Community dentistry and oral epidemiology最新文献

Background: International economic evaluations have not found convincing evidence that the application of fluoride varnish (FV) in preschool children is a cost-effective anti-caries measure, and there is a lack of economic evaluations of FV in the Brazilian context.

Aim: This study evaluated the cost-effectiveness (CE) of standard care plus FV for Brazilian preschoolers in the general population, comparing it to standard care in terms of prevention of cavitated caries lesions and disability-adjusted life years (DALY) outcomes.

Methods: Markov models were used, with a 4-year time horizon and 6-month cycles. Transition probabilities were obtained from a national epidemiological survey and randomised controlled trials (RCTs). The effectiveness of FV was derived from a systematic review of RCTs. Costs (in Brazilian reais) were sourced from the 2022 National Agency for Supplemental Health dental procedures list. A discount rate of 5% was applied. CE analyses, Markov simulations (MS), and sensitivity analyses (SA) were conducted. Deterministic sensitivity analysis (DSA) used a 95% confidence interval for each variable. For probabilistic sensitivity analysis (PSA), beta distribution curves were used for probabilities, gamma for costs, and lognormal for effectiveness.

Results: Standard care plus FV showed an increase in effectiveness (0.01894 and 0.00018 for avoided caries and DALY, respectively) compared to standard care, with an additional cost of R$131.27 per child in the 4-year period. The ICER (incremental cost-effectiveness ratio) was calculated at R$6929.09 per cavitated caries lesion prevented and R$727604.84 per DALY avoided. MS revealed little difference in the percentage of individuals in each health state at the end of the simulations. FV prevented cavities in 4 out of every 100 children over a 4-year period, at an average annual cost of R$33 per child (assuming each child who developed cavitated caries lesions had only one). DSA indicated that FV effectiveness was the parameter with the highest potential to influence the ICER. PSA suggested high CE thresholds, from which FV would be considered cost-effective: R$7000 for caries and R$730000 for DALY.

Conclusion: The total cost of care was lower in the group that invested less in prevention (without FV) compared to the group that invested more (with FV). While it is often said that "more prevention is always better," economic evaluations remind us that not all preventive strategies provide good value for money.

Objective: To visualise and explore patterns of daily toothbrushing frequency in Irish adolescents and contribute to the understanding of predictors of toothbrushing habits in autistic adolescents and adolescents with intellectual disability.

Methods: Data from the Growing Up in Ireland national longitudinal child study were explored to visualise patterns of toothbrushing in children between 9 and 17/18 years. Data for 17/18-year-olds were examined using descriptive and logistic regression analysis to gain insight into predictors of twice-a-day toothbrushing within the full adolescent dataset and a subgroup of autistic adolescents and adolescents with intellectual disability.

Results: Gender, eating breakfast every day and experience of orthodontics positively predicted twice-a-day toothbrushing for young people in general. Oral health rating below excellent, infrequent dental checkups, obesity and drinking soft drinks (not diet) daily negatively predicted twice-a-day toothbrushing. For autistic adolescents and adolescents with intellectual disability, results suggested that the lowest self-rating of oral health, drinking soft drinks (not diet) daily and being autistic with intellectual disability may be factors that influence less than twice-a-day toothbrushing.

Conclusion: Regular contact with the dental team and healthy lifestyle habits may positively influence twice-a-day toothbrushing. Frequency of toothbrushing and actionable targets to support oral health, where high support and more complex oral health challenges exist, require further research.

Objectives: This scoping review aimed to map global evidence on upstream interventions which promote oral health and reduce socioeconomic inequalities in oral health.

Methods: A review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. A multistranded comprehensive search strategy was employed to identify relevant studies. Article texts were retrieved and assessed for eligibility against the inclusion criteria. Key findings were extracted and summarised.

