Community dentistry and oral epidemiology最新文献

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: A National Academies Consensus Study report concluded that the evidence did not support an assessment that fluoride is a neurodevelopmental hazard. However, some researchers have undertaken benchmark dose modelling to determine a safe fluoride concentration level in water. Therefore, the suitability of the data for modelling fluoride concentration in urine and water and cognition response using standard criteria was assessed.

Methods: Data quality was evaluated using a standard tool. A random-effects meta-analysis of standardised mean difference (SMD) and regression coefficients was conducted to assess effect sizes and heterogeneity. The Environmental Protection Agency (EPA) benchmark dose modelling was utilised to determine the association between fluoride concentrations and cognition scores.

Results: All four maternal urinary fluoride (MUF) studies did not meet the standards for acceptable quality, as identified by the EPA data quality criteria, which are necessary for combining data from different studies for dose-response analysis. The pooled estimate was not statistically significant (β_MUF = -1.06, 95% CI: -3.63, 1.50; p = 0.42; I² = 62%). A meta-analysis of five studies conducted in fluoridated areas showed a pooled SMD effect size of 0.04 (95% CI: -0.06, 0.14; p = 0.42; I² = 0%), favoring higher fluoride. The benchmark dose models did not reveal a functional relationship between MUF or water fluoride concentration and cognitive outcomes (Goodness-of-fit p < 0.1).

Conclusions: The data quality assessment revealed serious flaws that render the maternal urinary studies unacceptable for hazard assessment and benchmark dose modelling. Therefore, more appropriate studies in endemic fluorosis areas are needed to accurately determine whether fluoride is associated with adverse cognitive outcomes in populations with meaningful exposure.

Objectives: Understudied populations such as those with intellectual disabilities (ID) face significant disease burden and oral health disparities. Systematic exclusion from oral health research contributes to resultant health inequalities, limits understanding of the determinants and implications of disease, and hinders the ability to improve health through evidence-based policy and healthcare planning. This study reports the development of the Modified Oral Status Survey Tool (MOSST), an accessible, low burden oral health assessment tool designed for use with populations who require communication and cognitive supports. It explores the MOSST's key measurement attributes: conceptual coverage, content validity, reliability, feasibility, and cost.

Method: The study followed an iterative tool development process. The MOSST was tested in two steps: (1) attribute testing of an interim version (MOSST v0.1) for inter and intra-rater reliability, burden, cost and feasibility; and (2) content validity testing of MOSST v1.0 using an expert and a Public and Patient Involvement (PPI) panel. Field testing involved data collection from Wave 5 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), with data from n = 469 participants undertaking a MOSST assessment.

Results: Data from n = 469 adults with ID were analysed. The MOSST demonstrated very strong/strong inter- and intra-rater reliability for tooth count (ICC = 0.999), denture wear, occlusal pairs, and oral pain (k = 0.808-1.00). Content validity was confirmed through expert and PPI panel reviews; item-level Content Validity Indices (iCVI) ranging from 0.85 to 1.00 were gained from the expert panel responses to measure agreement. This review process led to refinements, including replacing items representing occlusal function with functional tooth units and relocating the subjective oral pain item. This led to a final MOSSTv1.0 tool and associated training, protocol and resources. The MOSST was acceptable: 98% (n = 65) reporting data collection process acceptable; 100% (n = 66) painless and 100% (n = 66) not time-consuming. The cost per assessment was low (approx. €6.69) due to low equipment and staff costs.

Conclusion: The MOSST is a seven-item tool recording indicators of oral function and disease. It was shown to be reliable, valid, and feasible for use by non-dental assessors among people with ID. It is low cost, low burden, quick and feasible and offers potential for use among understudied communities.

Objective: Poor oral health (dental decay) is a globally recognised concern, especially among refugee and immigrant children. Poor oral health is linked with children's unhealthy dietary intake and eating patterns. The objective of this study was to explore lunchbox preparation as a social practice and its interconnection with other social practices to understand its effect on children's dietary consumption and in turn on oral health.

