Oral Health-related Beliefs, Behaviors, and Outcomes through the Life Course

Impact of dental visiting patterns on oral health: A systematic review of longitudinal studies

AIM

To systematically review longitudinal studies investigating the impact of dental visiting patterns on oral health across the life course.

METHODS

Five databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL) were searched up to March 2023. Results were screened based on eligibility criteria in a two-stage process: title and abstract, and full-text review. A backward search of reference lists and a forward search of citations of the included papers was also conducted. The quality of the included papers was assessed using the Newcastle-Ottawa Scale. Key study information was extracted and a narrative synthesis of the findings was performed.

RESULTS

Eleven papers from five longitudinal studies in five countries (Australia, Brazil, China, New Zealand, Sweden) met the inclusion criteria. Studies of moderate to high quality consistently reported that regular dental attendance was associated with having less dental caries experience, fewer missing teeth and better oral health-related quality of life. Inconsistent findings were observed for decayed teeth, and no association was found for periodontal condition.

CONCLUSIONS

This review highlights an association between regular dental visiting pattern and improved oral health, notably less dental caries experience and better oral health-related quality of life. Dental attendance emerges as an important predictor of oral health across the life course, underscoring the importance of routine dental care.

REGISTRATION INFORMATION

The PROSPERO registration number is CRD42023396380.

Common risk factors for dental caries and impaired glucose regulation in Guangxi, China

OBJECTIVES

To assess the prevalence of caries and impaired glucose regulation (IGR) and try to investigate their common risk factors among adult residents in Guangxi province.

METHODS

A cross-sectional study was conducted on a sample of 2993 adults from five different areas of Guangxi province. The sociodemographic data, history of personal habits such as diet and physical activities, physical measurements, oral examination results and biochemical laboratory test data were collected to establish a database and prepare a sound research model. Chi-square test and multiple logistic regression were used to analyse the risk factors for dental caries and IGR.

RESULTS

The prevalence rate for caries was 85.9%, and the mean DMFT score was 7.35. In multiple logistic regression, after adjustment, education level, occupation, daily consumption of vegetables, weekly consumption of carbonated beverages and weekly exercise were associated with caries (odds ratio [OR]: 2.10, OR: 1.80, OR: 1.40, OR: 2.45, OR: 2.38). The prevalence of IGR was 33.5%, and after adjustment, results showed that occupation, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, high-density lipoprotein-C levels and low-density lipoprotein-C levels were significantly associated with IGR (OR: 0.80, OR: 1.70, OR: 1.56, OR: 1.88, OR: 1.60, OR: 1.43, OR: 1.48). The strength of association between caries/IGR and risk factors was a weak association or moderate association.

CONCLUSIONS

We have not found common risk factors between dental caries and IGR. Therefore, further studies are needed to explore these common risk factors to prevent caries and IGR.

New measure of functional tooth loss for successful Oral ageing: a cross-sectional study

BACKGROUND

This cross-sectional study evaluated the impacts of functional tooth loss on oral health-related quality of life (OHRQoL) among elderly people compared with the impacts of several common indicators of oral health. Additionally, the cut-off of functional tooth loss needed for a better OHRQoL was investigated to establish a new measure for successful oral ageing.

METHODS

Data from people aged 65-74 were extracted from the Fourth National Oral Health Survey in Sichuan, China. Functional tooth loss was defined as both natural tooth loss and nonfunctional teeth, such as third molars, residual roots, and removable dentures. The cut-offs of tooth loss were first identified as 12, based on the previous definition of functional dentition (≥20 natural teeth except the third molars), and 14, 16, or 18 for further investigation. OHRQoL was evaluated by the standardized Geriatric Oral Health Assessment Index (sGOHAI) score. Logistic regression was performed to estimate the impacts on OHRQoL. Additionally, subgroup analyses were conducted using the stratified chi-square test to explore the effect of functional tooth loss at each position.

RESULTS

The mean GOHAI score of the 744 participants was 48.25 ± 7.62. Elderly people who had lost ≤12 functional teeth had greater odds of reporting a higher sGOHAI score than those who had lost more functional teeth (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.05-2.11). No significant difference in the sGOHAI score was detected between people who had lost 13-16 functional teeth and those who had lost ≤12 functional teeth (0.61, 0.35-1.07). The loss of second premolars and first and second molars had great impacts on the sGOHAI score when ≤12 or ≤ 16 functional teeth had been lost.

CONCLUSIONS

Compared with natural tooth loss, functional dentition and occluding pairs, functional tooth loss can be a better indicator of OHRQoL in the elderly population. Sixteen remaining functional teeth seem to be sufficient to maintain good OHRQoL and successful oral ageing despite that number being previously acknowledged as ≥20 teeth.

Adolescent Toothbrushing and Its Association with Sociodemographic Factors-Time Trends from 1994 to 2018 in Twenty Countries

Regular toothbrushing is the primary self-care method to prevent the most common dental diseases and is considered an important public health indicator. This retrospective observational study aimed to examine cross-national time trends in adolescent toothbrushing behaviour and its association with sociodemographic factors between 1994 and 2018. We studied data from 20 countries that conducted seven surveys of the Health Behaviour in School-aged Children (HBSC) study. Adolescents aged 11, 13 and 15 years responded to questions on their toothbrushing frequency, family affluence and structure. Altogether, reports of 691,559 students were analysed using descriptive statistics and binominal logistic regression. The findings showed an overall positive trend in the prevalence of more-than-once-a-day toothbrushing frequency during the entire study period mainly due to a noticeable increase from 1994 to 2010 (except Denmark and Sweden); this trend continued significantly thereafter in 12 of 20 countries. Across all countries, girls and adolescents from more affluent families were more likely to brush their teeth regularly. These relationships remained unchanged throughout the study period, whereas the age-related difference in toothbrushing prevalence decreased noticeably, and the negative relationship between toothbrushing and living in a non-intact family became evident. While the prevalence of regular toothbrushing among adolescents has increased in recent decades, it is still far behind the recommended level of twice-daily brushing for everyone across all countries. The promotion of toothbrushing needs to start at an early age, with a special focus on boys and adolescents from low-affluence and non-intact families.

Is Dichotomization into Regular versus Irregular Dental Attenders Valid? A Qualitative Analysis

AIMS

To discover whether dental visiting behavior can be understood as a dichotomy of planned versus problem based, or whether there were a range of different types of understanding and patient behavior, recognizable as patterns of dental visiting behavior.

METHODS

Secondary analysis drawing on 2 qualitative studies of patients' accounts of dental attendance and oral health, with 1) opportunistic interviews with people attending urgent dental care services (n = 43; including 19 with follow-up) and 2) home-based, in-depth interviews with people attending a dental practice with a mixture of improved or deteriorated/poor periodontal health (n = 25).

RESULTS

Four distinguishable patterns of dental visiting were identified in patients' accounts: Accepting and Active Monitoring, as well as Ambivalent and Active Problem-based dental visiting behavior. Individuals' patterns were relatively stable over time but could shift at turning points. Accepting Monitors were characterized as accepting dentists' recommendations and dental practice policies relating to oral health and visits, whereas Active Monitors were more independent in judging how often to attend for preventive appointments, while still valuing anticipatory care. Ambivalent Problem-based visitors placed a relatively low value on anticipatory care for oral health maintenance and drifted into lapsed attendance, in part because of service-related factors. This contrasted with Active Problem-based visitors, for whom using services only in an emergency was a conscious decision, with low value placed on anticipatory care.

CONCLUSION

This article demonstrates the dynamic nature of patterns of dental visiting where the dental system itself is partly instrumental in shaping patterns of utilization in an ecological way. Thus, service-related factors tend to combine with patients' behavior in expanding inequalities. This illuminates the reasons why risk-based recalls are challenging to implement as a dental policy.

KNOWLEDGE TRANSFER STATEMENT

The results of this analysis can be used by clinicians and policymakers to inform policy around supporting uptake of preventive health care visits, contributing in particular to understanding how risk-based preventive visiting policies may be better adapted to patients' understanding of the purpose of visits, taking into account that this is in part shaped by service-related factors in an ecological way, arising from patients' and dental teams' expectations.