Results: A total of 99 articles (74 empirical studies and 25 systematic, scoping and umbrella reviews) were included in the scoping review. The review findings revealed a limited number of upstream interventions specifically focused on promoting oral health and reducing oral health inequalities. Legislative and regulatory measures (e.g., advertising controls), fiscal measures (e.g., sugar-sweetened beverage taxation) and specific oral health interventions (e.g., water fluoridation) have shown a positive impact on promoting oral health. In addition, fiscal measures, food subsidies targeted at low-income groups and improvements to housing/work environments have proven effective in reducing socioeconomic inequalities in general health outcomes.

Conclusions: Despite a very detailed and thorough search of the global literature, this scoping review identified a limited number of upstream interventions that specifically focused on improving oral health, and an even smaller number of upstream interventions that tackled oral health inequalities. However, the review did identify three levels of upstream intervention including: policies tackling the broader socio-political determinants of health; policies combating non-communicable diseases (NCDs) linked to oral health; and some specific interventions (e.g., water fluoridation) focusing on oral health. The upstream approach to prevention remains highly relevant to public health policy and provides a guiding principle for future strategic action to promote oral health and tackle oral health inequalities.

Objectives: This study aimed to overview the available evidence from systematic reviews (SRs) on the effects of fluoride varnish (FV) for caries prevention in preschoolers.

Methods: Systematic reviews, with or without meta-analyses, of randomised controlled trials (RCTs) and quasi-randomised trials evaluating the use of FV in preschoolers to prevent dentin caries compared to placebo, standard care, or no intervention were included. The search was last updated in July 2025 across eight electronic databases. Two researchers independently assessed eligibility and extracted data, resolving disagreements by discussion or with a third researcher if needed. The methodological quality, risk of bias, and certainty of evidence of the SRs were assessed using AMSTAR-2, ROBIS, and GRADE, respectively. The results were synthesised descriptively.

Results: Fourteen SRs published between 2001 and 2023 were included. Six SRs reported insufficient evidence to conclude on the effectiveness of FV; six concluded that FV is effective; and two suggested that FV provides a probably irrelevant clinical benefit. One SR had a high methodological quality, two had low, and 11 were rated as critically low. The risk of bias was considered low in three SRs and high in 11. The certainty of evidence ranged from moderate to very low, with the risk of bias being the criterion that most contributed to downgrading it.

Conclusions: Most systematic reviews on the effectiveness of fluoride varnish in preventing caries in preschoolers are of critically low quality and high risk of bias, with conflicting findings. Systematic reviews that included more recent studies with lower risk of bias indicated that fluoride varnish provides relatively limited or no additional benefit to children who use fluoride toothpaste. Therefore, the routine application of fluoride varnish in preschoolers should be reconsidered.

Objectives: This study examined country-level geo-temporal sentiment trends in community water fluoridation (CWF) discussions on 'X' from 2014 to 2023 and generated a five-year forecast to anticipate future shifts.

Methods: Sentiment analysis was conducted using the VADER 'SentimentIntensityAnalyzer', with polarity thresholds defined as negative (< -0.05), neutral (-0.05 to +0.05) and positive (> +0.05). Data were collected via the 'X' API and examined for sentiment distribution, country-level geo-temporal patterns based on user location information, and engagement metrics (likes, retweets, replies). Ethical approval was obtained, and only publicly available data were analysed in compliance with the platform's terms of service. Limitations include restriction to English-language tweets and the non-representativeness and demographic biases of 'X' users compared with national populations.

Results: Of 72 309 original tweets analysed, 37.4% were negative, 34.4% positive and 28.2% neutral. Countries with low tweet volumes (e.g., Venezuela, Cyprus, Croatia, Pakistan, Vietnam) showed predominantly positive sentiment. In contrast, high-volume countries (the US, Canada, Australia, Brazil and the United Kingdom) displayed mixed sentiment without a clear majority. Predictive modelling indicated a modest shift toward less positive sentiment polarity over the next 5 years, with average polarity projected to decrease from 0.43 in 2024 to 0.38 in 2028. Supplementary analysis of more recent tweets (Jan 2024-Aug 2025) provided further insight into emerging patterns, broadly consistent with the projected trends.

Conclusions: CWF discourse on 'X' is polarised and varies across countries and time. The expected decline in positivity underscores the need for tailored country-specific public health communication strategies to strengthen engagement and counter misinformation.

