services to eligible beneficiaries. MA Encounter data were made available to better understand the use of health services by MA beneficiaries. The authors' objectives were to determine the degree to which dental care use data are available in the MA Encounter data source and understand the characteristics associated with dental care use in a sample of MA beneficiaries.

METHODS

The 2021 Centers for Medicare & Medicaid Services Master Beneficiary Summary File, Plan Benefit Package, and Encounter data sources were analyzed. The primary outcome was receipt of at least 1 dental care service during the year, identified by a CDT 2021: Current Dental Terminology code. Bivariate analyses and a multivariable logistic regression model were used to assess the association between dental care use and sociodemographic factors in a sample of MA beneficiaries.

RESULTS

A total of 23,725 MA beneficiaries in 21 plans met the inclusion criteria. Overall, 47% of beneficiaries in the sample had a CDT 2021: Current Dental Terminology code-recorded dental care use event. Beneficiaries used a range of comprehensive dental care services. Age, dual-eligibility status (ie, eligible for both Medicare and Medicaid), Medicare qualification reason, and plan type were associated with dental care use.

CONCLUSIONS

Dental care use data were available for only a small subset of plans within the MA Encounter data source. Select beneficiary characteristics were associated with dental care use in a limited MA beneficiary sample.

PRACTICAL IMPLICATIONS

There is a need for MA plans to enhance reporting of supplemental dental care use data to better understand whether MA is facilitating use of oral health care for the full beneficiary population.

Evaluation of the psychometric properties of the Oral Health Behavior Social Support (OHBSS) Scales in English and Spanish for Mexican-origin young adults

BACKGROUND

Valid, reliable measures of psychosocial constructs are needed in oral health research. This study quantitatively evaluated the psychometric properties of nine new Oral Health Behavior Social Support (OHBSS) scales, which measured support for three oral health behaviors (brushing, flossing, dental care), queried for each of three sources (family, health providers, others/friends).

METHODS

Young Mexican-origin adults in the southwestern United States-Mexico border region completed an online survey, in English or Spanish (N = 502). Survey items included: OHBSS scales, general social support scales, oral health behaviors, self-rated oral health status, dental anxiety, acculturation and socio-demographics. Subsample 1 participants also completed a dental exam (N = 41). Subsample 2 participants also completed a repeat OHBSS survey two-to-six weeks later (N = 56). Psychometric properties were tabulated, overall and by language preference (English or Spanish). Convergent and divergent validity were evaluated via correlations between the dental-specific OHBSS social support scales, scores from three validated general social support scales, and scales expected to be largely unrelated (acculturation, dental anxiety). Correlations examined predictive validity between the OHBSS scales and oral health behaviors, and self-reported and clinical outcomes. Test-retest reliability was assessed via intraclass correlation coefficients in Subsample 2.

RESULTS

Of 502 participants, 60% preferred speaking English, 37% were single, and 21% were male. OHBSS scores indicated that health providers then family provided the most support for all three oral health behaviors, while others/friends did not provide much support. Spanish speakers tended to have higher OHBSS scores than English speakers. Correlations followed expected patterns and supported convergent and divergent validity, in the full sample and across languages. OHBSS scales exhibited many significant weak-moderate positive correlations (r = 0.10-0.38) with general social support scales. Few (11/108) significant correlations (< -0.16) were observed between OHBSS scales, acculturation, and dental anxiety. OHBSS scales exhibited some significant weak-moderate positive correlations with oral health-promoting behaviors. OHBSS scales were not associated with clinical outcomes. OHBSS scales exhibited good test-retest reliability overall and in Spanish.

CONCLUSION

Psychometric properties for the OHBSS scales were acceptable in both English and Spanish versions. The scales are valid and reliable tools for assessing social support for oral health-promoting behaviors from family, health providers, and others/friends.

TRIAL REGISTRATION

Not applicable.

Using a Social Network Approach to Characterize Oral Health Behavior Social Support Among Mexican-Origin Young Adults

Using a social network approach, we characterize who Mexican-origin young adults perceive as social support sources for oral health behaviors and provide additional validity evidence for Oral Health Behavior Social Support Scales (OHBSS). From April to September 2022, we gathered social network data from 62 Mexican-origin adults (21-40 years old) through Zoom interviews about their perceived received social support for three oral health behaviors (toothbrushing, flossing, and obtaining dental care) from three potential sources of support (family, health providers, and others/friends). Overall, we found similar results across all three oral health behaviors. We also found evidence for convergent and discriminant validity of OHBSS scales using social network measures. Implications of findings are discussed.

Variations in Some Features of Oral Health by Personality Traits, Gender, and Age: Key Factors for Health Promotion

Background: Oral diseases remain among the most common non-communicable diseases worldwide, affecting almost half of the world's population. This is partly because there has been a separation of the mouth from the rest of the body and human health, and psychological aspects such as personality, thoughts, and emotions are not taken into account in the dental office. The objective was to analyze the relationship between oral health conditions and personality traits in adult patients who underwent dental treatment at the Center for Health Studies and Services. Methods: This was a descriptive, observational, and correlational study, carried out at the Center for Health Studies and Services. A total of 184 patients who attended the dentistry area in the period from October 2022 to May 2023 participated in the study, of which 59.78% were women and 40.21% men. The age of the population was 18 to 79 years, with the age range of 21-40 years being the most prevalent (48.37%). Results: The results show that although the hygiene of the population treated was good (0.77 ± 0.79) and that the perception of oral health was positive (14.34 ± 9.43), the means and percentages of oral pathologies and parafunctional habits were high (i.e., DMFT: 9.98 ± 5.40; attrition: 87.50%; onychophagia: 45.10%). It is noteworthy that both the correlation, network, multiple line regression, and logistic regression analyses showed associations of the personality, gender, and age variables with a history of caries and oral hygiene as well as with parafunctional habits. Conclusions: Therefore, variations in both the personality and the age and gender of the patients treated have repercussions on oral health conditions, which can be used in the prevention of oral diseases and in health promotion.

Census tract geospatial analysis comparing social determinants of health with tooth loss in California seniors: An ecologic study

OBJECTIVES

Individual-level social determinant of health (SDOH) measures alone may insufficiently explain disparities in edentulism among seniors. Therefore, the authors examined the correlation of census tract-level SDOH and residential racial segregation measures with edentulism in Californian adults aged ≥65 years old.

METHODS

Explanatory variables were obtained from Healthy Places Index (HPI), the National Cancer Institute and diversitydatakids.org. The edentulism outcome variable was obtained from CDC's PLACES small area estimates from the 2018 Behavioral Risk Factor Surveillance System data. Pearson and Spearman rank correlations were estimated. Multiple linear regression and multi-collinearity evaluations were performed. The Global Moran's I statistic assessed partial autocorrelation within census tracts.

RESULTS

Pearson and Spearman correlations were similar, supporting robustness. HPI, an area measure of advantage, strongly negatively correlated with edentulism prevalence [correlation coefficient: -0.87; 95% confidence interval (CI): -0.87, -0.86]. A change of 1.0 in HPI corresponded to an estimated decrease in edentulism prevalence of 5.9% (linear model adjusted R2 = 0.78). Racially segregated census tracts with Hispanics or Blacks alone were positively correlated with edentulism prevalence [0.60, 95% CI: 0.58, 0.62; and 0.33, 95% CI: 0.31, 0.35, respectively]. The converse was seen in census tracts with non-Hispanic Whites alone [-0.57, 95% CI: -0.58, -0.55]. Global Moran's I statistic for edentulism (0.13) and HPI scores (0.19) were significant (both p < .001) indicating geospatial autocorrelation.

CONCLUSIONS

Higher disadvantage and minority racial segregation within census tracts were positively correlated with edentulism prevalence. Future research and policy should consider possible interventions improving SDOH to reduce oral health inequities.