Dental Caries, Tooth Loss and Quality of Life of Individuals Exposed to Social Risk Factors in Northeast Brazil

This study aimed to investigate the impact of dental caries and tooth loss on oral health-related quality of life (OHRQoL) in socioeconomically disadvantaged people. A population-based, cross-sectional survey was conducted in 28 cities at social risk in Northeast Brazil. All permanent residents aged 12, 15-19, 35-44, and 65-74 years were eligible, and 3063 were included. Participants answered a questionnaire on socioeconomic status, beliefs, and behaviors. Trained local dentists performed oral clinical examinations during home visits. Caries and tooth loss were evaluated using the decayed, missing, and filled teeth (DMFT) index and OHRQoL was evaluated using the Oral Health Impact Profile-14 (OHIP-14). Poisson regression analysis was performed to assess the relationship between individual domains, OHIP-14 scores, dental caries, tooth loss, and socioeconomic/demographic characteristics. Mean DMFT (standard deviation) scores were 2.68 (4.01), 4.84 (4.30), 15.35 (7.26), and 26.72 (8.03) for groups aged 12, 15-19, 35-44, and 65-74 years, respectively. Most participants (70%) were partially edentulous and 13% were completely edentulous. Caries and tooth loss significantly increased with age and impacted OHRQoL. Physical pain (5.8%) and psychological discomfort (5.8%) were the most commonly reported on the OHIP-14. Untreated caries (prevalence ratio (PR), 1.54; 95% confidence interval (CI), 1.37-1.72) and edentulism (PR, 1.29; 95% CI, 1.08-1.53) had a significant negative impact on OHRQoL. Income, level of education, sex, age, and oral hygiene habits were also related to OHRQoL. There was a high prevalence of dental caries and edentulism in all age groups except 12-year-olds. OHRQoL was negatively impacted by these oral conditions across the lifespan, with a trend towards more negative scores and higher impact in older adults.

Acculturation and Dental Care-Related Anxiety: An Exploratory Assessment from the Hispanic Community Health Study / Study of Latinos

This study aimed to determine the associations between acculturation, dental anxiety, and dental utilization among Hispanics/Latinos living in the US. A proxy measure of dental anxiety was available for 7539 adults who had not visited a dentist within the last year. All completed the Short Acculturation Scale for Hispanics (SASH). Bivariate logistic regression and adjusted multivariable logistic regression analysis were conducted. Approximately 22% of the sample was dentally anxious. Dental anxiety was significantly associated with SASH language scale score (OR 1.09, 95%CI 1.02, 1.18, p = 0.04), years in US (OR 1.53, 95%CI 1.23, 1.91, p < 0.0001), and preferred Spanish language (OR 1.30, 95%CI 1.05, 1.63, p = 0.0192); lower acculturation corresponded to higher dental anxiety. Adjusting for sex, age, education, income, insurance, and oral health status, level of acculturation was associated with dental anxiety (AOR 0.87, 95%CI 0.75, 0.91, p = 0.009), but neither were associated with utilization. Acculturation may be an important predictor of dental anxiety for Hispanics/Latinos living in the US.

Community health worker intervention to improve tooth brushing in young children: Results from a cluster randomized controlled trial

OBJECTIVES

Coordinated Oral health Promotion (CO-OP) Chicago is a cluster randomized controlled trial testing the efficacy of a community health worker (CHW) intervention to improve tooth brushing in low-income children.

METHODS

Four hundred twenty children under 3 years old (mean 21.5 months) were recruited from 20 sites in or near Chicago, IL. Children were identified mainly as Black race (41.9%) or Hispanic ethnicity (53.8%) and most (85.2%) had Medicaid. Intervention families were offered four CHW home visits over 1 year. Brushing frequency was self-reported. Plaque score was determined from images collected in homes using disclosing solution. Analyses used GEE logistic models with variable selection at p < .05.

RESULTS

At enrolment, 45.0% of families reported twice a day or more child brushing frequency, and child plaque scores were poor (mean of 1.9, SD: 0.6). Data were obtained from 87.1% of children at 6 months and 86.2% at 12 months. In the CHW intervention arm (10 sites, N = 211), 23.7% received 4 visits, 12.8% 3 visits, 21.3% 2 visits, 23.2% 1 visit and 19% no visits from CHWs. No intervention effect was seen for brushing frequency or plaque score. Child brushing frequency improvement over time was associated with a range of child and caregiver factors. The only factor associated with a change in plaque score over time was parent involvement in brushing.

CONCLUSIONS

Oral-health-specific CHW services were not associated with improved brushing behaviours in these young children. However, caregiver involvement with brushing supported more quality brushing. More robust interventions are needed to support families during this critical developmental period.

Oral Health-Related Quality of Life from Young Adulthood to Mid-Life

Quality of life varies with time, often worsening, and is affected by circumstances, events, and exposures at different stages of life. Little is known about how oral health-related quality of life (OHRQoL) changes during middle age. We investigated OHRQoL changes from age 32 to 45 years among participants in a population-based birth cohort, along with clinical and socio-behavioural associations. Generalised estimating equation models were used to investigate the association between OHRQoL (assessed at ages 32, 38, and 45 years; n = 844), and the socioeconomic position in childhood (up to age 15 years) and adulthood (ages 26 through to 45 years), dental self-care (dental services utilisation and tooth brushing), oral conditions (such as tooth loss), and experiencing a dry mouth. The multivariable analyses were controlled for sex and personality traits. At each stage of life, those of a lower socioeconomic status were at greater risk of experiencing OHRQoL impacts. Those who engaged in favourable dental self-care habits (the regular use of dental services and at least twice daily tooth brushing) experienced fewer impacts. A social disadvantage at any stage of life has enduring deleterious effects on one's quality of life in middle age. Ensuring access to timely and appropriate dental health services in adulthood may reduce the impacts of oral conditions on one's quality of life.

Tooth Loss Trajectories and Their Association with Functional Disability among Older Chinese Adults: Results from the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

Tooth loss becomes more prevalent with age and increases risk of functional disability. However, the strength of tooth loss varies between individuals rather than a uniform loss with age. We aimed to evaluate tooth loss trajectories and their association with functional disability among older Chinese adults.

METHODS

We included 16,209 participants aged ≥65 years from five waves of the Chinese Longitudinal Healthy Longevity Survey 2002-2014. The number of teeth, Activities of Daily Living (ADL), and Instrumental ADL (IADL) were assessed at baseline and subsequently every three years. ADL disability and IADL disability were defined as needing any help in any item of the Katz scale and a modified Lawton's scale, respectively. A group-based trajectory model was used to determine tooth loss trajectories based on the self-reported number of teeth and generalized estimating equation models were used to explore associations of tooth loss trajectories with ADL disability and IADL disability.

RESULTS

This study identified four tooth loss trajectories, including Progressively Mild Loss (14.4%), Progressively Severe Loss (21.5%), Persistently Severe Loss (45.1%), and Edentulism (19.0%) among older Chinese adults. Compared with the Progressively Mild Loss trajectory, the Progressively Severe Loss (ADL disability: OR=1.45, 95% CI: 1.15-1.84; IADL disability: OR=1.71, 95% CI: 1.47-1.99), Persistently Severe Loss (ADL disability: OR=2.33, 95% CI:1.93-2.82; IADL disability: OR=3.29, 95% CI: 2.82-3.84) and Edentulism (ADL disability: OR=3.25, 95% CI: 2.58-4.09; IADL disability: OR=3.60, 95% CI: 2.93-4.42) trajectories were significantly associated with an increased risk of functional disability with adjustment for potential confounders.

CONCLUSION

Four distinct tooth loss trajectories were identified among older adults and those with severe tooth loss trajectories had an increased risk of functional disability than those with a mild loss trajectory.

Gender Differences in Oral Health: Self-Reported Attitudes, Values, Behaviours and Literacy among Romanian Adults

A topic that has been less researched on, especially in Romania, is the identification of gender differences in oral health. The present scientific research used an online survey to assess the attitudes (dental beliefs survey-R/R-DBS), the values (oral health values scale/OHVS), the behaviours (dental neglect scale/DNS), and the literacy (oral health literacy scale/OHLS) related to oral health and to dental professional services in the case of a sample of 600 Romanian adults (Mean_age = 30.84). The relation between the level of knowledge as a predictor of attitudes and values related to oral health was analysed by the means of a structural equation based on the partial least square method (PLS-SEM). The results show that women have more positive attitudes towards dental medical services, higher oral health values, better self-care behaviours, and higher oral health literacy than men. In the case of men, attitudes and behaviours related to self-care are influenced by their oral health literacy and level of education; in the case of women, the latter are influenced only by their level of oral health literacy. The impact that knowledge in oral health has on attitudes, values, and behaviours was highlighted. The differences in attitudes and values related to oral health between the two genders can be accounted for by the differences in formal and informal education (studies and oral health literacy, respectively).

Oral Health Coaches at Well-Baby Clinics to Promote Oral Health in Preschool Children From the First Erupted Tooth: Protocol for a Multisite, Pragmatic Randomized Controlled Trial

Background

Early childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children.

Objective

Within the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months.

Methods

This pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared.

Results

The first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads.

Conclusions

All follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication.

Trial Registration

Netherlands Trial Register NL8737; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8737

International Registered Report Identifier (IRRID)

DERR1-10.2196/39683

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.