Objectives: To describe the landscape of dental care provided by specialised centres for children and adolescents with rare diseases (RDs) in the state of Minas Gerais, southeastern Brazil.

Methods: A retrospective cross-sectional study was conducted involving individuals aged 0-18 years with a confirmed diagnosis of a RD who received care at five specialised dental centres. Data on the diagnosis, age at first dental appointment, frequency of annual visits and travel distance from home to treatment centre were analysed using descriptive and inferential statistics.

Results: A total of 1057 individuals with 244 different RDs were identified. Most were boys (54.9%). The average age at the first dental appointment was 8.52 years. Haematological diseases were the most prevalent (38.9%). The average travel distance for treatment was 99.1 km, with individuals from the Jequitinhonha region traveling the farthest (526.3 km). The average number of annual dental visits was 2.4. Patients with craniofacial syndromes accessed care earlier (average: 3.6 years) and had more frequent follow-up appointments (average: 4.8 visits/year). Significant regional disparities were found in age at first appointment (p < 0.001), travel distance (p < 0.001) and frequency of visits (p = 0.002).

Conclusions: Children and adolescents with RDs had delayed initiation of dental care, low follow-up rates and substantial travel burdens. The concentration of specialised centres in the state capital underscores the need for policy reforms to improve equitable access, particularly for patients in remote areas.

Objectives: Tooth loss was longitudinally associated with social isolation. The absence of dental prosthesis use was an additional risk factor. However, the mediating pathways for this association are unknown. The aim of this cohort study was to estimate the mediating effect of three oral functions: speaking, smiling and chewing observed at baseline on the association between oral health at baseline and social isolation after 6 years of follow-up.

Methods: The 2010-2016 panel data from 6103 functionally independent participants aged ≥ 65 years who were not socially isolated at baseline was used from the Japan Gerontological Evaluation Study (JAGES). Causal mediation analysis using parametric logistic regression models was used to calculate the natural direct effect (NDE), the natural indirect effect (NIE), and the total effect. Social isolation was derived from a 5-point index and dichotomised (0/3 = not isolated, 4/5 = isolated). The confounders observed at baseline were age, sex, educational attainment, income, activities of daily living, living area, and having depressive symptoms assessed using the geriatric depression scale (GDS-15).

Results: The mean age of the participants was 72.4 years (SD = ±5.1), and 44.7% were males. Social isolation was observed at follow-up among 3.6% of participants (n = 220). The cumulative incidence rate of socially isolated participants among those with ≥ 20 teeth was 2.9% increasing gradually to 3.2%, 3.5%, 3.7% and 7.2% among those with 10-19 teeth and used dental prosthesis, 10-19 teeth and did not use the dental prosthesis, 0-9 teeth and used dental prosthesis, and 0-9 teeth and did not use the dental prosthesis respectively. Compared with those with ≥ 20 teeth, having difficulty in speaking [NIE odds ratio (OR) = 1.02, 95% confidence interval (CI) = 0.93-1.11], problems in smiling (NIE OR = 1.02, 95% CI = 0.93-1.10) and difficulty in chewing (NIE OR = 1.04, 95% CI = 0.94-1.14) might have mediated the association for those with 10-19 teeth and used dental prosthesis as well as for those with 10-19 teeth without dental prosthesis (NIE OR = 1.02, 95% CI = 0.94-1.10), (NIE OR = 1.02, 95% CI = 0.93-1.11) and (NIE OR = 1.02, 95% CI = 0.93-1.11) respectively. While they might not have mediated the association for those with 0-9 teeth with and without dental prosthesis use.

Conclusion: With low precision and uncertain estimates, limited oral function might have mediated the association between tooth loss (10-19 with and without dental prosthesis use groups) and social isolation over 6 years. It was uncertain whether a mediation effect of oral functions was observed for those with 0-9 teeth with and without dental prosthesis use.

Objectives: Health literacy refers to an individual's ability to understand health information, navigate healthcare systems, make informed decisions and adopt health-promoting behaviours. The scoping review examined the available literature to explore adults' health literacy levels, health literacy measurements, and the role of health literacy in adults' dental service utilisation.