Oral Health Research in the WHO African Region between 2011 and 2022: A Scoping Review

The status of oral health research in the World Health Organization (WHO) African region is unclear, yet the need for such information is central to moving an oral health agenda forward. Such an agenda is essential for effectively translating research into actionable practices and supporting regional strategies. The aim of this scoping review was to provide data on the scope and output of oral health research in the WHO African region to be used as a starting point for establishing a research agenda that can affect oral health in the region. We conducted a systematic search in PubMed; EMBASE; Epistemonikos; Scopus; the International Association for Dental, Oral, and Craniofacial Research General and Regional Sessions; ProQUEST; PROSPERO; and African regional databases such as Regional African Index Medicus and the African Journal Online. We included primary and secondary studies published in English, French, or Portuguese between January 1, 2011, and December 31, 2022, addressing oral health-related research having individuals, groups, or populations as units of analysis. These reports either addressed a topic relevant to the WHO African region assessed using the title and study objective or were conducted in a country in the region. We excluded in vitro and in vivo studies focusing on cells, biomarkers, or animals. We assessed 24,014 records, and 1,379 proved eligible. Our findings indicate a preference for particular research designs less suitable for evidence-informed practice guidelines and oral policies, a limited scope of oral health research topics, and important regional differences in research capacity. Furthermore, publications by researchers in the WHO African region tend to be published in journals with a limited readership. A discussion of our findings among oral health researchers at academic institutions in the WHO African region on how to create within- and across-country collaborations could potentially improve both health and oral health in the region.

Cultural Competency in Dental Practice: Navigating the Experiences and Perspectives of Dentists in South Punjab, Pakistan

Introduction Cultural competence in healthcare embraces the principles of equal access and nondiscriminatory services in healthcare delivery. Dentists as significant healthcare professionals should definitely have the skills needed to diagnose and treat patients' conditions, but it is crucial to also address nontechnical skills such as cross-cultural communication, the ability to empathize, and inclusive-mindedness. Globally, cultural competency training has been included in healthcare educational programs; however, national practices reportedly have revolved around patients' clinical competencies and thus entailed overlooking the cultural dimensions of dental education that include diverse sociocultural factors that influence how dental practices are taught, learned, and delivered. These dimensions encompass elements such as language, communication styles, attitudes toward healthcare, and culturally specific oral health beliefs and behaviors. Therefore, the aim of this study is to explore the experiences and perspectives of dentists practicing in South Punjab regarding cultural competency. Methodology The study employed a qualitative phenomenological approach. Data was collected through purposive sampling techniques utilizing semistructured interview guides. The participants recruited were licensed dentists practicing in dental institutions in South Punjab, Pakistan. A total of 18 dentists were recruited in the study. The interviews were focused on the different aspects of cultural competency by exploring the perspectives of dentists. Thematic analysis was carried out utilizing the Bran and Clarkes framework to categorize data into key themes and subthemes utilizing inductive coding. Results The study revealed that dentists lack awareness and understanding of cultural competency; they also faced significant problems due to limited cultural proficiency while dealing with diverse patients. Major challenges included inadequate training, communication barriers, and cultural bias in dentists while dealing with such diverse populations. Patients recognized the benefits of cultural competency and highlighted facilitators like institution support, peer support, mentorship support, and patient trust. Participants suggested incorporating cultural competency in dentistry curricula, continuous professional development, and community outreach programs for the development of cultural competency among dentists. Conclusions The study highlighted perspectives and experiences of dentists regarding cultural competency. The findings demonstrated key problems due to limited or lack of cultural proficiency that included communication and language barriers and unconscious cultural bias among dentists. The study also highlighted facilitators of cultural competency like institutional facilitation, mentoring opportunities from peers and seniors, and patient trust. Facilitating cultural competency among dentists may result in improved patient satisfaction, enhanced patient care, and an increase in compliance, hence overall enhancing the quality of care.

Ethical Challenges in Oral Healthcare Services Provided by Non-Governmental Organizations for Refugees in Germany

Oral healthcare is attracting much attention after decades of neglect from policymakers. Recent studies have shown a strong association between oral and overall health, which can lead to serious health problems. Availability of oral healthcare services is an essential part of ensuring universal healthcare coverage. More importantly, current gaps in its accessibility by minority or marginalized population groups are crucial public health as well as ethical concerns. One notable effort to address this issue comes from Non-Governmental Organizations (NGOs), which offer oral healthcare services for non-insured refugees. However, the challenge remains that these care services are not comprehensive, which has implications for the refugees' oral and general health. In this article, we discuss this complex issue in the German healthcare context by including ethical reflections. Therefore, the purpose of this article is to discuss the ethical challenges related to oral healthcare services provided by NGOs for refugees in Germany. First, we will introduce the general oral healthcare context worldwide and in Germany. Second, we will provide a general description of the oral healthcare services provided by NGOs for refugees in Germany, as well as an overview of existing gaps. This will provide us with the context for our third and most important task-discussing the ethical implications of the gaps. In doing so, and since the ethical implications can be several, we demarcate the scope of our analysis by focusing on the specific ethical issues of justice, harm, and autonomy. Finally, we offer some recommendations for how to move forward.

Evaluating the type of pediatric dental care use in the context of neighborhood opportunity

BACKGROUND

Increasing evidence supports the influence of neighborhood factors on health care use and outcomes. This study measured the association between area-level social determinants of health (SDH) and type of dental care use among Ohio pediatric Medicaid beneficiaries.

METHODS

A retrospective dental claims analysis was completed for children aged 1 through 5 years enrolled in Ohio Medicaid with a dental visit in 2017. Dental care use was measured from 2017 through 2021 as 1 of 4 visit types: (1) preventive, (2) caries treatment, (3) dental general anesthesia (GA), and (4) dental emergency department. The Ohio Children's Opportunity Index defined area-level SDH at the census tract level. Exploratory analysis included descriptive statistics of area-level SDH for each outcome. Poisson regression models were developed to examine the associations between the number of each dental care use outcome and Ohio Children's Opportunity Index quintiles. Visualizations were facilitated with geospatial mapping.

RESULTS

Fifty-six percent of children (10,008/17,675) had caries treatment visits. Overall area-level SDH were positively associated with preventive (fifth vs first quintile incidence rate ratio [IRR], 1.09; 95% CI, 1.07 to 1.12), caries treatment (fifth vs first quintile IRR, 1.16; 95% CI, 1.08 to 1.24), and dental GA visits (fifth vs first quintile IRR, 2.13; 95% CI, 1.13 to 4.01).

CONCLUSIONS

Children with preventive, caries treatment, and dental GA visits were more likely to live in neighborhoods with better SDH. Future efforts should investigate the mechanisms by which area-level factors influence dental access and use.

PRACTICAL IMPLICATIONS

Neighborhood factors influence pediatric dental care use. Patient home addresses might add value to caries risk assessment tools and efforts by care networks to optimize efficient care use.

Metal mixtures and oral health among children and adolescents in the National Health and Nutrition Examination Survey (NHANES), 2017-2020

INTRODUCTION

Dental caries is the most common non-communicable human disease, yet little is known about the role of environmental metals, despite teeth consisting of a hard matrix of trace elements. We conducted a cross-sectional study of associations between environmental metals and objective assessment of dental caries and subjective assessments of oral health among a representative sample of U.S. children and adolescents.

METHODS

Data were from the 2017-March 2020 pre-pandemic data file of the National Health and Nutrition Examination Survey (NHANES). To account for metal mixtures, we used weighted quantile sum (WQS) regression to estimate the joint impact of multiple trace elements assessed in blood and urine with oral disease outcomes.

RESULTS

The blood metal mixture index was associated with a 32% (95% CI: 1.11, 1.56) increased risk of decayed surfaces while the urine metal mixture index was associated with a 106%, RR (95% CI = 2.06 (1.58, 2.70) increased caries risk. For both blood and urine, Mercury (Hg) had the largest contribution to the mixture index followed by Lead (Pb). The WQS blood metal mixture index was also significantly associated with poorer self-rated oral health, although the magnitude of the association was not as strong as for the objective oral disease measures, RR (95% CI) = 1.04 (1.02, 1.07).

DISCUSSION

Increased exposure to a metal mixture was significantly related to poorer objective and subjective oral health outcomes among U.S. children and adolescents. These are among the first findings showing that metal mixtures are a significant contributor to poor oral health.

Understanding parental perspectives on young children's oral health (≤ 4 years) growing up in a disadvantaged neighbourhood of Amsterdam, the Netherlands: an exploratory study

BACKGROUND

Families' understanding towards oral health problems among young children is poorly studied. More insight into parents' experiences, especially of those living in disadvantaged neighbourhoods, is needed to address persistent oral health inequalities. This qualitative study aims to explore parental perspectives on children's oral health (≤ 4 years) and the opportunities they see to improve children's oral health.