Patients Perceived Knowledge, Attitude, and Practice of Dental Abscess Management in Periurban District, Ghana

Background

Seeking conventional oral health care for various dental conditions is still a challenge for many worldwide and poses a global public health challenge. It is not until the individual starts experiencing pain and disfigurement of the facial profile that they seek dental care after many self-care interventions have failed. This study sought to determine perceived knowledge, attitude, practice, and satisfaction of dental abscess management among dental abscess patients (DAPs).

Methods

The research used a cross-sectional design to collect data from patients who visited the Dental Department of Effiduase Government Hospital with dental abscess from 6 May 2020–27 August 2020. A total sample size of 82 was selected from a population of 377. About 76 DAPs who met the inclusion criteria and consented to participate were interviewed.

Results

About 57% of respondents believed that dental caries caused their abscess. However, 46% sought medical treatment between 0 and 2 weeks after the onset of their dental abscess, while the rest did that after 3 weeks. Close to 64.5% have ever had episode of abscess before current one which they managed with alternative treatment. About 95% of respondents saw the hospital as a good place for dental care. A significant association was established between patient's level of education and influence to seek orthodox treatment (p = 0.015, Fisher's exact test (FET)). Another significant association was established between patient's level of education and the kind of alternative treatment they used (p = 0.016, Fisher's exact test (FET)).

Conclusions

Most DAPs believe that dental caries was the main cause of dental abscess. DAPs sought late medical care, after they have tried a failed alternative treatment. DAPs expressed satisfaction with reception, equipment and materials, and medicines used. Majority of the patients rated the cost of dental care in the facility as affordable.

Romanian Version of the Oral Health Values Scale: Adaptation and Validation

Background and Objectives: Oral health values are an indicator of how people decide their priorities for oral health—an integral part of general health. The purpose of the study was the validation of the Oral Health Values Scale (OHVS), which measures the extent to which individuals invest in their oral health and which includes four factors: Professional dental care, Appearance, Flossing, and Retention of teeth. Materials and Methods: A cross-sectional study was conducted on a sample of adults (n = 869; Mean age = 32.98) who completed the online questionnaire set. The OHVS was translated into Romanian through the forward-backward translation procedure. The construct validity was assessed through a confirmatory factor analysis (CFA) based on the maximum likelihood estimation method. The convergent validity was assessed by associating the OHVS with scales that evaluate the oral health quality of life (OHIP-14), the attitude towards one’s dentist (R-DBS), oral self-care (DNS), and general health literacy (GHL). The internal consistency was examined using Cronbach’s α and McDonald’s ω. Results: The CFA supports the four-factor model of the scale. The OHVS total score and its subscales are negatively associated with the impact of oral health on the quality of life (except for the Appearance subscale) and with a distrust in the dentist’s treatments; they are positively associated with oral self-care and general health literacy. The gender difference shows females have higher scores on all four subscales. The internal consistency is good for Appearance, Flossing, and the OHVS total score, but weak for Professional dental care and Retention. Conclusions: OHVS is a valid instrument in the Romanian context that can enrich the set of tools that contribute to oral health research, especially in epidemiological studies.

Prepregnancy BMI, gestational weight gain and offspring caries experience: Avon longitudinal study of parents and children

Pre-existing maternal overweight/obesity and pregnancy weight gain are associated with adverse birth outcomes such as low birth weight and prematurity, which may increase the risk of developmental tooth defects and early childhood caries. We sought to investigate the association between prepregnancy BMI, gestational weight gain (GWG) and the risk of early childhood caries. Data from 1,429 mother-offspring participants of the 1991/1992 Avon Longitudinal Study of Parents and Children were analyzed. The exposures were prepregnancy BMI (under/normal weight vs. overweight/obese), and gestational weight gain (GWG) based on the Institute of Medicine’s recommended levels. The main outcome measured was offspring caries experience determined by clinical oral examinations at three time points. Log binomial regression estimated risk ratios and 95% confidence intervals. Seventy six percent (76%) of the mothers were under/normal weight prepregnancy, 39% and 26% respectively gained less and more than the recommended weight for their prepregnancy BMI during pregnancy. Being overweight/obese prepregnancy was associated with unadjusted RR (95% CI) of offspring caries of 1.16 (0.90, 1.51) at 31-months, 1.20 (0.96, 1.49) at 43-months and 1.09 (0.91, 1.30) at 61-months. GWG less than recommended was associated with higher unadjusted offspring caries experience of 1.13 (0.86, 1.48), 1.17 (0.92, 1.48) and 1.04 (0.87, 1.25) at 31-months, 43-months and 61-months respectively. There was insufficient evidence to indicate an association between prepregnancy BMI and gestational weight gain on offspring caries experience risk.

Digital surveillance: Monitoring the activity of Internet users searching for information related to early childhood caries

This study evaluated the behavior of Internet users from seven countries through the analysis of the monthly variation of the Relative Search Volume (RSV) for queries related to early childhood caries (ECC), retrieved by Google Trends application programming interface between January 2004 to December 2020. The association of RSV with years lived with disability (YLDs) for untreated dental caries in deciduous teeth and Internet penetration were tested by regression models. Forecasting models were developed to predict the interests until December 2021. Relevant topics linked to searches were assessed qualitatively. Increasing levels of interests were observed in most countries, regarding the comparison of periods 2004-2012 and 2013-2021, without influence of seasonality. These results were associated with YLDs only in France and with the Internet penetration in Mexico and France. Searches were mostly related to the definition, risk factors, and preventive care of ECC. The interests of Internet users in ECC-related information increased in the last years in all seven countries, although it was maintained low over time. It might indicate a lack of awareness about the negative consequences of the disease in the early stages of life. Specific policies should be developed toward the dissemination of oral health information and the prevention of the disease.

Urban-Rural Disparities in Dental Services Utilization Among Adults in China's Megacities

Objective: China's dental care system is bifurcated between urban and rural areas. However, very few studies have examined the dental services utilization inequities in China's megacities, particularly in these urban and rural areas. This study aims to examine the urban-rural disparities in dental services utilization among adults living in China's megacities based on the Andersen dental services utilization model.

Methods: This study used data from 4,049 residents aged 18–65 who participated in the “2019 New Era and Living Conditions in Megacities Survey.” Multivariate logistic regressions were employed to examine the associations between place of residence and dental services utilization for individuals from ten megacities in China. Predisposing variables (age, gender, marital status, living arrangement, and education), enabling variables (socioeconomic status, occupational status, income, insurance coverage, health attitude, and health behavior), and need variables (self-rated health, oral health status, gum bleeding) were controlled for.

Results: The mean age of the 4,049 adults was 45.2 (standard deviation = 13.0), and 30.4% (n = 1,232) had no dental visits at all. Adults who resided in urban areas were more likely to use dental services [odds ratio (OR) = 1.57, 95% confidence interval (CI) = 1.30 to 1.91] than those residing in rural areas after controlling for key covariates. Factors associated with higher odds of visiting dentists include having a higher income (OR = 1.44, P < 0.001), higher education level (OR = 1.53, P = 0.042), being covered by insurance for urban residents/employees (OR = 1.49, P = 0.031), having a positive attitude toward healthy diets (OR = 1.43, P < 0.001), attending regular physical examination (OR = 1.66, P < 0.001), having more tooth loss (OR = 1.05, P < 0.001), and having frequent gum bleeding (OR = 2.29, P < 0.001).

Conclusion: The findings confirm that place of residence is associated with dental services utilization while adjusting for key covariates. Despite rapid economic development in China, many adults had never visited dentists at all. More efforts should be taken to encourage widespread dental care, such as providing more dental coverage and better access to dental care services.

Oral Health Behaviors and Oral Health-Related Quality of Life Among Dental Patients in China: A Cross-Sectional Study

BACKGROUND AND PURPOSE

Oral health plays an important role in overall health. But little is known about the problems with oral health behaviors and oral health-related quality of life (OHRQoL) among dental patients in China. This study aimed to investigate oral health behaviors and OHRQoL, as well as to examine the effects of oral health behaviors and associated factors on OHRQoL among dental patients.

METHODS

This cross-sectional study was conducted from June 2022 to July 2022 in the Department of Stomatology of the First Mobile General Hospital of Armed Police, Hebei, China. The five-item short form of the Oral Health Impact Profile (OHIP-5) was used to evaluate OHRQoL. Oral health behaviors were assessed by a 16-items oral health behavior questionnaire, and socio-demographic data were collected by a socio-demographic questionnaire. The t-test, one-way ANOVA, and multiple linear regression analysis were used to investigate the associations between the study variables.