Methods: The scoping review used Arksey and O'Malley's framework, refined by Joanna Briggs Institute methodology. The inclusion criteria were peer-reviewed studies, published in English with adult participants in a dental setting. Four databases (MEDLINE via PubMed, Scopus, CINAHL and ASSIA) were searched for relevant studies from January 2000 to January 2025.

Results: Nineteen studies met the inclusion criteria, with 12 out of 19 conducted in the US. Health literacy was assessed by 11 different measures. Although most studies reported relatively inadequate health literacy levels, inconsistent findings persist due to a lack of consensus on measurement. Dental service utilisation, primarily assessed by dental visits, dental information seeking, and dentist-patient communication, demonstrated inconsistent associations with health literacy.

Conclusions: While some studies suggested a positive association between health literacy and dental service utilisation, the mechanisms through which health literacy influenced dental service utilisation remained unclear and required further investigation.

Objectives: Although previous studies explored parents' perceptions of accessing dental care, few examined their link to treatment completion, follow-up and children's quality of life. This study aimed to (1) examine the association between parents' perceptions and utilisation outcomes (access, treatment completion and follow-up) alongside children's quality of life; and (2) identify barriers reported by parents for failing to complete treatment or adhere to follow-up.

Methods: A cross-sectional study was conducted among primary schoolchildren in Jeddah, Saudi Arabia, using stratified cluster sampling. Caregivers completed surveys on access and barriers, whereas children completed the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) and underwent clinical examinations. Multilevel logistic regression models analysed predictors of care utilisation and CARIES-QC scores.

Results: 785 schoolchildren and their parents from 11 schools were included. Perceived difficulty accessing care increased the odds of treatment incompletion (AOR: 5.84, 95% CI: 2.98-11.44), lack of follow-up (AOR: 2.11, 95% CI: 1.15-3.87) and poorer CARIES-QC scores (β = 1.70, 95% CI: 0.56-2.85). The most common reported barriers for incomplete treatment or not following up were financial barriers (25.6%, n = 72 and 45.9%, n = 56) and dismissive attitudes toward primary teeth (17.4%, n = 49 and 22.1%, n = 27), respectively.

Conclusion: Perceived difficulty in accessing dental care was significantly associated with incomplete treatment, missed follow-ups and poorer caries-specific quality of life. Financial constraints and misconceptions about primary teeth were key reported barriers, emphasising the need to address both parents' perceptions and reported barriers to improve oral health outcomes.

Objectives: This study conducted a latent class analysis (LCA) on a large, nationally representative dataset of United States adults to determine whether there are distinct archetypes of oral health-related outcomes associated with discrimination and microaggression experiences in the oral health setting.

Methods: Respondents (18+ years) to the 2022 and 2023 rounds of the State of Oral Health Equity in America survey completed the 7-item Everyday Discrimination Scale-Oral Health (EDSOC) to assess discriminatory experiences, and the 4-item Dignity in Oral Care Scale (DOCS) to assess microaggression experiences. LCA model inputs were variables related to oral health, social determinants of health, socio-demographic factors and EDSOC and DOCS scores. Models were compared using multiple goodness-of-fit estimates.

Results: The best-fitting model (N = 10 922; 50.9% female) produced 6 archetypes, generally representing shifts in demographic characteristics and discrimination and microaggression experiences in oral health settings. For example, while the "American Dream of Success" archetype consisted of mostly white adults aged 30 and above with regular access to dental care and fewer discriminatory and microaggression experiences, the "Vulnerable Adulthood" archetype consisted of younger (44 and below), more racially diverse adults with less access to dental care and more experiences with discrimination and microaggressions.

Conclusions: Results emphasise disproportionate discrimination and microaggression experiences in the oral health care system by younger and more diverse groups of adults compared to older, more non-Hispanic white adults. These findings emphasise the importance of oral health professionals providing culturally sensitive care that considers the intersectionality of all patients' backgrounds and experiences.