METHODS

Forty-seven mothers and five fathers with different migration backgrounds from a disadvantaged neighbourhood in Amsterdam, the Netherlands, participated in our study. Semi-structured interviews (n = 27), participant observations (n = 7) and one focus group discussion were conducted. A thematic data analysis was used.

RESULTS

Parents describe their daily life with young children as busy, hectic and unpredictable. Parents seem to be most concerned about parenting. Mothers, in particular, feel fully responsible for raising their children and managing daily complexities. While most parents value their children's oral health, they all experience challenges. Parents find it hard to limit daily candy intake and to handle unwilling children during tooth brushing. They feel limited support for these issues from their household, social network and professionals.

CONCLUSION

Parental struggles in children's oral health are complex and interrelated as they occur across family, societal, community and professional levels. Given the complex daily reality of families with young children, establishing and maintaining healthy oral health habits seems not at the top of parents' minds. They ask for advice in the upbringing of their children backed up by social support, increased attention to children's oral health within the community and professional assistance. Collaborating with parents as knowledgeable partners might be the first step in acting upon the endeavour to address oral health inequality among young children.

Quantitative analysis on dental utilisation in culturally and linguistically diverse mothers

BACKGROUND

Culturally and linguistically diverse (CALD) mothers are influential in children's behaviours, yet little is known about this population. Furthermore, insufficient quantitative and context-based studies are available with CALD mothers and their access to oral health care. To address this gap, the study investigates oral health behaviours, psychological factors and remoteness area with dental utilisation in CALD mothers, within the NSW context.

METHODS

Informed by middle-range theory and a CALD-specific rainbow model, the 2013 and 2015 NSW Adult Population Health Survey was analysed. Variables for CALD mothers included household structure, age and language spoken. Multivariable analysis was conducted with oral health behaviours, psychological and remoteness variables, with dental utilisation as the outcome.

RESULTS

The sample was weighted (n =190,283). In total, 39.8% did not have a dental visit, and older mothers (aged 36-55 years) sought more dental services than younger mothers (aged 18-35 years). Higher odds for treatment dental care (aOR 2.21, 95% CI 1.12-4.37) than prevention-oriented care were found. Mothers experiencing moderate levels of psychological distress (aOR 0.49, 95% CI 0.31-0.77), or residing in outer regional and remote regions (aOR 0.19, 95% CI 0.04-0.85) were less likely to utilise dental care.

CONCLUSION

Findings underline geographical issues in dental care utilisationand the need for integrated care for CALD mothers experiencing psychological distress, and to encourage uptake of preventive oral health care. Addressing cost barriers necessitates for universal health coverage. Multidisciplinary integration of healthcare services with improved primary sector collaboration between governments and healthcare providers, and the expansion to regional services are required for equity in CALD communities.

Optimizing Parent Training to Improve Oral Health Behavior and Outcomes in Underserved Children with Autism Spectrum Disorder

A randomized controlled trial established initial efficacy of a novel parent training (PT) intervention for improving oral hygiene and oral health in underserved children with ASD (Fenning et al., 2022), a population at risk for unmet dental needs. The present study describes our emic approach to PT development alongside treatment outcome data examining feasibility, acceptability, and engagement. Families with Medicaid-eligible children with ASD ages 3 to 13 years (85% male, 62% with intellectual disability) were assigned to receive PT (n = 60) or a psychoeducational toolkit (n = 59). Results indicate strong retention, fidelity, and adherence, with quantitative and qualitative metrics revealing high treatment satisfaction and utilization. Discussion focuses on implications for individualizing treatment to optimize engagement of underrepresented families.

Decomposing socioeconomic inequalities in dental caries among Chinese adults: findings from the 4th national oral health survey

OBJECTIVE

This cross-sectional study aimed to investigate socioeconomic inequalities in dental caries among adults (35 years and older) in China and explore the contributions of various factors to these inequalities.

METHODS

This study included 10,983 adults (3,674 aged 35-44 years, 3,769 aged 55-64 years and 3,540 aged 65-74 years) who participated in the 4th National Oral Health Survey (2015-2016) in China. Dental caries status was evaluated by the decayed, missing and filled teeth (DMFT) index. Concentration indices (CIs) were applied to quantify the different degrees of socioeconomic-related inequality in DMFT, decayed teeth with crown or root caries (DT), missing teeth due to caries or other reasons (MT), and filled teeth without any primary or secondary caries (FT) among adults of different age groups. Decomposition analyses were conducted to identify the determinants and their associations with inequalities in DMFT.

RESULTS

The significant negative CI indicated that DMFT for the total sample were concentrated among socioeconomically disadvantaged adults (CI = - 0.06; 95% confidence interval [CI], - 0.073 to - 0.047). The CIs for DMFT for adults aged 55-64 and 65-74 years were - 0.038 (95% CI, - 0.057 to - 0.018) and - 0.039 (95% CI, - 0.056 to - 0.023), respectively, while the CI for DMFT for adults aged 35-44 years was not statistically significant (CI = - 0.002; 95% CI, - 0.022 to 0.018). The concentration indices of DT were negative and concentrated in disadvantaged populations, while FT showed pro-rich inequalities in all age groups. Decomposition analyses showed that age, education level, toothbrushing frequency, income and type of insurance contributed substantially to socioeconomic inequalities, accounting for 47.9%, 29.9%, 24.5%,19.1%, and 15.3%, respectively.

CONCLUSION

Dental caries was disproportionately concentrated among socioeconomically disadvantaged adults in China. The results of these decomposition analyses are informative for policy-makers attempting to develop targeted health policy recommendations to reduce dental caries inequalities in China.

Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed-methods systematic review

OBJECTIVES

Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers.

METHODS

Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed-method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review.

RESULTS

A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual-family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial-system, provider and individual-family levels and illustrated in the rainbow model of CALD oral health.

CONCLUSION

The review strengthens evidence for multilayered, system-related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.

Dissemination and implementation research for oral and craniofacial health: Background, a review of literature and future directions

Oral conditions are highly prevalent globally and have profound consequence on individuals and communities. Clinical (e.g. dental treatments, behavioural counselling) and non-clinical (e.g. community-based programming, water fluoridation, oral health policy) evidence-based interventions have been identified, recommended and applied at the clinic, community and policy levels. Still, the burden of oral conditions persists, with inequitable distribution across populations. A major driver of this lack of progress is poor translation of research findings, which results in an evidence-to-practice gap. Dissemination and implementation science (DIS) has emerged to address this gap. A relatively new field, application of DIS represents an important avenue for achieving good dental, oral and craniofacial health for all. The goal of this introductory article is to provide a brief background on DIS relevant to researchers in dentistry and oral health. The problem of knowledge translation, basic concepts and terminology in DIS, and approaches to doing dissemination and implementation research-including implementation strategies, key outcomes, and implementation theories, models and frameworks-are discussed. Additionally, the article reviews literature applying DIS to dentistry and oral health. Results of published studies and their implications for the field are presented. Drawing on the literature review and contemporary thinking in DIS, current gaps, opportunities and future directions are discussed. Resources for understanding and applying DIS are provided throughout. This article serves as a primer on DIS for dental and oral health researchers of all types working across a range of contexts; it also serves as a call to action for increased application of DIS to address the burden of oral conditions globally.

Reflections on oral health inequalities: Theories, pathways and next steps for research priorities

Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.

Guardians' Self-Reported Fair/Poor Oral Health Is Associated with Their Young Children's Fair/Poor Oral Health and Clinically Determined Dental Caries Experience

In this cross-sectional, community-based study among a multi-ethnic sample of preschool-age children in North Carolina, United States, we sought to quantify the association between guardians' self-reported oral health and their children's oral health and determine whether race/ethnicity and education level modify these associations. We used questionnaire (n = 7852) responses about caregivers' and their children's oral health and clinical examination-derived (n = 6243) early childhood caries (ECC) status defined at the ICDAS ≥ 3 caries lesion detection threshold. We used multi-level mixed-effects generalized linear models to examine the associations between the guardians' reported oral health and their children's reported and clinically determined oral health among the entire sample and within strata of race/ethnicity, guardians' education, and children's dental home. The guardians' and their children's reported fair/poor oral health (FPOH) were 32% and 15%, respectively, whereas 54% of the children had ECC and 36% had unrestored disease. The guardians' FPOH was strongly associated with their children's FPOH (average marginal effect (AME) = +19 percentage points (p.p.); 95% CI = 17-21), and this association was most pronounced among Hispanics, lower-educated guardians, and children without a dental home. Similar patterns, but smaller-in-magnitude associations, were found for the guardians' FPOH and their children's clinically determined ECC (AME = +9 p.p.; 95% CI = 6-12) and unrestored disease (AME = +7 p.p.; 95% CI = 4-9). The study's findings support a strong association between guardians' and their children's reported and clinically determined oral health and implicate ethnicity, education, and having a dental home as factors possibly modifying the magnitude of these associations.

