Community dentistry and oral epidemiology最新文献

Background: Dental caries remains a significant public health issue in Indonesia, with high prevalence across age groups and ongoing disparities in access to preventive care. While national initiatives such as the 'Caries-Free Indonesia by 2030' goal signal increasing political attention, the effectiveness and equity of current oral health strategies remain uncertain.

Objective: This scoping review aims to assess the policy direction and documented effectiveness of Indonesia's national-level caries prevention programmes through a review of government policy documents and relevant literature.

Methods: This scoping review followed the PRISMA-ScR guidelines. A systematic search was conducted through PubMed, Scopus, Cochrane Library and Google Scholar, and supplemented by government policy documents. Studies were included if they focused on oral health policy or national caries prevention programmes in Indonesia and were published in English or Indonesian. Exclusion criteria included reviews, commentaries, clinical treatment-focused studies and articles without full text or policy relevance. In total, 32 articles were included in this study.

Results: Indonesia's oral health policy framework has evolved toward greater integration and equity, reflected in expanded target populations and alignment with WHO's life-course approach. However, implementation remains fragmented due to inconsistent implementation, workforce shortages, inadequate funding and weak evaluation. The School Dental Health Program (UKGS) demonstrates inconsistent outcomes across provinces and lacks a robust data system for monitoring. Community-based initiatives, such as Posyandu and integrated antenatal care (iANC), show promise but are limited in scale and evaluation. Preventive efforts are underfunded under the UHC scheme, while curative services dominate. Additionally, the absence of a sugar-sweetened beverage (SSB) tax and poor integration of oral health into national surveillance systems hinders upstream and system-wide interventions.

Conclusion: Despite policy advancements, Indonesia's oral health policies and national-level programmes face some barriers that limit programme effectiveness. Strengthening data systems, rebalancing health financing toward prevention, implementing fiscal measures and formalising multi-sectoral coordination are essential to support sustainable oral health improvements.

Objective: To estimate the probability of dental services utilisation according to demographics, socioeconomic characteristics, and social networks of Brazilians aged 15 years and above.

Methods: The study used data from the 2019 Brazilian National Health Survey, a household-based representative nationwide survey. Individual interviews collected information on time interval since the last dental appointment, residential setting, sex, race/skin colour, years of school completed with approval, family income and social networks. Predicted probabilities and 95% confidence intervals (CIs) of time since last dental visit were estimated using a multinomial logistic regression model. Estimates were obtained using the post-estimation commands of Stata MP, version 17.0, considering the complex sampling design and sampling weights.

Results: Prevalence of last dental visit in the last 12 months was 48.4% (47.8%-49.0%). The projected scenarios showed a significant effect of sex, socioeconomic characteristics and social networks on dental services utilisation. The worst scenario was observed for male individuals living in rural areas, with lower schooling, lower income and lower social networks. In this group, the prevalence of dental visit in the previous 12 months was 14.7% (13.1%-16.2%) and 23.1% (19.3%-26.9%) reported never having had a dental visit. Individuals with low social networks exhibited lower dental services utilisation than those with high social networks, across both better and worse socioeconomic status scenarios.

Conclusion: Individuals aged 15 years and above with poor socioeconomic status, living in rural areas, and those with low social networks had lower use of dental services.

Background/objectives: Socio-economic inequalities in oral health are a universal phenomenon. This study investigated socio-economic differences in Irish adolescents' oral health and the potential role of behaviour (oral health behaviours), material (structural, material and economic constraints) and psychosocial factors (parental stress and family structure) in these differences.

Methods: Data analysed were from the first three waves of the Growing Up in Ireland child cohort survey on self- (self-rated oral health (SROH)) and parent-reported oral health outcomes (dental fillings) at age 17/18 years; socio-economic status (SES) measures, behavioural, material and psychosocial factors at 13 years; and potential confounders at 9 years of age. Logistic regression was used to study associations between oral health outcomes and SES indicators and for mediation analysis.

Results: Socio-economic disadvantage was associated with poorer oral health outcomes, with gender-specific patterns. Young males from the lowest educational and income groups had higher odds of suboptimal (fair/poor) self-rated oral health (odds ratio (OR)_Education: 2.31 (1.29; 4.13) and OR_Income: 1.72 (1.16; 2.56)), and those in the lowest income quintile and with full medical cards had higher odds of dental fillings (ORs_Income: 1.58-1.82 and ORs_{Medical card}: 1.44-1.65) compared with higher socio-economic groups. Young females showed significant associations between selected socio-economic indicators (education, income, occupation and medical status) (ORs: 1.39-3.34) and dental fillings, with education demonstrating the strongest association (ORs_Education: 1.91-3.34). For males, material, behavioural, and psychosocial factors mediated the SES-SROH relationship (97%-100%, 22%-69% and 5%-56% respectively), whereas for dental fillings, mediation was observed for material (11%-55%) and psychosocial (10%-37%) factors, with minimal mediation by behavioural factors (0%-2%). Among females, material factors were the primary mediators of the SES-dental fillings relationship (11%-55%), with smaller contributions from behavioural (0%-21%) and psychosocial (0%-26%) factors.