RESULTS

186 participants were included in the study. The average age of the participants was 24.62 years (SD = 10.67). The mean OHIP-5 score was 4.31 (SD =3.35). Oral health-related quality of life differed significantly by smoking history, history of alcohol consumption, work status, economic pressure, self-rated oral health status, daily brushing frequency, dental caries condition, and whether they take the initiative to learn about oral health. Multivariate analysis found that the self-rated oral health status and work status were significantly associated with the OHIP scores. The retired people and those with poor self-rated oral health displayed poor OHRQoL.

CONCLUSION

In general, dental patients' oral health needs to be improved, the majority of patients reported practicing poor oral health behaviors, among which the retired population and hose with poor self-rated oral health showed poor OHRQoL. OHRQoL in dental patients is a complex issue associated with social and behavioral factors.

Oral health self-care behaviours in serious mental illness: A systematic review and meta-analysis

AIM

To understand the relationship between serious mental illness and oral health self-care behaviours using meta-analytic methods and a narrative synthesis of available literature.

METHOD

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines [PROSPERO reference: CRD42020176779]. Search terms pertaining to serious mental illness and oral health were entered into EMBASE, PsycINFO, Medline and CINAHL. Eligible studies included a sample of people with a serious mental illness and a quantitative measure of an oral health self-care behaviour (eg dental visits, toothbrushing). The Effective Public Health Practice Project tool was utilised to appraise the quality of the literature. Studies in the meta-analysis contained a non-clinical or general population comparator sample.

RESULTS

People with a serious mental illness were significantly less likely to visit the dentist (OR 0.46, 95% CI 0.32-0.065, p > 0.001) or brush their teeth (OR 0.19, 95% CI 0.08-0.42, p < 0.001) when compared to non-clinical comparator samples. Few studies explored other oral health self-care behaviours (eg flossing and mouth washing), but uptake was generally low in people with a serious mental illness. The study quality of included studies was variable.

CONCLUSIONS

The research showed a reduced uptake of oral health self-care behaviours in people with a serious mental illness. Suboptimal oral health can negatively impact on physical, social and psychological functioning. Further research is needed to understand the reasons for low rates of oral health self-care behaviours in this population.

Impact of Intelligence Quotient (IQ) on Dental Caries amongst Socially Handicapped Orphan Children and Children Living with Their Parents

Objective

To evaluate the IQ and dental caries status of socially deprived orphan children and compare with children living with their parents.

Study design

For comparison, 100 children in age-group 7-11 years, were divided in two groups: 50 orphanage children (orphanage-group) and 50 school-going children living with their families were included (home group). Raven's colored progressive matrices test was used to record the intelligence quotient (IQ) and dental caries status of children was recorded using dmft Index.

Results

There was statistically significant difference between children with different levels of IQ for both the groups. However, the majority of children who belong to below average IQ score had higher dental caries.

Conclusion

Children with better IQ had less dental caries. There was no difference in IQ and DMFT/dmft score between both the genders. The overall DMFT/dmft was high in children living with their parents when compared to orphanage children.

How to cite this article

Agarwalla S. The Impact of Intelligence Quotient (IQ) on Dental Caries amongst Socially Handicapped Orphan Children and Children Living with Their Parents. Int J Clin Pediatr Dent 2022;15(S-2):S230-S233.

Adverse Childhood Experiences and Oral Health Outcomes in U.S. Children and Adolescents: A Cross-Sectional Study of the 2016 National Survey of Children's Health

This study investigated the cross-sectional associations between exposure to nine Adverse Childhood Experiences (ACEs) and U.S. children's and adolescent's oral health outcomes. Data from 41,294 participants of the 2016 National Survey of Children's Health (NSCH) were analyzed. Past year exposure to ACE, oral health outcomes (decayed teeth, bleeding gums, and condition of the teeth), and child and caregiver sociodemographic factors were self-reported. Using SAS v. 9.4, propensity score weighted, multilevel survey-logistic regression estimated adjusted odds ratios (AORs) and 95% Confidence Intervals (CIs) of the proposed associations. The overall mean (SE) age was 8.9 (0.1) years with 51% being male. Fifty-four percent (54%) identified as non-Hispanic white, and 12% as non-Hispanic black. The prevalence of the nine ACE measures ranged from 3% for caregiver death to 25% for financial hardship and parental divorce. Children who experienced caregiver mental illness, when compared to those who did not, were more likely to report decayed teeth (AOR: 1.73 (95% CI: 1.24, 2.42)) and the condition of their teeth as fair/poor (AOR: 1.60, 95% CI: 0.61, 4.19). Children in households with financial hardship were about twice as likely to report dental caries (AOR: 1.85, 95% CI: 1.50, 2.29) and have fair/poor teeth (AOR: 1.87, 95% CI: 1.40, 2.51) and bleeding gums (AOR: 2.39, 95% CI: 1.48, 3.86). ACEs appear to be associated with worse oral health outcomes among children and adolescents. Nevertheless, the cross-sectional nature of this study precludes a causal interpretation of these findings and necessitates more research to elucidate the oral health impacts of exposure to ACEs in longitudinal follow-up studies.

A cross-sectional analysis of oral health care spending over the life span in commercial- and Medicaid-insured populations

BACKGROUND

Life course theory creates a better framework to understand how oral health care needs and challenges align with specific phases of the life span, care models, social programs, and changes in policy.

METHODS

The authors obtained data from the 2018 IBM Watson Multi-State Medicaid MarketScan Database (31 million claims) and the 2018 IBM Watson Dental Commercial and Medicare Supplemental Claims Database (45 million claims). The authors conducted analysis comparing per enrollee spending on fee-for-service dental claims and medical spending on oral health care for patients from ages 0 through 89 years.

RESULTS

Oral health care use rate and spending are lower during the first 4 years of life and in young adulthood than in other periods of life. Stark differences in the timing, impact, and severity of caries, periodontal disease, and oral cancer are seen between those enrolled in Medicaid and commercial dental plans. Early childhood caries and oral cancer occur more frequently and at younger ages in Medicaid populations.

CONCLUSIONS

This life span analysis of the US multipayer oral health care system shows the complexities of the current dental service environment and a lack of equitable access to oral health care.

PRACTICAL IMPLICATIONS

Health policies should be focused on optimizing care delivery to provide effective preventive care at specific stages of the life span.

Associations between dental care approachability and dental attendance among women pregnant with an Indigenous child: a cross-sectional study

Background

Oral health during pregnancy is vital for both mother and child. Indigenous Australians face many barriers in accessing dental care. Service approachability is one of the key domains in accessing health services. There is little empirical evidence of the association between service approachability and dental care attendance or oral health outcome. The aim of this study is to examine the relationship between dental service approachability on dental care attendance and self-reported gum disease among South Australian women pregnant with an Aboriginal child.

Methods

Four hundred and twenty-seven women pregnant with an Aboriginal child completed questionnaires in both metropolitan and regional health settings in South Australia in 2011. Four variables related to approachability of dental services: (1) perception of need; (2) service-related health literacy; (3) oral health beliefs and; (4) trust and expectation of dental service. The association between service approachability-related factors, dental utilisation and self-reported gum disease during pregnancy were assessed using Generalised Poisson regression models, after adjusting for age, remoteness, employment status and education. Estimates were presented as adjusted prevalence ratios (APR).

Results

Most participants (85.8%) reported a need for dental care, had positive oral health beliefs (88.3%) and had expectations towards dental care (86.2%). Dental service utilisation during pregnancy was low (35.7%). Many participants (78.0%) expressed knowing what to do if they needed dental care, while most (39.8%) doubted that dental care would be available the next day. Poor health service literacy was identified as a risk factor for non-optimal dental attendance (APR = 0.86, 95%CI 0.74–0.99). Perceived need for dental care was positively associated with self-reported gum disease (APR = 1.24, 95%CI 1.06–1.45).

Conclusion

Inability to navigate the dental care system was a risk factor for poor dental attendance among South Australian women pregnant with an Aboriginal child. Perceived need for dental care was associated with gum disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01816-5.

Social Mobility and Tooth Loss: A Systematic Review and Meta-analysis

This study systematically reviews the evidence of the association between life course social mobility and tooth loss among middle-aged and older people. PubMed, Scopus, Embase, and Web of Science were systematically searched in addition to gray literature and contact with the authors. Data on tooth loss were collated for a 4-category social mobility variable (persistently high, upward or downward mobility, and persistently low) for studies with data on socioeconomic status (SES) before age 12 y and after age 30 y. Several study characteristics were extracted to investigate heterogeneity in a random effect meta-analysis. A total of 1,384 studies were identified and assessed for eligibility by reading titles and abstracts; 21 original articles were included, of which 18 provided sufficient data for a meta-analysis with 40 analytical data sets from 26 countries. In comparison with individuals with persistently high social mobility, the pooled odds ratios (ORs) for the other categories were as follows: upwardly mobile, OR = 1.73 (95% CI, 1.53 to 1.95); downwardly mobile, OR = 2.52 (95% CI, 2.19 to 2.90); and persistently low, OR = 3.96 (95% CI, 3.13 to 5.03). A high degree of heterogeneity was found(I² > 78%), and subgroup analysis was performed with 17 study-level characteristics; however, none could explain heterogeneity consistently in these 3 social mobility categories. SES in childhood and adulthood is associated with tooth loss, but the high degree of heterogeneity prevented us from forming a robust conclusion on whether upwardly or downwardly mobile SES may be more detrimental. The large variability in effect size among the studies suggests that contextual factors may play an important role in explaining the difference in the effects of low SES in different life stages (PROSPERO CRD42018092427).