Social capital and oral health in children and adolescents: A systematic review and meta-analysis

OBJECTIVES

To systematically evaluate the association of individual and contextual social capital with oral health outcomes in children and adolescents.

METHODS

Electronic searches were performed in PubMed/Medline, Embase, Web of Science and Scopus databases for articles published from 1966 up to June 2021. Two calibrated reviewers screened and critically appraised the identified papers. Observational studies that evaluated the relationship of individual or/and contextual social capital or their proxies with oral health outcomes in children and adolescents using validated methods were included. Quality assessment was conducted using the Newcastle-Ottawa Scale. Data were extracted for narrative synthesis and meta-analysis followed by a meta-regression model. Meta-analysis using random effects method was used to estimate pooled prevalence ratio (PR) and 95% confidence intervals (CI).

RESULTS

Of the 3060 studies initially retrieved, 31 were included in the systematic review and 21 in the meta-analysis, totalling 81 241 individuals. The clinical outcomes included dental caries and gingival bleeding and subjective outcomes were oral health-related quality of life (OHRQoL) and self-rated oral health (SROH). Individuals with lower levels of individual social capital had a higher prevalence of poor clinical (PR 1.11; 95%CI 1.02-1.22) and subjective (PR 1.25; 95%CI 1.09-1.45) oral health conditions. The prevalence of worse clinical (PR 1.34; 95%CI 1.11-1.61) and subjective (PR 1.56; 95%CI 1.13-2.16) oral health outcomes were also associated with lower levels of contextual social capital. In general, the contextual level of social capital exerted more impact, and the subjective oral health outcomes were the more affected.

CONCLUSIONS

Contextual and individual social capital were positively related to oral health outcomes, such as dental caries, gingival bleeding, SROH and OHRQoL in children and adolescents.

High sugar intake from sugar-sweetened beverages is associated with prevalence of untreated decay in US adults: NHANES 2013-2016

OBJECTIVES

To assess the association between sugar from sugar-sweetened beverages (SSBs) and untreated decay in permanent teeth and calculate the cost burden of sugar from SSBs on untreated decay in US adults.

METHODS

Cross-sectional data from the 2013-2014 and 2015-2016 cycles of the National Health and Nutrition Examination Survey (NHANES) were analysed in 2020 (n = 9001 adults aged ≥20). Multivariable analyses assessed sugar intake from SSB consumption with the presence of untreated decay in permanent teeth and number of untreated decayed teeth. Population attributable risk was used to estimate the cost burden arising from SSBs on untreated decay in US adults.

RESULTS

One fourth (25.1%) of US adults had untreated dental decay, and higher prevalence was observed among those with low income, low education and race/ethnicity of non-Hispanic Black. Overall, 53% of adults reported no intake of SSBs. For the remaining 47%, the median 24-h intake was 46.8 g of sugar from SSBs. The adjusted prevalence ratio (PR) for untreated decay was 1.3 (95% confidence interval [CI] 1.1-1.5) for consumption of 46.8 g or more of sugar from SSBs compared to those reporting no sugar from SSBs. Number of untreated decayed teeth increased with sugar intake from SSBs from lowest to highest tertile: 0.1, (p = .35); 0.4, (p = .006); and 0.6, (p < .001). The cost burden of untreated decay attributable to SSBs in US adults is estimated conservatively at $1.6 billion USD.

CONCLUSIONS

Community level interventions directed at sugar from SSBs are justified to address disparities in the burden of untreated dental decay.

Professionals’ perspectives on how to address persistent oral health inequality among young children: an exploratory multi-stakeholder analysis in a disadvantaged neighbourhood of Amsterdam, the Netherlands

Background

Oral health promotion interventions have had limited success in reaching families in disadvantaged neighbourhoods resulting in persistent oral health inequality. This qualitative study provides insight into professionals’ perspectives on children’s poor oral health (≤ 4 years), their perceptions of the roles and responsibilities, and opportunities for child oral health promotion strategies.

Methods

Thirty-Eight professionals from different domains (community, social welfare, general health, dental care, public health, private sector) working in a disadvantaged neighbourhood in Amsterdam, the Netherlands, participated through 24 semi-structured (group) interviews. Transcripts and notes were analysed through thematic analysis.

Results

Professionals indicate that unhealthy diet, children’s non-compliance, poor parental coping, parental low oral health literacy, parent’s negative attitude, family’s daily struggles, and insufficient emphasis on childhood caries prevention in dental practices, general healthcare and social welfare organisations, underlie poor oral health. They hold parents most responsible for improving young children’s oral health, but recognise that families’ vulnerable living circumstances and lack of social support are important barriers. Interestingly, non-dental professionals acknowledge their beneficial role in child oral health promotion, and dental professionals stress the need for more collaboration.

Conclusion

A broad child-, parental-, and societal-centred educational communication strategy is perceived as promising. Professionals working within and outside the dental sector acknowledge that local and collective action is needed. This involves a better understanding of family’s complex daily reality. Furthermore, intensifying child oral health knowledge in dental practices is essential in collaboration with families, general health and social welfare organisations.

Your health is in your mouth: A comprehensive view to promote general wellness

Background

Even though various studies recognize the importance of the oral cavity to have general health, in multidisciplinary professional practice it is almost always excluded and on an individual basis, very commonly neglected. Oral diseases are preventable, still, they are highly prevalent. Although some studies consider oral health within integral health, currently, there is no model in which the mouth is integrated within other levels for the achievement of well-being. The objective of this article was to review the importance of oral health and its connection with well-being and, based on these findings, propose a complex and comprehensive perspective for approach and care.

Methods

The databases MEDLINE, PubMed, and Google Scholar were revised for randomized controlled trials and reviews that included search terms related to oral health and its relationship with the general health in its different levels (physical, psychological, social and environmental).

Results

The review shows that oral health is critical, as the teeth and mouth are not only an integral part of the body, but also, they also support and enable essential human functions. That is, oral health has a multidimensional nature, as it includes the physical, psychological, social, and environmental domains that are essential for overall health and well-being. Likewise, the mouth is the psychological seat of the first physiological needs and emotional gratifications, with it we take a taste of the world around us. Thus, the mouth plays an important role in the feeling of unity and in the constitution of the self. Based on these results we propose an integrative model in which the mouth is the first step for well-being and from this integrative model we build a multidisciplinary approach which could be used in the clinical practice for the promotion of oral care and general health.

Conclusion

The effort on the part of oral health professionals is essential for people's well-being and must be integrated as part of health promotion. Dental treatments alone cannot solve this problem, it requires a comprehensive and approach in which the bio-psychological, behavioral, and socio-environmental determinants are included to face this global oral health challenge. That is, without a comprehensive and multidisciplinary approach to medical science that includes dental and oral health, our public policies cannot provide the best answers to health promotion, disease prevention, early detection, and treatment.

What Do Mothers (or Caregivers) Know about Their Children’s Oral Hygiene? An Update of the Current Evidence

Tooth decay remains one of the most common diseases in children, although it is a preventable injury and despite significant advances that has been made in terms of attention and care for oral hygiene. Several studies have shown the association between prevalence of tooth decay in children and parents’ incorrect oral care habits, with a low educational level and a low socioeconomic background. The question that arises concerns the actual oral hygiene knowledge of mothers, fathers, family members or caregivers of young patients; therefore, the aim of this review is to investigate the genesis of gaps in the topic. A literature search was conducted through the Scopus and PubMed search engine and ended in May 2022; only studies from the past 20 years were included. Current evidence suggests that parents and caregivers still have little knowledge about their children’s oral health: there is not enough awareness about the importance of preventing oral diseases, due to poor attention to good oral hygiene but also lack of information from health professionals and institutions. In the future, all the professionals involved in the pregnant woman’s care should increase parents’ knowledge, solve their doubts, collect and compare data in order to design effective intervention programs.