Conclusion: Social disparities in oral health are common among Irish adolescents with gender-specific patterns. Material factors were the primary pathway explaining these inequalities, though the strength and nature of these relationships vary by oral health outcome and gender.

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.

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 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.

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.

Objective: Demonstrate and evaluate methodology to estimate annual probability a sound-unsealed molar develops caries (AP) among US adults, aged 21 and 25 years.

Methods: A synthetic birth cohort was created with National Health and Nutrition Examination Survey data from 2001 to 2004 and 2011 to 2014. The synthetic birth cohort was born between 1982 and 1989 and was aged 15 to 19 years in 2001-2004 and 25 to 29 in 2011-2014. Caries increment (difference in per-person decayed, missing and filled molars (DMF) between adolescence and young adulthood) obtained from the synthetic birth cohort was used to estimate AP not adjusted for the presence of sealants. Adjusted estimates were obtained by inputting information on sound-sealed, sound-unsealed and DMF molars among adolescents and DMF among young adults from the synthetic cohort and sealant retention from the literature into a Markov model. AP was estimated by solving for the AP that yielded the DMF for the synthetic cohort in young adults. To evaluate Markov-model performance, longitudinal data from five caries effectiveness trials were used to estimate true AP and adjusted AP. One-way sensitivity analyses of model parameters were also conducted.

Results: The adjusted AP (0.038) was notably higher than the unadjusted AP (0.031). The average and median percentage deviation of adjusted APs relative to their true values were, respectively, 10.1% and 7.1%. The most influential model parameters were DMF in adulthood and annual retention.

Conclusion: This methodology provides reasonable estimates of AP that can be used in cost-effective analyses of providing sealants to young adults.

Objective: The objective of the present study was to map the available research, investigating how dental professionals perceive those who experience poverty, and what educational interventions are available in this area, with the aim of providing a narrative summary and identifying key research gaps within the literature.

Method: Following Joanna Briggs scoping review methodology, databases searched included PubMed, Scopus, CINAHL, Dentistry and Oral Sciences, Health Research Premium and Web of Science databases. A manual search was also performed on Google Scholar to identify grey literature. Search strategies included medical subject headings and key terms including poverty, financial hardship, social deprivation, oral health, oral diseases, dental caries, communication, learning and dental education.

Results: A total of 1046 articles were assessed for eligibility, of which 34 studies met the predefined inclusion criteria. The studies included in this review highlight conflicting understandings about what it means to be living in poverty. Outreach activities shared lived experiences, and immersive opportunities were reported to improve dental professionals' attitudes and willingness to provide dental care for people living in poverty.

Conclusion: To the study teams' knowledge, this is the first review to examine specifically how poverty and oral health are understood by the dental profession. This review highlights the need for further research as to the long-term effectiveness and cost-effectiveness of educational interventions to increase understanding.

Objectives: Many oral health-related quality of life instruments have been developed but few have undergone a comprehensive psychometric assessment. One commonly used measure is the Oral Impact on Daily Performance (OIDP). This study revised the configural and metric properties as well as the performance of items based on Item Response Theory (IRT) of a dichotomous-item version of OIDP in Brazil.

Methods: The nine-item dichotomous version of the OIDP was analysed using data from a nationally representative sample from the Oral Health Survey (SBBrasil 2010). It consisted of 30 064 individuals aged 12 to 75 and was split into two partitions comprising n₁ = 20 040 and n₂ = 10 024, respectively. Confirmatory factor analyses (CFA) were conducted on the larger partition and cross-validated on the smaller to assess configural and metric properties. The item performance was evaluated using a 2-parameter item response theory (IRT) model. Sampling weights were used in all analyses.

Results: The unidimensional model presented two violations of conditional independence, one between items i5 (practising sports) and i4 (going out) and another between items i6 (trouble in speaking) and i7 (shame of speaking or smiling). A CFA of the most parsimonious model (removing i5, i6 and i7) yielded a RMSEA = 0.02, WRMR = 1.42, CFI = 0.99 and TLI = 0.99. The IRT analyses showed that three pairs of items had very similar levels of difficulty and discrimination suggesting redundancy.

Conclusions: A shorter dichotomous version of the OIDP scale has acceptable configural and metric properties. Being more concise and thus efficient, it may be better suited for large-scale population surveys than the version currently in use.