Methods: Focused ethnography was utilised to enable an in-depth understanding of lunchbox preparation as a social practice and its elements: materials (physical objects), meanings (purpose) and competences (knowledge). Semi-structured interviews with 35 mothers from culturally and linguistically diverse backgrounds and five service providers, along with observations, were used for data collection. Data were analysed inductively and deductively through a social practice theory lens.

Results: Lunchbox preparation was identified as a social practice shaped by interconnected practices of meal planning, food shopping and cooking. Meanings behind the contents of lunchboxes included children's preferences, emotional dynamics, ideals of responsible parenting not limited to nutrition. Competences in preparing convenient, easy and desirable meals were also noted. Inclusion of ready-to-eat discretionary foods (materials) was also reported.

Conclusion: Through a social practice lens, it was demonstrated how everyday decisions around the contents of lunchboxes are often driven by convenience, emotional needs and not by individual choices. This may contribute to increased consumption of retentive and sugary foods thus shaping dietary routines and eating patterns that have implications for children's oral health. The findings also highlight the need to view these food-related practices as socially embedded rather than purely individual or nutrition-driven.

Recent calls from the World Health Organization (WHO) to globally impose a one-time tax, labelled as "Health tax", on tobacco, alcohol and sugar sweetened beverages (SSBs) aim to achieve a 50% retail price increase to reduce consumption and improve health outcomes. However, with the rise of right-wing governments globally, this substantial intervention might be a hard sell. Right-wing governments usually lean towards tax reductions to stimulate economic growth, job creation and encourage investments. In addition, they support free-market capitalism, deregulation and minimum government interventions. Furthermore, some of such governments share a sentiment of distrust in science and cut health and research spending. Moreover, regardless of political orientations, path dependence (the institutional resistance to change) is another hurdle. In addition, the expected restrictions on the availability and affordability of these products in case of implementing such tax may lead to public rebuttal. All these structural, political and commercial determinants of health raise concerns about the applicability of such intervention and its sustainability if implemented. This commentary argues that the implementation of this substantial one-time tax would be a hard sell and could backlash among most of the right-wing policy makers due to their inherent tax aversion stance and other factors. It suggests that advocacy using a more negotiable approach could be a way forward. For example, "a gradual phased implementation" could offer a viable alternative following two successful case studies from the Philippines and Egypt under their right-wing governments. The Philippines implemented the "Sin Tax Reform" an annual excise tax increase on (tobacco, alcohol, and SSBs) from 2012 onwards, while Egypt imposed annual tax increases on tobacco products since 2010 onwards. These phased approaches seemed to have gained more favourable consideration from right-wing policy makers and contributed to smoking reduction in the Philippines but not in Egypt. In addition, some alternatives such as marketing restrictions on these products among other interventions could be considered. Context specific variations as well as the variations in readiness to adopt such fiscal policies for the health cause among the right-wing political spectrum are acknowledged.

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: 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: A phase-down of dental amalgam use has been mandated and the feasibility of its phase-out in England by 2030 is being explored. Amalgam use in English National Health Service (NHS) care still predominates for posterior restorations, though access to this care is increasingly limited. The objective of this study was to quantify the relative long-term costs and consequences of amalgam versus composite direct posterior restorations in adult permanent teeth in the English NHS setting.

Methods: A microsimulation model of restoration failure and reintervention was constructed and parameterised in TreeAge Pro, based on a review of the literature. It extrapolated costs and outcomes of directly restoring cariously-cavitated lower premolar teeth in 10 000 18-year-old English NHS patients with amalgam and composite restorations over a lifetime-horizon. Discounting of 3.5% was applied to costs and outcomes. An extended medical-sector perspective with societal considerations was taken. Deterministic and probabilistic sensitivity analyses were performed.