Dental Caries, Oral Health Behavior, and Living Conditions in 6-8-Year-Old Romanian School Children

Dental caries still have a high prevalence in Romania. The aim of this paper is to determine the prevalence of caries in children (aged 6 to 8 years) correlated with individual-level predictors and socio-economic variables. A stratified, randomized nationally representative sample was established, taking into consideration the total number of preschool children and based on administrative units and residence. Self-assessment was performed by means of the Oral Health Questionnaire for Children (WHO). Examinations were conducted by 10 standardized examiners, with International Caries Detection and Assessment System (ICDAS) caries codes higher than 3 considered as dentinal caries, missing teeth as MT, and restorations as FT. DMFT and SiC indexes were calculated accordingly. The dataset for each outcome variable was analyzed by the Hurdle approach analyzed. The gender distribution was similar (47.22% male and 52.78% female), with 42.65% residing in rural areas. The mean DMFT value for the sample was 4.89 and SiC index 9.83. A negative association could be seen between DMFT and the father’s level of education (β = −0.33, SE = 0.07, p < 0.01) as well as the mother’s education (β = −0.25, SE = 0.07, p < 0.01). In conclusion, caries prevalence is very high in Romania as compared to the World Health Organization (WHO) recommendation for this age group in correlation with socio-economic factors and oral health behavior.

Peer-led oral health education model for elementary school-aged children in British Columbia, Canada

Objective

To examine the effectiveness of peer-led preventive oral health education for elementary school-aged children.

Methods

A controlled, non-randomized interventional study included children in grades 4 to 6 (N = 372) from 6 schools in British Columbia, Canada. The control group (3 schools) received a class-based lecture on oral health. In the intervention group (3 schools), each sixth grader mentored a small group of fourth and fifth graders. The study outcomes were 1) need for oral care referrals (visual screening); 2) oral health knowledge (self-reports); 3) oral self-care practice (OSC-P); and 4) oral self-care skills (OSC-S). Assessments of OSC-P and OSC-S were based on disclosed dental biofilm levels. Study group comparisons were done at baseline and 8 to 12 months.

Results

A high need for oral care referrals was found, with a substantial reduction achieved during the study period. Dietary knowledge improved minimally in the intervention group. In both study groups and within age groups, there was a wide variation in OSC-P and OSC-S. Overall, children's OSC-P scores were substantially higher than their OSC-S scores. Oral self-care outcomes improved over time in both groups (except for fourth graders in the control group), with a more substantial improvement in the intervention group. From baseline to study end, the mean OSC-P improved by 11.9% (intervention group) and 5.9% (control group). Improvement values for OSC-S were 12.8% and 5.2%.

Conclusions

The need for oral care referrals was reduced, but improvement in oral health knowledge was minimal. Oral self-care outcomes improved more in the intervention than in the control group.

Oral Health Service Access in Racial/Ethnic Minority Neighborhoods: A Geospatial Analysis in Washington, DC, USA

Previous studies on individual-level variables have improved our knowledge base of oral health service use. However, environmental or contextual variables are also important in understanding oral health disparities in racial and ethnic neighborhoods. Based on Bronfenbrenner’s ecological framework, this study examines the geographic availability of oral health providers in Washing-ton DC, U.S.A. Census tract-level data were drawn from the American Community Survey, joined with tract-level shapefiles, and overlaid with the geographic location of dental services throughout the city. Visual maps, descriptive statistics, and spatial lag regression models showed that census tracts with higher concentrations of African Americans were significantly farther from their nearest oral health providers (r = 0.19, p < 0.001), after controlling for neighborhood poverty rate, median age, and gender. Such findings confirm that in urban areas with highly di-verse populations such as Washington DC, racial disparities in oral health care access are signifi-cant. The study highlights that identifying neighborhoods with limited oral health care providers should be a priority in diminishing racial disparities in oral health service access. Improving access to racial/ethnic minority communities, especially African American neighborhoods, will require changes in health policies and programs, workforce development, resource allocation, community outreach, and educational programs.

Anti-racist approaches to increase access to general and oral health care during a pandemic in the Pacific Islander community

Limited data exists on Pacific Islander (PI) health, but a growing body of literature reports the existence of racial discrimination and inequities and mistrust of the healthcare system, leading to poor health outcomes. When COVID‐19 restricted health services, such inequities and mistrust due to historical trauma were magnified. This report describes one federally qualified health center's dental department's response utilizing culture‐based approaches, community relationships, and the social determinants of health (SDOH) to dispel the stigma of COVID and restrictions on in‐person care in order to lower barriers to accessing care. When the dental department transitioned to emergency‐only care, staff were redeployed to address significant inequities facing the PI community. Redeployment activities included building relationships with the most vulnerable patients, delivering healthy foods, supplies, oral hygiene kits to households, and canvasing neighborhood businesses with public health education. The mobile dental clinic, a trusted symbol in the community, also brought public health education to community testing events and food distributions. From March 2020 to July 2020, staff conducted over 800 outreach calls for health and food security, delivered over 2000 care packages and oral hygiene kits. Also, frequent community outreach by the mobile dental clinic led to a 10‐fold increase in COVID testing. Investing in relationship building can maintain access to health care and build trust in the health care system for PI communities. This approach may be relevant to others serving other communities experiencing racism.

Oral health inequality among Indonesian workers in South Korea: role of health insurance and discrimination factors

Background

The health of migrant workers is becoming an important public health issue. Although there are an increasing number of migrant workers in Korea, the health status in migrant populations remains unknown. The aims of this study were (1) to evaluate the association between income and self-rated oral health (SROH), and (2) to assess the role of health insurance and self-perceived discrimination in the association between income and SROH among Indonesian migrant workers in Korea.

Methods

Information about self-reported income, SROH, coverage/utilization of health insurance (HI), living difficulties related to oral health (LDROH), oral health literacy (OHL), and discrimination were obtained from Indonesian migrant workers in Korea (n = 248). The main explanatory variable was income, and SROH was an outcome variable. Logistic regression analyses were performed controlling for age, gender, HI, LDROH, OHL, and discrimination. The paths from income to SROH were analyzed using the Partial Least Square-Structural Equation Model (PLS-SEM).

Results

Among Indonesian migrant workers, the lower income group had the highest probability of a poor SROH compared to the higher income group. The variables showing a high explanatory power were discrimination among the low income group and HI among the middle income group. In PLS-SEM, the variables such as HI, LDROH, OHL, and discrimination contributed 11% to explaining the association between income and SROH.

Conclusion

A monotonic gradient was revealed among migrant workers according to the association between income and SROH. Discrimination and HI contributed to oral health inequalities.

Parenting practices and oral health behaviors of children in rural Egypt: gender differences in a household survey

Background

Parenting practices influence children’s health and development. The current study aimed at assessing gender differences in children’s perception of the parenting practices of both parents, and in the association between children’s oral health behaviors and parenting practices.

Methods

A cross-sectional household survey of 6–12 year old children was conducted in a rural area in Northwestern Egypt in 2019. Clinical examination assessed caries and gingivitis. The Alabama Parenting Questionnaire assessed parenting practices in five domains (positive parenting, involvement, inconsistent disciplining, poor monitoring and corporal punishment) and the World Health Organization questionnaire assessed oral health behaviors including sugar consumption and daily toothbrushing. Sugar consumption was the dependent variable in linear regression and daily toothbrushing was the dependent variable in logistic regression. Parenting practices were the explanatory variables adjusting for confounders. Effect modification by child gender was assessed.

Results

The response rate was 94.1% (n = 433), mean age = 9.9 years, 44.1% boys, 17.8% with daily toothbrushing and mean sugar consumption score = 3.4/8. Girls perceived more mothers’ positive parenting than boys (mean = 14.15 and 13.46) and boys perceived more poor monitoring and corporal punishment. Boys and girls differed in the association between sugar consumption and fathers’ inconsistent disciplining, poor monitoring (P = 0.004 and 0.02) and mothers’ corporal punishment (P = 0.02), and also daily toothbrushing and mothers’ involvement, positive parenting (P = 0.05 and 0.02), fathers’ positive parenting (P = 0.02), mothers’ inconsistent discipling and poor monitoring (P = 0.01 and 0.04).

Conclusions

There were differences between boys and girls in perceiving mothers’ and fathers’ parenting practices and in the association between these parenting practices and toothbrushing and sugar consumption.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02054-z.