Oral health and oral health behavior in young adults with caries disease

Objective

The aim of this study was to describe and analyze oral health, oral health behaviors, and oral health-related quality of life (OHRQoL) in relation to the level of caries disease among caries-active young adults.

Material and methods

This study presents data from a sample of young adults (n = 135) with active caries disease who were enrolled in a clinical, randomized controlled trial. The independent variables of sociodemographics, oral health (gingivitis, plaque), oral health behaviors (such as toothbrushing, dental attendance, sugar-containing sweets and drinks), dental anxiety, self-rated oral health, and OHRQoL were collected. Multinomial logistic regression was used to simultaneously evaluate the associations between the independent variables and caries severity.

Results

Multinominal logistic regression showed that poor OHRQoL and gingivitis were associated with caries severity in a gradient fashion in accordance with caries disease activity. Also, irregular dental care and frequent consumption of sugary soda were significantly associated with very high caries severity.

Conclusions

The risk factors related to caries severity among young adults were poor OHRQoL, gingivitis, consumption of sugary soda and irregular dental care attendance, indicating the need for a combination of different interventions specifically health behavior change. Furthermore, these findings may contribute to identifying high caries-risk individuals.

Evaluation of Clinical, Biochemical and Microbiological Markers Related to Dental Caries

Our aim was to evaluate clinical, biochemical and microbiological markers related to dental caries in adults. A sample that consisted of 75 volunteers was utilized. The presence of caries and the presence of plaque and gingival indices were determined. Unstimulated salivary flow, pH, lactate, Streptococcus mutans and Streptococcus dentisani were measured in the participants’ plaque and saliva samples before and after rinsing with a sugar solution. Lactate in plaque was found to be significantly related to age, gender, tooth-brushing frequency, the presence of cavitated caries lesions and plaque and gingival indices (p < 0.05). The levels of S. dentisani in plaque increased significantly with tooth-brushing frequency (p = 0.03). Normalized plaque S. dentisani values and the percentage of S. dentisani were slightly higher in patients with basal lactic acid levels ≤ 50 mg/L. After rinsing with a sugary solution, the percentage of S. mutans levels in plaque were higher in patients with lactic acid levels > 350 mg/L (p = 0.03). Tooth-brushing frequency was the factor which was most associated with oral health. Women reflected better clinical and biochemical parameters than men. Low pH and high lactic acid levels tended to be associated with high caries rates. No association was found between bacteria levels and caries indices.

Moving toward a competency-based curriculum: Analyzing patients' information and students' evaluation in geriatric dentistry

OBJECTIVE

There is no core competency for geriatric dentistry and special patient care (GSP) in Thailand. Therefore, GSP program was developed as a knowledge-based curriculum. This study aimed to describe the development and architecture of the GSP curriculum by analyzing patients' information and students' evaluation to move toward a competency-based curriculum. Comparisons with the original GSP curriculum and future direction are discussed.

METHODS

Development and architecture of the GSP curriculum were described. Information of 130 patients attending the GSP clinic, and those who participated in a maintenance recall was analyzed. Students' evaluation was performed using a 21-item questionnaire within seven domains based on the ASEAN University Network-Quality Assurance (AUN-QA) checklist. The responses were made using a five-point ordinal scale ranging from totally agree to totally disagree.

RESULTS

Only 50% of the patients attended a maintenance recall. Among the recalled patients, 74.2% reported emerging problems. The AUN-QA questionnaire responses indicated that students mostly agreed with the program specification, teaching and learning approach, students' assessment methods, student quality, and support domains. The modified curriculum was developed based on the patients' information and students' evaluation. The original and modified GSP curricula were compared.

CONCLUSIONS

Information analysis of the patients and students' evaluation are essential to move a knowledge-based curriculum for geriatric and special patient care dentistry toward a competency-based curriculum that is appropriate for patients' condition and serves students' requirements. Oral health care in elderly and special care patients requires a multidisciplinary approach, and should encompass oral disease problems, behavior, and social context.

Changes in the characteristics of dental emergencies under the influence of SARS-CoV-2 pandemic: a retrospective study

Background

Further understanding of the distribution and changing characteristics of dental diseases is of great significance for all dental emergency centers for strengthening the medical staff’s treatment knowledge abilities and effective use of emergency resources in the face of public health emergencies involving highly infectious respiratory diseases.

Methods

The medical records of 4158 dental emergency patients in 2019 and 2020 were retrospectively analyzed and divided into pre-SARS-COV-2 group and SARS-COV-2 group according to time. The demographic data, date and time, diagnosis, and treatment methods of the two groups were statistically described, and the chi-squared test was used to analyze the differences. The medical records of 4158 dental emergency patients during the same period of two years in 2019 and 2020 were retrospectively analyzed and divided into SARS-COV-2 pre-group and SARS-COV-2 group according to time. The demographic data, date and time, diagnosis and treatment methods of the two groups were statistically described, and the chi-square test was used to determine the differences.

Results

During the SARS-COV-2 pandemic, the number of dental emergency visits increased by 29.7%. During the pandemic, males (n = 286, 58.1%) were more likely to visit dental emergency centers for trauma than females (n = 206, 41.9%) (P < 0.05); females (n = 242, 60.8%) were more likely to visit dental emergency centers for acute gingivitis and acute pericoronitis than males (n = 156, 39.2%) (P < 0.05). A major change in diagnosis was related to acute pulpitis (K04.0) and acute apical periodontitis (K04.4), which increased by 9.2%; acute gingivitis (K05.0) and acute pericoronitis (K05.2) increased by 3.5%; open wound of the lip and oral cavity (S01.5) decreased by 17.9%; other conditions (non-emergency diseases) increased by 6.8%, compared with the pre-SARS-COV-2 period. Among the treatment modalities, during the pre-SARS-COV-2 period, 304 patients (17.7%) received a prescription for antibiotics and analgesics, and 1485 (86.5%) received a prescription for local treatment. During the SARS-COV-2 period, 958 (39.2%) received a prescription for antibiotics and analgesics, and 1636 (67.0%) received a prescription for local treatment.

Conclusion

SARS-COV-2 pandemic led to changes in the characteristics of dental emergency patients. Trauma, acute pulpitis, and acute periodontitis are the leading reasons patients refer to dental emergency centers. Dental emergency centers should optimize treatment procedures, optimize the staff, and reasonably allocate materials according to the changes to improve the on-site treatment capacity and provide adequate dental emergency care.

Relationship between oral health-related knowledge, attitudes, practice, self-rated oral health and oral health-related quality of life among Chinese college students: a structural equation modeling approach

Background

This study aimed to evaluate the associations among oral health-related knowledge, attitudes, practice (KAP), self-rated oral health and oral health-related quality of life (OHRQoL) among Chinese college students.

Methods

Of the 2000 participants, 1751 (87.55%) students answered an online questionnaire between October 2019 and January 2020. The questionnaire included demographic characteristics, knowledge, attitudes, and practice related to oral health, self-rated oral health, and OHRQoL. Structural equation modelling was applied to assess the associations among study variables.

Results

Among the total students, oral health-related knowledge and attitudes were satisfactory, while the oral health practice was not optimistic. The final model showed satisfactory fitness to the data. Oral health knowledge was associated with attitudes directly and positively. Attitudes toward oral health had a direct and positive effect on practice. Oral health knowledge had an indirect effect on practice through attitudes. Oral health practice was directly associated with self-rated oral health. Oral health knowledge, practice, and self-rated oral health all affected OHRQoL directly and positively, while attitudes had a direct negative impact on OHRQoL.

Conclusions

OHRQoL was influenced by oral health knowledge, attitudes, practice, and self-rated oral health. Our findings support the KAP theory. Limitations of the KAP model were also found.