Results: Amalgam robustly dominated conventional and bulk-fill composite restorations, being less costly over a lifetime from patient (£70) and funder perspectives (£34), with the restoration and tooth surviving significantly longer (4-years; 12-years non-discounted). Amalgam also incurred reduced numbers of visits (1), treatment time (43-min), and laboratory costs (£8) for fixed and removable prosthodontics over a lifetime. Time until a direct restoration was no longer possible was significantly higher for amalgam than composite (6-years; 17-years non-discounted).

Conclusions: The model showed good internal and external validity, accurately predicting tooth survival following restoration in relation to long-term NHS claims data. Without considerable educational change to upskill clinicians and health service change, an amalgam phase-out in England will likely have significant lifelong impacts on restoration and tooth survival and costs for all stakeholders, whilst reducing societal productivity and exacerbating already existing issues of limited access to care and socio-economic inequalities.

Objectives: While there are plausible biological explanations for the association between oral health and head and neck cancers (HNC), existing studies have yielded conflicting results. A key concern is that these associations are influenced by mediators, unmeasured risk factors, and biases. To address this, a negative control exposure was used to evaluate whether the associations between oral health and HNC risk could be attributed to unmeasured confounding. Additionally, quantitative bias analysis (QBA) was performed to estimate the extent of non-differential misclassification of exposure.

Methods: The HeNCe study, a hospital-based case-control study, recruited incident HNC cases (n = 389) frequency matched to controls (n = 429) by sex and age (within 5 years) from four major referral hospitals in Montreal, Canada. In-person interviews collected information on life course exposures. Unconditional logistic regression estimated the odds ratios (OR) and 95% confidence intervals (CI) for the associations between oral health indicators and HNC, controlling for confounders identified using directed acyclic graphs (DAG). Sexually transmitted diseases (STD) were used as a negative control exposure to test for unmeasured confounding in the associations. QBA, using predetermined bias parameters from previous studies, estimated the magnitude and direction of exposure misclassification bias.

Results: Complete denture use and having more than nine missing teeth were associated with an increased HNC risk [OR = 1.33, 95% CI (0.93-1.90) & OR = 1.31, 95% CI (0.93-1.83)], respectively. Similar results were obtained when stratified by HNC subsite. Negative control analysis yielded a null finding, indicating no significant bias due to unmeasured confounders. Bias-corrected estimates of the association between oral health indicators and HNC risk moved further from the null.

Conclusion: Negative control exposure analysis indicated that unmeasured confounding did not affect the association between oral health and HNC risk. QBA yielded corrected estimates of increased magnitude, suggesting that the crude associations may have been underestimated.

Objectives: To establish the monetary costs of supporting the Indigenous community in Australia to receive culturally safe dental care.

Methods: Financial data was analysed from a follow-up dental intervention study involving 173 Indigenous Australians-164 adults and nine children-who received fully funded dental treatment through private dental clinics. Participants were seen at baseline and 12-month follow-up for an oral health assessment, conducted at a location of their preference. Following the initial assessment, participants were referred to a private dental practice near their residence or of their choosing, with preference given to a practice that employed an Indigenous dentist. The study team provided additional support as required, such as transportation vouchers to attend appointments, assistance with bookings, providing reminders, and checking in regarding treatment experiences.

Results: Most participants were employed and primarily resided in metropolitan and inner regional locations of South Australia. The total expenditure for private dental treatment was nearly $300 000 AUD, with a median per capita cost of $1332 AUD (IQR: $727-$2311). The largest proportion of funding (42.3%) was spent on restorative treatments, both overall and within each age group. Participants who reported they would have considerable difficulty paying a $100 dental bill had a higher median cost of treatment ($1384, IQR: $1073-$2691) than those who reported they would have less difficulty ($961, IQR: $633-$2001). Following dental treatment, participants reported that both their general and oral health improved.

Conclusions: The dental expenditure and volume of care required by participants in this study demonstrate that unmet dental needs persist in the Indigenous community, which can be addressed by reducing cultural, structural, and financial barriers.