Guardian Reports of Children's Sub-optimal Oral Health Are Associated With Clinically Determined Early Childhood Caries, Unrestored Caries Lesions, and History of Toothaches

Background: Parents'/guardians' perceptions of their children's oral health are useful proxies of their clinically determined caries status and are known to influence dental care-seeking behavior. In this study, we sought to examine (1) the social and behavioral correlates of fair/poor child oral health reported by guardians and (2) quantify the association of these reports with the prevalence of early childhood caries (ECC), unrestored caries lesions and toothaches. Methods: We used guardian-reported child oral health information (dichotomized as fair/poor vs. excellent/very good/good) obtained via a parent questionnaire that was completed for n = 7,965 participants (mean age = 52 months; range = 36-71 months) of a community-based, cross-sectional epidemiologic study of early childhood oral health in North Carolina between 2016 and 2019. Social, demographic, oral health-related behavioral data, and reports on children's history of toothaches (excluding teething) were collected in the same questionnaire. Unrestored ECC (i.e., caries lesions) was measured via clinical examinations in a subset of n = 6,328 children and was defined as the presence of one or more tooth surfaces with an ICDAS ≥ 3 caries lesion. Analyses relied on descriptive and bivariate methods, and multivariate modeling with average marginal effect (A.M.E.) estimation accounting for the clustered nature of the data. Estimates of association [prevalence ratios (PR) and adjusted marginal effects (AME) with 95% confidence intervals (CI)] were obtained via multilevel generalized linear models using Stata's svy function and accounting for the clustered nature of the data. Results: The prevalence of fair/poor oral health in this sample was 15%-it increased monotonically with children's age, was inversely associated with parents' educational attainment, and was higher among Hispanics (21%) and African Americans (15%) compared to non-Hispanic whites (11%). Brushing less than twice a day, not having a dental home, and frequently consuming sugar-containing snacks and beverages were significantly associated with worse reports (P < 0.0005). Children with fair/poor reported oral health were twice as likely to have unrestored caries lesions [prevalence ratio (PR) = 2.0; 95% confidence interval (CI) = 1.8-2.1] and 3.5 times as likely to have experienced toothaches [PR = 3.5; 95% CI = 3.1-3.9] compared to those with better reported oral health. Conclusions: Guardian reports of their children's oral health are valuable indicators of clinical and public health-important child oral health status. Those with fair/poor guardian-reported child oral health have distinguishing characteristics spanning socio-demographics, oral-health related practices, diet, and presence of a dental home.

A cross-sectional study of relationships between periodontal disease and general health: The Hitachi Oral Healthcare Survey

BACKGROUND

This cross-sectional study performed to clarify the relationship between periodontal disease and non-communicable diseases (NCDs), such as obesity, diabetes mellitus, impaired glucose tolerance (IGT), chronic obstructive pulmonary disease (COPD), and atherosclerotic cardiovascular disease (ASCVD) by introducing dental examinations into the annual health examinations conducted by Japanese companies, and to highlights the importance of a medical system that connects dental and medical professionals.

METHODS

A total of 1.022 Hitachi Ltd. employees were enrolled in this cross-sectional study. We examined correlations and odds ratios (ORs) between the dental and overall health of employees using stratification and multiple logistic regression analyses based on the periodontal health indicators, general health indicators, and occlusal force.

RESULTS

The adjusted OR of PPD for obesity (OR, 1.42; 95% confidence interval [CI], 1.09-1.84; p = 0.009), IGT (OR, 1.48; 95% CI, 1.00-2.20; p = 0.049), and COPD (OR, 1.38; 95% CI, 1.02-1.88; p = 0.038) significantly differed. The adjusted OR of body mass index (OR, 1.28; 95% CI 1.15-1.42; p < 0.001), haemoglobin A1C (HbA1c) (OR, 4.34; 95% CI, 1.89-9.98; p < 0.001), fasting blood glucose (FBG) levels (OR, 1.08; 95% CI 1.04-1.11; p < 0.001), postbronchodilator forced expiratory volume in one second/forced vital capacity ratio (%FEV1) (OR, 0.95; 95% CI 0.91-1.00; p = 0.031) and smoking (OR, 2.32; 95% CI 1.62-3.33; p < 0.001) for severe periodontal disease also significantly differed. Occlusal force was significantly reduced in employees aged 50-59 years compared to those aged 40-49 years. Both PPD, HbA1c, FBG levels were significantly associated with occlusal force among employees with moderate/severe periodontitis. PPD was significantly associated with occlusal force among employees with and moderate COPD, and ASCVD. %FEV1 was significantly associated with occlusal force among employees with IGT.

CONCLUSIONS

This cross-sectional study revealed mutual relationships among periodontal disease, NCDs, and occlusal force on Japanese corporate workers. We demonstrated that a comprehensive, regional healthcare system centred on annual integrated dental and physical health examinations in the workplace will benefit employees and positively impact corporate health insurance.

Brazilian Oral health teams in primary care and oral cancer: Results of a national evaluation

Oral cancer is one of the most prevalent cancers in Brazil. An understanding of how public policies are implemented to address this problem can contribute to the construction of solutions. The "Programa de Melhoria do Acesso e da Qualidade" (PMAQ-AB and PMAQ-CEO) at the level of primary and secondary care are evaluations that also collect data on prevention and monitoring strategies for oral cancer. This study aimed to analyze the results of the incorporation of oral health teams to evaluate the strategies adopted by Brazil regarding the impact on the diagnosis of oral cancer. Of the 17,202 family health teams evaluated, 72.10% had oral health teams (OHT). Considering the strategies for prevention, screening, campaign, and follow-up of suspected cases, 72.27% of the campaign teams and 59.09% of the teams who accompanied suspected cases had OHT. In secondary care, more than 65% of the teams in the Southeast and South regions registered cases of oral cancer, and the referral network was more represented. The inclusion of OHT had a positive impact on campaign actions, follow-up, referral to specialists, and registration of suspected cases throughout Brazil.

Early-Life Adversity Leaves Its Imprint on the Oral Microbiome for More Than 20 Years and Is Associated with Long-Term Immune Changes

The early-life microbiome (ELM) interacts with the psychosocial environment, in particular during early-life adversity (ELA), defining life-long health trajectories. The ELM also plays a significant role in the maturation of the immune system. We hypothesised that, in this context, the resilience of the oral microbiomes, despite being composed of diverse and distinct communities, allows them to retain an imprint of the early environment. Using 16S amplicon sequencing on the EpiPath cohort, we demonstrate that ELA leaves an imprint on both the salivary and buccal oral microbiome 24 years after exposure to adversity. Furthermore, the changes in both communities were associated with increased activation, maturation, and senescence of both innate and adaptive immune cells, although the interaction was partly dependent on prior herpesviridae exposure and current smoking. Our data suggest the presence of multiple links between ELA, Immunosenescence, and cytotoxicity that occur through long-term changes in the microbiome.

Greater inequalities in dental caries treatment than in caries experience: a concentration index decomposition approach

Background

The aim of the current study was to (a) measure the socioeconomic inequalities in oral health and examine whether the inequalities are greater in disease experience or in its treatment and to (b) decompose the factors that influence oral health inequalities among the adults of Guangdong Province.

Methods

A cross-sectional study was conducted among 35- to 44-year-old and 65- to 74-year-old adults in Guangdong Province. All participants underwent oral health examinations and answered questionnaires about their oral health. We measured the concentration indices of the DMFT and its separate components, namely, decayed teeth (DT), missing teeth (MT), and filled teeth (FT), to explore the inequalities in oral health status; then, we analysed its decomposition to interpret the factors that influence the inequalities.

Results

The results showed that significant inequality was concentrated on FT (CI =  0.24, 95% CI = 0.14/0.33, SE = 0.05). The concentration indices for the DMFT (CI =  0.02, 95% CI =  0.02/0.06, SE = 0.02) and MT (CI =  0.02, 95% CI 0.03/0.08, SE = 0.03) were small and close to zero, while the concentration for DT (CI =  − 0.04, 95% CI =  − 0.01/0.02, SE = 0.03) was not statistically significant. The results from the decomposition analysis suggested that a substantial proportion of the inequality was explained by household income, high education level, regular oral examination and type of insurance (5.1%, 12.4%, 43.2%, − 39.6% (Urban Employee Basic Medical Insurance System) and 34.5% (New-Type Rural Medical Collaboration System), respectively).