Immigration and Oral Health in Older Adults: An Integrative Approach

The aim of this study was to develop an integrative framework on aging, immigration, and oral health. The methodology was a critical review that used immigration as a social determinant framework through which to evaluate its impact on the oral health of older immigrants. We reviewed recent empirical evidence on factors related to oral health in older immigrants. In a systematic search across multiple databases, we identified 12 eligible studies in this review. Among the eligible studies, most were conducted among East Asian immigrants (8 articles), followed by non-Hispanic White/European origin (2 articles), Mexican origins (1 article), and Iran and other Middle East regions (1 article). The research revealed knowledge gaps in the evidence base, including the dynamic relationship between acculturation and oral health, the role of environmental factors on oral health for immigrants, psychosocial stressors and their relationship with oral health, and oral health literacy, norms, and attitude to dental care utilization and oral hygiene practices. The development of the integrative framework suggests the pathways/mechanisms through which immigration exerts influences on oral health in later life. This provides opportunities for researchers, practitioners, and policy makers to gain greater insights into the complex associations between immigration and oral health among older adults.

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Oral health conditions and correlates: a National Oral Health Survey of Rwanda

Background: Dental diseases are chronic, lifelong and preventable yet affect over half the world's population. Personal oral hygiene practices and socio-economic factors contribute to oral health outcomes affecting oral health quality of life. Integrating basic oral care within community level health systems increases accessibility and availability of oral health resources.Objective: National Oral Health Survey of Rwanda (NOHSR) data were investigated for associations of socio-demographic characteristics, personal oral hygiene practices, oral health outcomes, and oral health quality of life indicators.Methods: Data were analyzed and descriptive statistics calculated. Multivariable logistic regression models were developed to assess associations between untreated caries, calculus, and pain with various independent variables (demographics and personal oral hygiene practices). Additional logistic regression models examined associations between quality of life indicators and the aforementioned independent variables as well as untreated caries and pain.Results: Those who did not use a toothbrush (62.7%), or toothpaste (70.0%), and cleaned their teeth less than once per day (55.3%) had a higher prevalence of untreated caries. Approximately one-third of those in rural areas cleaned their teeth once per day or more compared to two-thirds of those in urban areas (35.4% vs. 71.2%). Those cleaning their teeth less than once daily were estimated to have 56.0% higher odds of caries than those who cleaned their teeth once a day or more (OR = 1.56, [95% CI 1.25-1.95]). Those with secondary education or higher and those with skilled jobs demonstrated more frequent teeth cleaning and higher toothbrush and toothpaste use. Quality-of-life indicators varied significantly with untreated caries and pain.Conclusion: Socio-economic, individual, and workforce characteristics are important considerations when assessing oral health outcomes. This study investigated social demographic disparities in relation to oral health related behaviors and outcomes. This information can help guide oral health care programming in Rwanda.

Oral Health Behaviors in Very Young Children in Low-Income Urban Areas in Chicago, Illinois, 2018-2019

Introduction

Because most data on oral health do not include infants and toddlers, we aimed to describe the oral health behaviors of low-income children younger than 3 years and determine factors associated with child tooth brushing.

Methods

We obtained data from the Coordinated Oral Health Promotion Chicago study, which included 420 families with children aged 6 to 36 months and their caregivers in Cook County, Illinois. We assessed child frequency of brushing from caregiver reports and objectively determined child dental plaque scores. Significant factors associated with tooth brushing frequency and dental plaque score were identified using the Least Absolute Shrinkage and Selection Operator variable selection.

Results

Mean child age was 21.5 (SD, 6.9) months, and only 45% of caregivers brushed their children’s teeth twice per day or more. The mean plaque score was 1.9 (SD, 0.6), indicating high levels of plaque. Child brushing frequency was higher when children were older; used the correct toothpaste amount; brushed for a longer duration; and when caregivers brushed their own teeth more frequently, had more help with the overall care of the child’s teeth, and had family to help. Child brushing frequency was lower for caregivers with more interference from activities of daily life. Children whose caregivers had more adult help with child brushing had better plaque scores; worse plaque scores were seen in children with higher sugary beverage and food consumption and lower household incomes.

Conclusion

The tooth brushing behaviors of young children are strongly associated with those of their parents and with the level of family support for brushing. Interventions to improve brushing in young children should focus on the entire family.

Dental status of young adults born with very low birthweight: A national cohort study

OBJECTIVES

Little is known about the oral health of very low birthweight (<1500 g: VLBW) young adults. This study compared the oral health and self-reported oral health in a 1986 birth cohort of VLBW young adults with that of term-born controls.

METHODS

Oral health interviews and dental examinations were conducted. The dental examinations were carried out in a dental clinic using the standardized examination protocols from the 2009 New Zealand Oral Health Survey. Participants were interviewed to obtain data on self-reported oral health, oral hygiene practices, use of dental health services and oral health-related quality of life using the OHIP-14 measure.

RESULTS

Interviews were completed by 250 VLBW participants and 226 (90.4%) of those underwent the dental examination. All 100 controls completed both the interview and dental examination. While there were few overall differences in clinical or self-reported oral health between the VLBW or control groups, proportionally fewer VLBW participants attended the dentist for regular check-ups or cleaned between their teeth than controls. The VLBW and controls did not differ in the prevalence of untreated dental caries or in the number of carious tooth surfaces after adjusting for confounders. However, participants in the control group had more teeth that had been restored due to caries (4.4 teeth) than did the VLBW group (3.4 teeth, P = .045), after adjusting for confounding.

CONCLUSIONS

Very low birthweight young adults showed poorer self-care than the control group when it came to oral health; they were less likely to regularly attend dental visits, had poorer oral hygiene and were less likely to have had their dental disease treated. VLBW young adults should be encouraged to attend regular dental check-up appointments and to carry out effective home oral hygiene care.

Socioeconomic Life Course Models and Oral Health: A Longitudinal Analysis

We compared socioeconomic life course models to decompose the direct and mediated effects of socioeconomic status (SES) in different periods of life on late-life oral health. We used data from 2 longitudinal Swedish studies: the Level of Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Two birth cohorts (older, 1925 to 1934; younger, 1944 to 1953) were followed between 1968 and 2011 with 6 waves. SES was measured with 4 indicators of SES and modeled as a latent variable. Self-reported oral health was based on a tooth conditions question. Variables in the younger and older cohorts were grouped into 4 periods: childhood, young/mid-adulthood, mid /late adulthood, late adulthood/life. We used structural equation modeling to fit the following into lagged-effects life course models: 1) chain of risk, 2) sensitive period with late-life effect, 3) sensitive period with early- and late-life effects, 4) accumulation of risks with cross-sectional effects, and 5) accumulation of risks. Chain of risk was incorporated into all models and combined with accumulation, with cross-sectional effects yielding the best fit (older cohort: comparative fit index = 0.98, Tucker-Lewis index = 0.98, root mean square error of approximation = 0.04, weighted root mean square residual = 1.51). For the older cohort, the chain of SES from childhood → mid-adulthood → late adulthood → late life showed the following respective standardized coefficients: 053, 0.92, and 0.97. The total effect of childhood SES on late-life tooth loss (standardized coefficient: -0.23 for older cohort, -0.17 for younger cohort) was mediated by previous tooth loss and SES. Cross-sectional effects of SES on tooth loss were observed throughout the life course, but the strongest coefficients were at young/mid-adulthood (standardized coefficient: -0.41 for older cohort, -0.45 for younger cohort). SES affects oral health cumulatively over the life course and through a chain of risks. Actions to improve socioeconomic conditions in early life might have long-lasting effects on health if they help prevent people from becoming trapped in a chain of risks.

ASSOCIATION BETWEEN TROUBLE SLEEPING AND ORAL CONDITIONS AMONG SCHOOLCHILDREN

Objective:

To investigate the prevalence of self-reported trouble sleeping due to dental problems and its association with oral conditions in schoolchildren.

Methods:

This is a cross-sectional study carried out with a representative sample of 1,589 schoolchildren aged 8-10 years enrolled in public schools from Florianópolis, Santa Catarina, Brazil. Non-clinical data included a questionnaire about socioeconomic indicators answered by parents/guardians. Children were questioned about whether they had trouble sleeping due to dental problems and about previous history of toothache. Clinical oral examinations were performed to evaluate dental caries - Decayed, Missing, and Filled Teeth Index (DMFT/dmft index) and its clinical consequences [PUFA/pufa index: considering the presence of pulpal involvement (P/p); ulceration of tissues due to tooth fragments from decayed crowns (U/u); fistula (F/f); and abscesses (A/a), and traumatic dental injuries (TDI)]. We conducted a descriptive analysis and used adjusted logistic regression models (p<0.05; 95%CI).

Results:

The prevalence of trouble sleeping due to dental problems was 28%. Children with untreated dental caries (OR 1.32; 95%CI 1.05-1.67) and clinical consequences from the PUFA/pufa index (OR 1.89; 95%CI 1.45-2.46) had higher chances of reporting trouble sleeping due to dental problems.