Conclusions

The results indicated greater inequalities in dental caries than in caries experience. Among the included factors, household income, high education level, and regular oral health examinations had the greatest impact on the inequalities in the number of FT. In addition, the current medical insurance systems, including the Urban Employee Basic Medical Insurance System, Urban Resident Basic Medical Insurance System, and the New-Type Rural Medical Collaboration System, have not been effectively used in oral treatment. Policy-making and the implementation of interventions for tackling socioeconomic oral health inequalities should focus on reducing the burden of treatment and providing greater access to dental care for low-income groups. Welfare policies are skewed towards rural areas and low-income people.

Oral health and atherosclerotic cardiovascular disease: A review

Periodontal disease (PD) is common in the US and globally. Evidence suggests that poor oral health is associated with atherosclerotic cardiovascular disease (ASCVD); however, this relationship has not been a major focus in clinical cardiology. This manuscript will review the growing evidence linking PD to ASCVD, including pathophysiologic mechanisms and coexistent risk factors. Public health considerations with a focus on disparities, social determinants, preventive strategies, and a call to action to reduce the burden of coincident ASCVD and PD are also reviewed.

Dental Therapists in the United States: Health Equity, Advancing

BACKGROUND

Dental therapists (DTs) are primary care dental providers, used globally, and were introduced in the United States (US) in 2005. DTs have now been adopted in 13 states and several Tribal nations.

OBJECTIVES

The objective of this study is to qualitatively examine the drivers and outcomes of the US dental therapy movement through a health equity lens, including community engagement, implementation and dissemination, and access to oral health care.

METHODS

The study compiled a comprehensive document library on the dental therapy movement including literature, grant documents, media and press, and gray literature. Key stakeholder interviews were conducted across the spectrum of engagement in the movement. Dedoose software was used for qualitative coding. Themes were assessed within a holistic model of oral health equity.

FINDINGS

Health equity is a driving force for dental therapy adoption. Community engagement has been evident in diverse statewide coalitions. National accreditation standards for education programs that can be deployed in 3 years without an advanced degree reduces educational barriers for improving workforce diversity. Safe, high-quality care, improvements in access, and patient acceptability have been well documented for DTs in practice.

CONCLUSION

Having firmly taken root politically, the impact of the dental therapy movement in the US, and the long-term health impacts, will depend on the path of implementation and a sustained commitment to the health equity principle.

Development and usability testing of mobile application on diet and oral health

In several nations, caries in pre-school children remain a significant oral health issue. In an outbreak period such as the Coronavirus disease 2019 (COVID-19), remote contact and education aimed at the prevention of oral diseases and the preservation of children's oral health are more relevant than ever. Currently, the amount of published applications is far higher than the published scientific studies while the problems of usability remains vulnerable. The goal of this paper was to comprehensively document the phase of development and usability testing of a mobile application for diet and oral health, namely Gigiku Sihat, which was primarily intended to be used by parents and guardians of pre-school children. The mobile application was developed using the System Development Life Cycle principle. Apart from searching for the available oral health application on Android platform, the initial requirement gathering process consisted of situational analysis, concept generation, content development, and features and functional requirement determination. The mobile application design and implementation evolved at each phase before being finalised. Gigiku Sihat was successfully developed in the Bahasa Malaysia. Finalised Gigiku Sihat was installed on mobile devices to determine the usability using translated and validated System Usability Scale questionnaire namely Skala Kebolehgunaan Aplikasi Mudah Alih (SKAMA). The mean score usability with score of 68 and above was deemed to have good usability. This study found that Gigiku Sihat mean (SD) usability score was 77.0 (14.18). The results were promising as they showed that Gigiku Sihat had a good usability. Thus, the development of this mobile application focusing on diet and oral health served as a new source of oral health education and provided a necessary foundation in developing future improved mobile application development for parents in the prevention of early childhood caries.

Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis

OBJECTIVE

To identify predictors of unmet dental needs for adults 18 y of age or older in the United States.

METHOD

Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents.

RESULTS

Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y.

CONCLUSION

Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health.

KNOWLEDGE TRANSFER STATEMENT

Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.

Trends in socioeconomic inequality of periodontal health status among Dutch adults: a repeated cross-sectional analysis over two decades

Background

Studies exclusively focusing on trends in socioeconomic inequality of oral health status in industrialized countries are relatively sparse. This study aimed to assess possible differences in oral hygiene and periodontal status among people of different socioeconomic status (SES) in the Netherlands over two decades.

Methods

A repeated cross-sectional analysis of 3083 participants aged 25–54 years was conducted on the Dutch National Oral Health Surveys of 1995, 2002, 2007, and 2013. Plaque-free was defined according to the Simplified Oral Hygiene Index (OHI-S = 0). Periodontal status was classified in two different ways, either periodontal health/disease (probing pocket depth index [PDI] = 0/ ≥ 1) or with/without deep pockets (PDI = 2). We used the regression-based absolute and relative effect index to measure the absolute and relative socioeconomic inequalities. Multivariable logistic regressions were used to explore temporal trends in oral hygiene and periodontal status by low- and high-SES groups.

Results

Age-standardized percentages of individuals with plaque-free increased in the whole population from 1995 to 2013 (12.7% [95% CI 10.5–14.9] to 28.1% [24.8–31.5]). Plaque-free showed significant socioeconomic differences in absolute and relative inequalities in 2007 and 2013. Between 1995 and 2013, age-standardized percentage of periodontal health increased (from 51.4% [48.1–54.7] to 60.6% [57.0–64.1]). The significant absolute inequalities for periodontal health were seen in 2002 and 2013. The relative scale presented a similar pattern. Regarding deep pockets, there was little difference in the age-standardized overall prevalence in 1995 versus 2013 (from 6.5% [4.9–8.2] to 5.4% [3.7–7.0]). The significant absolute and relative inequalities in deep pockets prevalence were found in 1995. Yet, all interaction terms between survey year and SES did not reach significance (plaque-free: P = .198; periodontal health: P = .490; deep pockets: P = .678).

Conclusions

Socioeconomic inequalities in oral hygiene and periodontal status were present in the Netherlands in the last two decades.

Clinical and Self-Reported Measurements to Be Included in the Core Elements of the World Dental Federation's Theoretical Framework of Oral Health

INTRODUCTION

Oral health is part of general health, and oral diseases share risk factors with several non-communicable diseases. The World Dental Federation (FDI) has published a theoretical framework illustrating the complex interactions between the core elements of oral health (CEOHs): driving determinants, moderating factors, and general health and well-being. However, the framework does not specify which self-reported or clinical measurements to be included in the CEOHs.

OBJECTIVES

To explore oral health measurements relevant for a general adult population to be included in the CEOHs in the FDI's theoretical framework of oral health.

MATERIALS AND METHODS

A psychometric study was performed, using cross-sectional data from Sweden (N = 630, 54% women, mean age 49.7 years). The data set initially consisted of 186 self-reported and clinical measurements. To identify suitable measurements, the selection was discussed in different settings, including both experts and patients. Principal component analyses (PCAs) were performed to explore, reduce and evaluate measurements to be included in the three CEOHs. Internal consistency was estimated by Cronbach's Alpha.

RESULTS

The validation process yielded 13 measurements (four clinical, nine self-reported) in concordance with the CEOHs. PCAs confirmed robust validity regarding the construction, predicting 60.85% of variance, representing psychosocial function (number of measurements = 5), disease and condition status (number of measurements = 4), and physiological function (number of measurements = 4). Cronbach's Alpha indicated good to sufficient internal consistency for each component in the constructs (α = 0.88, 0.68, 0.61, respectively).

CONCLUSION

In a Swedish general adult population, 13 self-reported and clinical measurements can be relevant to include to operationalise CEOHs in the FDI's theoretical framework.

Experiencing Financial Strain and Clinically Assessed Caries Experience in Dentate Adults Aged 25-44 Years: An Exploration of Potential Pathways

Large socioeconomic inequalities still exist in oral health. It is already known that oral health-related behaviour may contribute to these inequalities, but why people with a lower socioeconomic position behave less healthily is not easily understood. A possible explanation that integrates insights on health behaviour, stress, and financial resources is the pathway of behavioural responses to financial strain. The aim of this study was to assess to what extent financial strain is associated with clinically assessed caries experience in a population-based study of dentate adults, independently of other socioeconomic indicators. Furthermore, the potential mediating pathways of oral health-related behaviours (oral hygiene, dietary habits, preventive dental visits) were explored. Dentate participants, aged 25-44 years, taking part in a survey on oral health and preventive behaviour in the Netherlands in 2013 were clinically examined on - among others - caries experience (DMFS index) and level of oral hygiene (OHI-s index). Financial strain, frequency of tooth brushing, dietary habits, attendance of (preventive) dental visits in the past year, and demographic variables were assessed via questionnaires. Negative binomial hurdle models were used to study the association between financial strain and DMFS and between oral health behavioural indicators and DMFS. Although it was observed that experiencing financial strain did not seem to affect whether there is any caries experience or not, among those having any caries (DMFS >0) suffering from financial strain was associated with a higher caries prevalence, independent of educational level and income. None of the studied potential mediators could explain this association.

Interprofessional Collaboration to Promote Culturally Engaged and Strengths-Based Practice

Purpose

To effectively prepare students to engage in interprofessional practice, a number of Communication Disorders (COMD) programs are designing new courses and creating additional opportunities to develop the interprofessional competencies that will support future student success in health and education-related fields. The ECHO (Educational Community Health Outreach) program is one example of how the Rongxiang Xu College of Health and Human Services at California State University, Los Angeles, has begun to create these opportunities. The ultimate goal of the ECHO project is to increase both access to and continuity of oral health care across communities in the greater Los Angeles area.

Method

We describe this innovative interdisciplinary training program within the context of current interprofessional education models. First, we describe the program and its development. Second, we describe how COMD students benefit from the training program. Third, we examine how students from other disciplines experience benefits related to interprofessional education and COMD. Fourth, we provide reflections and insights from COMD faculty who participated in the project.

Conclusions

The ECHO program has great potential for continuing to build innovative clinical training opportunities for students with the inclusion of Child and Family Studies, Public Health, Nursing, and Nutrition departments. These partnerships push beyond the norm of disciplines often used in collaborative efforts in Communication Sciences and Disorders. Additionally, the training students received with ECHO incorporates not only interprofessional education but also relevant and important aspects of diversity and inclusion, as well as strengths-based practices.

How Neoliberalism Shapes Indigenous Oral Health Inequalities Globally: Examples from Five Countries

Evidence suggests that countries with neoliberal political and economic philosophical underpinnings have greater health inequalities compared to less neoliberal countries. But few studies examine how neoliberalism specifically impacts health inequalities involving highly vulnerable populations, such as Indigenous groups. Even fewer take this perspective from an oral health viewpoint. From a lens of indigenous groups in five countries (the United States, Canada, Australia, Aotearoa/New Zealand and Norway), this commentary provides critical insights of how neoliberalism, in domains including colonialism, racism, inter-generational trauma and health service provision, shapes oral health inequalities among Indigenous societies at a global level. We posit that all socially marginalised groups are disadvantaged under neoliberalism agendas, but that this is amplified among Indigenous groups because of ongoing legacies of colonialism, institutional racism and intergenerational trauma.

Cohort Profile: ZOE 2.0-A Community-Based Genetic Epidemiologic Study of Early Childhood Oral Health

Early childhood caries (ECC) is an aggressive form of dental caries occurring in the first five years of life. Despite its prevalence and consequences, little progress has been made in its prevention and even less is known about individuals' susceptibility or genomic risk factors. The genome-wide association study (GWAS) of ECC ("ZOE 2.0") is a community-based, multi-ethnic, cross-sectional, genetic epidemiologic study seeking to address this knowledge gap. This paper describes the study's design, the cohort's demographic profile, data domains, and key oral health outcomes. Between 2016 and 2019, the study enrolled 8059 3-5-year-old children attending public preschools in North Carolina, United States. Participants resided in 86 of the state's 100 counties and racial/ethnic minorities predominated-for example, 48% (n = 3872) were African American, 22% white, and 20% (n = 1611) were Hispanic/Latino. Seventy-nine percent (n = 6404) of participants underwent clinical dental examinations yielding ECC outcome measures-ECC (defined at the established caries lesion threshold) prevalence was 54% and the mean number of decayed, missing, filled surfaces due to caries was eight. Nearly all (98%) examined children provided sufficient DNA from saliva for genotyping. The cohort's community-based nature and rich data offer excellent opportunities for addressing important clinical, epidemiologic, and biological questions in early childhood.

U-shaped association between maternal age at delivery and dental caries in offspring

OBJECTIVE

To determine the association between maternal age at delivery and caries in offspring.

MATERIALS AND METHODS

This registry-based cohort study included all children born between 2000 and 2003 and who were residing in Stockholm County, Sweden, at 7 years of age. Between 2007 and 2010, the cohort (n = 65,259) was examined to determine caries experience (deft scores) at 7 years of age. Age of mother at childbirth was retrieved from the patient histories. Data were analysed using linear regressions.

RESULTS

The lowest mean deft occurred in children born to mothers aged 25-34 years. The final model - adjusted for sex, income, educational level, migration background, family situation, smoking, obesity, small for gestational age, and number of siblings - found that young mothers and older mothers were significant risk indicators for caries experience at 7 years of age.

CONCLUSIONS

The present study found a U-shaped relationship between maternal age at childbirth and caries experience in the offspring at age 7 years. The offspring of mothers under 25 or over 34 years of age are at greater risk of having more teeth with caries experience.

What Child Oral Health-Related Behaviors Can First-time Mothers Actualize? A Pragmatic Prospective Study

INTRODUCTION

First-time pregnant women are considered to be receptive to health information, rendering the prenatal period an opportune time to provide helpful information on the importance of child-related oral health. However, little is known about pregnant women's knowledge of child oral health-related behaviors (COHBs) during pregnancy and their implementation after birth. We sought to address this knowledge gap by a prospective investigation of intended and actualized oral health behaviors among first-time pregnant women.

METHODS

We examined relationships between intended and actualized COHBs and their correlations with changes in oral health knowledge, health literacy, general self-efficacy, and dental neglect in a cohort of first-time pregnant clients at Women, Infants, and Children sites in North Carolina-participants of a large community-based study. The COHBs were related to diet (i.e., frequency of fruit juice and sweet snacks consumption and nighttime bottle-feeding) and oral hygiene practices (e.g., performance of daily oral hygiene and use of fluoridated toothpaste). Analyses relied on descriptive statistics and bivariate tests (Student's t and McNemar's). Data were collected from 48 participants (White, 44%; African American, 40%; Native American, 17%) at baseline and again at least 12 months after the birth of their first child.

RESULTS

On average, most mothers actualized 3 of 5 COHBs (range, 1 to 4). Significant differences between before and after birth were noted for frequency of sweet snacks consumption and putting the baby in bed with a bottle. No correlation was found between knowledge, literacy, self-efficacy, neglect, and sociodemographic characteristics and COHB actualization.

CONCLUSION

Our findings suggest that first-time mothers in the studied population are likely to implement some but not all positive intended COHBs during pregnancy. Interventions are needed to assist women in implementing these practices. We support that, for prenatal interventional efforts to reap positive benefits, messaging should be personalized and include specific guidance on how to implement these recommendations.

KNOWLEDGE TRANSFER STATEMENT

A knowledge gap exists in our understanding of the relationship between first-time mothers' intended and actualized child oral health behaviors, with implications in the optimal timing of infant and early childhood oral health messaging. Our findings suggest that first-time mothers are likely to implement some but not all positive behaviors that they intended to adopt during pregnancy. Interventions are needed to assist women in implementing these practices.

Assessing oral health of crack users in Brazil: Perceptions and associated factors, findings from a mixed methods study

This study explores associated factors and perceptions of oral health among crack users recruited in open drug scenes in Brazil. A mixed methods approach was used. The quantitative component analysed findings from a large (N = 7381), population-based survey. The outcomes under analysis were 'self-perception of oral health' and 'self-reporting of problems affecting the mouth, teeth and gingiva (gums)'. The qualitative component comprised a focus group, with 12 individuals recruited from a drug treatment clinic. Lower self-perception of oral health problems vis-à-vis a higher prevalence of problems affecting the mouth, teeth, and gingiva were found in users who had a lower level of education, used substances daily, had worse self-perception of physical health, did not receive health care and regularly used alcohol and/or tobacco. The results show an association between substance use and decline in oral health, as well as the lack of health services focusing on such issues. Oral health services should be emphasised as a gateway to the health system. So far, the putative cross-referral between services and professionals working in oral health and other health professionals working in the field of drug dependence has not been observed.