Conclusions:

Approximately one-third of the children declared having trouble sleeping due to dental problems. Untreated dental caries and its clinical consequences were associated with self-reported trouble sleeping due to dental problems in schoolchildren.

Associations between Individual-level and Area-level social disadvantage and oral health behaviours in Australian adolescents

BACKGROUND

Oral health behaviours are significant determinants of oral health. There is evidence that socioeconomic position influences oral health behaviours, but little is known about this association during adolescence. This study aims to investigate the association between social disadvantage (individual and area level) and oral health behaviours among Australian adolescents.

METHODS

This study utilized data from the Longitudinal Study of Australian Children (LSAC). The sample consisted of 2877 adolescents. Exposure measures were area-level social disadvantage (Socioeconomic Indexes for Areas) and parent-reported household income from Wave 5. Outcomes, measured in Wave 6, were three different adolescent-reported oral health behaviours: frequency of brushing, consumption of sugar-sweetened beverages (SSB) and dental visits. Associations between quintiles of each exposure and each oral health behaviour were tested by fitting multivariable logistic regression models.

RESULTS

Household income and area-level disadvantage were associated with dental visits and brushing frequency. Associations between social disadvantage and consumption of SSBs were less apparent, with only the least disadvantaged adolescents having lower odds of consumption of SSBs compared to the most disadvantaged group.

CONCLUSION

Individual and area-level socioeconomic factors are associated with dental visits, and frequency of brushing.Broad population-based strategies must be adopted to reduce intake of SSBs, however, targeted strategies are needed among more disadvantaged populations to address infrequent toothbrushing and irregular dental visits among adolescents.

Conceptualization of dental caries by dental students is related to their preventive oral care routine

OBJECTIVE

Whether the understanding of dental caries influences how future dentists manage the disease themselves has not been previously studied. Thus, this study evaluated whether the conceptualization (understanding) of dental caries by dental students is related to their own preventive oral care routine.

METHODS

Dental students at a U.S. dental school (n = 517) were invited to voluntarily respond to an anonymous electronic survey in spring 2018. Demographic characteristics, caries conceptualization (CC), dental care habits, and self-caries risk determination were asked. Discursive responses to CC were analyzed by content analysis technique, and categories [c] were created. Chi-square and Fisher's exact tests were used for analysis.

RESULTS

Overall response rate was 54.5% (n = 282, 48.2% female). Three researchers independently analyzed discursive answers and classified them into 1 of 6 caries concept categories [c]: [c1] only signs of the disease (10.3%), [c2] bacterial disease-not specifying bacterial metabolism (38.3%), [c3] bacterial byproducts-not specifying substrate (13.8%), [c4] biological or multifactorial concept (24.8%), [c5] comprehensive multifactorial disease (8.2%), or [c6] other (4.6%). Only 33% completely defined dental caries according to the modern understanding of the disease (c4-c5). Statistical differences were found between: CC and diet modification, CC and rinsing after brushing, year of school (YS) and self-determined caries-risk, YS and brushing at school, and YS and rinsing after brushing (P < 0.05).

CONCLUSION

Our data suggest that the students' understanding of the disease can influence how they will manage the disease in terms of diet modification and behavior after brushing. Moreover, self-caries risk determination influenced students' brushing behavior.

Behavioral Sciences in the Promotion of Oral Health

The importance and value of behavioral sciences in dentistry have long been recognized, and their contribution to dental education, research, clinical practice, and oral health policy has been significant over the past half century. Over time behavioral sciences have expanded our understanding of oral health beyond "disease" to a broader biopsychosocial concept of oral health. This in turn has led dentistry away from a focus of "treatment" to oral health "care," notably in the new millennium. Key oral health behaviors have been identified for more than half a century: the importance of diet, oral hygiene, dental services, and other factors. Various behavioral models and theories have been proposed, particularly since the 1970s, providing useful frameworks with sound psychological basis to help understand the paths of oral health behaviors. These models draw on theories of self-efficacy, motivation, counseling, and "behavior change." Since the 1980s, there has been a greater understanding that these behaviors often share a common pathway with the etiology of other diseases (common risk factors). Furthermore, the relationship between individual factors and the broader environmental factors has been increasingly emphasized since the 1990s, leading to a united call for action in addressing oral health inequalities. Within the past decade, there are useful examples of models, frameworks, and techniques of behavior change with respect to oral health, involving planning, prompting, encouraging, goal setting, and/or motivating. In particular, there is a growing interest and use of motivational interviewing. Likewise, behavioral therapies, such as cognitive behavioral therapy, are increasingly being employed in dental practice in the management of dental anxiety, pain, and psychosomatic dental and oral problems, with promising results. Recommendations are outlined for future directions for behavioral sciences in the promotion of oral health.

Association between asthma and dental caries in US (United States) adult population

Objective: To investigate the associations of asthma with dental-caries-experience (DFT: decayed and filled teeth) and untreated-dental-caries (DT: decayed teeth) in the US adult population.Methods: Data from the National Health and Nutritional Examination Survey, 2009-2014 were analyzed. Study-participants were classified into current, former and never asthmatics based on their asthma-status. Former-asthmatics were excluded. Both the outcomes, dental-caries-experience and untreated-dental-caries were dichotomized as being either present or absent, and were also categorized into tertiles based on their distributions in our study-sample. Logistic regression analyses were performed to determine the associations of asthma with dichotomized outcomes. The generalized logit model was applied for multilevel categorical outcomes. Multivariable models were developed to control for common demographic, clinical, and lifestyle factors.Results: Total study-participants were 13,135, representing 175.26 million US adults. In the adjusted models, current-asthmatics, when compared to the reference group of never-asthmatics, were more likely to have dental-caries-experience (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.13-1.66) and untreated-dental-caries (OR, 1.38; 95% CI, 1.10-1.73) in ≥1 tooth. Asthma was associated with all three categories of dental-caries-experience in our study-sample. We observed a positive gradient in the OR with an increasing extent of untreated-dental-caries. Relative to never-asthmatics, asthma doubled the odds of having untreated dental caries in the subgroup of current-smokers.Conclusion: Current-asthmatic adults had higher odds of dental-caries-experience and untreated-dental-caries as compared to never-asthmatic adults in the US. Based on the observations from this study, interprofessional collaboration should be recommended to institute caries control and health promotion in current-asthmatic adult population.

A longitudinal study of the impact of change in socioeconomic status on dental caries in the permanent dentition of Swedish children and adolescents

OBJECTIVES

The overall aim was to analyse longitudinally the development of dental caries in the permanent dentition of children and adolescents in a Swedish region, in relation to possible change in socioeconomic status (SES).

METHODS

A total of 259 448 individuals in western Sweden were followed over a 3-year period, through dental journal records at baseline (3-19-year-olds) and 1-3 dental check-ups during the follow-up period. Official socioeconomic register information (ethnicity, wealth, parental education and employment) was available at both baseline and follow-up. Data were used both as independent single variables and combined in an index. Gender, age and caries status at baseline and the examination years were included as covariates in the regression models.

RESULTS

Associations over time were found between SES and dental caries in young people. A persistently low SES was associated with the greatest risk of both new and accumulated (decayed plus filled teeth/approximal surfaces) caries; however, any change in SES, whether improved or worsened, led to a greater risk. An increased risk of new caries events was identified for those who were older at baseline and by examination year. On average, the increase per year in decayed and/or filled teeth and in approximal surfaces was 0.23 and 0.12, respectively.

CONCLUSION

SES was shown to be an important risk factor for dental caries over time in young Swedish people. Prevention programmes should pay particular attention to the needs of socioeconomically vulnerable individuals and groups.

The association of socio-economic status, dental anxiety, and behavioral and clinical variables with adolescents' oral health-related quality of life

PURPOSE

It is not clear which factors hold more weight in predicting oral health-related quality of life (OHRQoL). Therefore, this study explored which component of factors (e.g., socio-economic status, clinical status or oral health behaviors, dental anxiety, oral health knowledge) has a better predictive value in different aspects (e.g., oral symptoms, functional limitations, social and emotional conditions) of adolescents' OHRQoL.

METHODS

Participants were randomly selected from Grade Two (S2) students within 12 secondary schools in Hong Kong. The independent variables include the following : socio-economic (monthly family income, parents' educational background), oral health behaviors (the frequency of brushing and having snacks like chocolate or biscuits), and oral health-related factors (oral health knowledge, dental anxiety, dental caries and bleeding index). Adolescents' OHRQoL was evaluated using the 16-item Child Perception Questionnaire (CPQ_11-14-ISF:16). Frequencies and means were used for data description. Different variables were analyzed as predictors of OHRQoL by multi-level linear regression analysis.

RESULTS

1207 adolescents (46.6% females) participated in this study. The mean total CPQ_11-14-ISF:16 was 14.2 (9.8). Mean scores of oral symptoms, functional limitations, and emotional and social well-being were 4.4 (2.8), 4.2 (2.8), 3.2 (3.1), and 2.4 (2.7), respectively. In the final model, adolescents with poorer oral health knowledge, higher dental anxiety levels, brushed their teeth less than once a day and consumed chocolates or biscuits more regularly as reported by a statistically worse OHRQoL (p < 0.05). In addition, gingival bleeding was a predictor of the oral symptom domain (β = 0.7, p = 0.027); the emotional well-being of adolescents whose father went to college had a better OHRQoL (β =  - 0.9, p = 0.014) and adolescents from the higher-income family had a statistically better social well-being (p = 0.015).

CONCLUSION

Our study indicates that adolescents with poorer oral health knowledge, higher dental anxiety levels, brushing their teeth less than once a day, or having a daily consumption of chocolate or biscuits had statistically worse OHRQoL. These findings can provide guidance for future oral health promotion in improving OHRQoL among adolescents.

Disparities in Access to Oral Health Care

In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.

Pathways between parental and individual determinants of dental caries and dental visit behaviours among children: Validation of a new conceptual model

OBJECTIVES

To delineate the pathways between the parental and individual determinants of dental caries and dental visit behaviours among children, using path analysis.

METHODS

The study employed an observational design; the study sample consisted of 583 parent-child dyads. Data were collected using a sociodemographic and oral health behaviour form, the Parenting Styles and Dimensions Questionnaire, the Corah Dental Anxiety Scale and the Children's Fear Survey Schedule-Dental Subscale. A conceptual model was developed, and it consisted of four endogenous variables (dental caries, children's oral health, dental visit behaviours and children's dental anxiety) and four exogenous ones (parental socioeconomic status, parental dental anxiety, parental oral health behaviours and parenting style). Path analysis was used to test the compatibility of the conceptual model, with a statistical significance at P < .001.

RESULTS

49.1% of participants (n = 286) were male. The mean age of participants was 8.3 (SD = 2.1). The mean DMFT score was 6.0 (SD = 3.0) and the mean Frankl behaviour score 3.0 (SD = 1.0). Parental socioeconomic status showed the strongest association with dental caries (β = .276; P < .001), and children's dental anxiety had the strongest association with dental visit behaviours (β = -.414; P < .001). Parental socioeconomic status and oral health behaviours were directly associated with dental caries (P < .001), and parental socioeconomic status had the most association. Parenting style and parental and children's dental anxiety were associated with dental visit behaviours (P < .001). Further, while all parental variables except prior exposure to training about oral and dental health were significantly correlated with dental caries, only educational level and coverage by health insurance were significantly associated with Frankl behaviour scale score.

CONCLUSIONS

This study developed and validated a conceptual model that delineates the pathways between the parental and individual determinants of children's oral health and dental visit behaviours. The model should help us to understand these pathways to lower the incidence of dental caries and improve dental visit behaviours among children.

The Dunedin Multidisciplinary Health and Development Study: Oral health findings and their implications

Longitudinal research is needed to better understand the natural history of oral conditions and long-term health and social outcomes. Oral health data has been collected periodically in the Dunedin Multidisciplinary Health and Development Study for over 40 years. To date, 70+ peer-review articles on the Study's oral health-related findings have been published, providing insight into the natural history of oral conditions, risk factors, impacts on quality of life, and disparities in oral health. Some of these report new findings, while others build upon the existing body of evidence. This paper provides an overview of these findings and reflects on their public health implications and policy utility in New Zealand.

Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FiCTION three-arm RCT

BACKGROUND

Historically, lack of evidence for effective management of decay in primary teeth has caused uncertainty, but there is emerging evidence to support alternative strategies to conventional fillings, which are minimally invasive and prevention orientated.

OBJECTIVES

The objectives were (1) to assess the clinical effectiveness and cost-effectiveness of three strategies for managing caries in primary teeth and (2) to assess quality of life, dental anxiety, the acceptability and experiences of children, parents and dental professionals, and caries development and/or progression.

DESIGN

This was a multicentre, three-arm parallel-group, participant-randomised controlled trial. Allocation concealment was achieved by use of a centralised web-based randomisation facility hosted by Newcastle Clinical Trials Unit.

SETTING

This trial was set in primary dental care in Scotland, England and Wales.

PARTICIPANTS

Participants were NHS patients aged 3-7 years who were at a high risk of tooth decay and had at least one primary molar tooth with decay into dentine, but no pain/sepsis.

INTERVENTIONS

Three interventions were employed: (1) conventional with best-practice prevention (local anaesthetic, carious tissue removal, filling placement), (2) biological with best-practice prevention (sealing-in decay, selective carious tissue removal and fissure sealants) and (3) best-practice prevention alone (dietary and toothbrushing advice, topical fluoride and fissure sealing of permanent teeth).

MAIN OUTCOME MEASURES

The clinical effectiveness outcomes were the proportion of children with at least one episode (incidence) and the number of episodes, for each child, of dental pain or dental sepsis or both over the follow-up period. The cost-effectiveness outcomes were the cost per incidence of, and cost per episode of, dental pain and/or dental sepsis avoided over the follow-up period.

RESULTS

A total of 72 dental practices were recruited and 1144 participants were randomised (conventional arm, n = 386; biological arm, n = 381; prevention alone arm, n = 377). Of these, 1058 were included in an intention-to-treat analysis (conventional arm, n = 352; biological arm, n = 352; prevention alone arm, n = 354). The median follow-up time was 33.8 months (interquartile range 23.8-36.7 months). The proportion of children with at least one episode of pain or sepsis or both was 42% (conventional arm), 40% (biological arm) and 45% (prevention alone arm). There was no evidence of a difference in incidence or episodes of pain/sepsis between arms. When comparing the biological arm with the conventional arm, the risk difference was -0.02 (97.5% confidence interval -0.10 to 0.06), which indicates, on average, a 2% reduced risk of dental pain and/or dental sepsis in the biological arm compared with the conventional arm. Comparing the prevention alone arm with the conventional arm, the risk difference was 0.04 (97.5% confidence interval -0.04 to 0.12), which indicates, on average, a 4% increased risk of dental pain and/or dental sepsis in the prevention alone arm compared with the conventional arm. Compared with the conventional arm, there was no evidence of a difference in episodes of pain/sepsis among children in the biological arm (incident rate ratio 0.95, 97.5% confidence interval 0.75 to 1.21, which indicates that there were slightly fewer episodes, on average, in the biological arm than the conventional arm) or in the prevention alone arm (incident rate ratio 1.18, 97.5% confidence interval 0.94 to 1.48, which indicates that there were slightly more episodes in the prevention alone arm than the conventional arm). Over the willingness-to-pay values considered, the probability of the biological treatment approach being considered cost-effective was approximately no higher than 60% to avoid an incidence of dental pain and/or dental sepsis and no higher than 70% to avoid an episode of pain/sepsis.

CONCLUSIONS

There was no evidence of an overall difference between the three treatment approaches for experience of, or number of episodes of, dental pain or dental sepsis or both over the follow-up period.

FUTURE WORK

Recommendations for future work include exploring barriers to the use of conventional techniques for carious lesion detection and diagnosis (e.g. radiographs) and developing and evaluating suitable techniques and strategies for use in young children in primary care.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN77044005.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 1. See the NIHR Journals Library website for further project information.

Predisposing, enabling, and need characteristics of dental services utilization among socially deprived schoolchildren

OBJECTIVES

To test the relationship of predisposing, enabling and need characteristics with dental services utilization and pattern of dental attendance among 12-year-old schoolchildren living in a socially deprived urban area.

METHODS

A cross-sectional study was carried out involving 358 children enrolled in public schools located in a deprived area of the city of Manaus, Brazil. Predisposing, enabling, and need characteristics were selected according to Andersen's behavioral conceptual model. Self-completed questionnaires were used to collect the predisposing characteristics (child's gender, sense of coherence, self-esteem, oral health beliefs). Parents or guardians provided data on enabling characteristics, including dental health insurance and socioeconomic status. Evaluated need characteristics included oral clinical status assessed through dental examinations conducted by five calibrated examiners. Structural equation modeling was used to test the predictors of dental services utilization and pattern of dental attendance.

RESULTS

Predisposing characteristics, including male gender and low parents/guardians sense of coherence predicted poor dental services utilization and inadequate pattern of dental attendance, respectively. Low socioeconomic status and poor oral clinical status were linked to poor dental services utilization and worse children's pattern of dental attendance.

CONCLUSIONS

The present findings suggest that predisposing (child's gender and parental sense of coherence), enabling (socioeconomic conditions) and evaluated need characteristics (oral clinical status) are associated with dental services utilization among children.