Community dentistry and oral epidemiology最新文献

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.

Objectives: The "valley of death" between research and practice remains a major challenge. The five-stage Translational Research framework (TR1-TR5) provides a pathway, moving evidence into real-world impact. Traditionally, Randomised Controlled Trials (RCTs) dominate TR stages, yet they are often impractical in public health. Longitudinal observational studies (LOSs), combined with advanced causal statistics, can emulate RCTs. Using the relationship between socioeconomic status (SES) and early childhood caries (ECC) as a case study, where SES is a complex, upstream determinant lacking trial evidence, this study illustrates how LOSs paired with causal statistics, within the TR framework, can generate policy-relevant action, highlighting a promising yet underused strategy.

Methods: This paper first reviewed causal inference gaps identified in a published scoping review of 85 LOSs (TR1), focusing on a subset of 20 studies presented in this paper that examined the relationship between SES and dental caries. The review analysed SES construction, gaps in SES-oral health behaviour-caries pathways, and the use of advanced causal statistics. Findings from TR2 (published) were then summarised to highlight key modifiable mediators linking SES and ECC, followed by TR3-4 (published), which examined interventions targeting these mediators across populations. Finally, this paper presented TR5 for the first time, extending the analysis to estimate population-level impact metrics.

Results: TR1 highlighted that most LOSs remained focused on associations rather than causal inference. SES construction was inconsistent and the mechanisms linking SES to dental caries have not been comprehensively examined. TR2 identified free sugar intake (FSI) as a key modifiable mediator. TR3-4 emphasised on reducing FSI to < 10% lowered ECC risk in the general population and suggested < 5% for the high-risk groups. TR5 highlighted that stricter FSI thresholds produced substantial population-level gains.

Conclusion: The TR framework supported by advanced causal statistics enables translating LOSs into effective public health evidence in the absence of RCTs.

Objectives: The engagement and retention of Indigenous participants are critical factors in the success of oral health research, particularly in longitudinal studies. However, participant experiences and perceptions of Indigenous research involvement remain underexplored. The objective of this qualitative study was to explore Indigenous participants' experiences of culturally safe oral health research.

Methods: The longitudinal intervention study involved Indigenous adults who received culturally safe dental care. The intervention included home-based dental checks, flexible appointment scheduling, regular follow-up and financial support for dental treatment at a local dental clinic. Following dental treatment, semi-structured interviews were conducted using a yarning-based approach to document participants' experiences of both the intervention and the study processes. Interviews were audio-recorded, transcribed and analysed thematically.

Results: Four themes were developed from 136 participants' experiences of culturally safe dental research: (1) research and clinical team characteristics including positive interactions with team members and personalised care; (2) participation in a research intervention that breaks down barriers to dental care including home visits, flexible scheduling and financial support; (3) research participation as a means of supporting personal and community health; and (4) a community-driven recruitment strategy that improved trust and retention.

Conclusions: Culturally safe, community-driven dental research centred on Indigenous representation, personalised care and home-based dental service delivery can effectively reduce barriers to dental care and improve engagement and retention among Indigenous participants in oral health research.

Objectives: The objective of this scoping review was to map existing literature on oral health and related care in individuals with Motor Neurone Disease (MND). Specifically, the review aimed to identify barriers and facilitators to maintaining oral hygiene, summarise available clinical guidelines and patient-facing resources, and examine how oral health care is integrated within multidisciplinary management of MND.

Methods: The review focused on oral health practices without restrictions on language, publication date or study type, excluding studies unrelated to MND or oral health. Data sources included MEDLINE, Embase, CINAHL, and grey literature such as clinical guidelines and patient resources. Screening and data extraction were performed independently by two reviewers to ensure rigor.

Results: Of 847 studies screened, eleven primary studies met the inclusion criteria, comprising case reports, case series, self-reports, cross-sectional studies and letters. The grey literature search identified three clinical guidelines and eight patient information leaflets/resources. The included studies spanned diverse populations, including Amyotrophic Lateral Sclerosis (ALS) patients with varying disease subtypes and care needs, and explored oral hygiene difficulties, care barriers and unique insights from the case studies. Identified gaps highlighted the lack of integration of dental professionals into multidisciplinary care teams. Barriers such as physical limitations, caregiver dependency and limited-service accessibility were prevalent. However, caregiver involvement, multidisciplinary collaboration and innovative solutions like antimicrobial photodynamic therapy and adaptive oral aids emerged as enablers. Poor oral health was strongly associated with increased pain, aspiration pneumonia and diminished well-being, emphasising the need for targeted interventions.

Conclusion: Embedding oral health management within multidisciplinary care frameworks for MND patients, enhancing caregiver training, improving access to dental services and adopting innovative strategies will improve patient outcomes and inform future research.

Objectives: To determine the extent that parenting styles and oral health behaviours mediate the relationship between socioeconomic circumstances (SEC) and childhood dental caries experience: pre-/post-national roll-out in 2011 of Childsmile, the child oral health improvement programme for Scotland.

Methods: A longitudinal design linked 2798 participants from Birth Cohort-1 (following from age 10 months in 2005/06 to age 5 years in 2009/10) and 3015 from Birth Cohort-2 (following from age 10 months in 2011 to age 5 years in 2015) of the Growing Up in Scotland study with caries experience at age five from the National Dental Inspection Programme. Two Structural Equation Models (Birth Cohort-1 and 2) tested an a priori framework to explain the social gradient (SEC: Income Poverty, Area-based Deprivation, Household Education, Household Employment) in caries experience, considering proximal behaviours (toothbrushing, cariogenic diet, regular dental attendance) before introducing validated parenting styles (Parental Responsiveness/Demandingness).

Results: Models for both the pre-/post-Childsmile cohorts illustrated similar pathways. Dental attendance and parenting had no direct effect on caries experience. Responsiveness partially mediated the SEC-toothbrushing relationship, while demandingness partially mediated the SEC-diet relationship. Cariogenic diet directly increased caries experience prevalence (β = 0.33/0.24), while increased toothbrushing persistently decreased caries (β = -0.18/-0.13). Total mediated effect of SEC decreased from 58.8% to 39.1%, with the largest relative decrease being directly via toothbrushing (9.5%/4.0%). The effect mediated through parenting pathways remained minimal (4.8%/3.5%).

Conclusions: Pathways between SEC and childhood caries were unchanged after Childsmile roll-out, with minimal effects from parenting styles. The diminishing SEC effects via toothbrushing may be positively attributed to Childsmile interventions. The persistent unexplained effect of SEC on caries experience highlights the need for equity-focused structural approaches that address broader socioeconomic inequalities.

Despite its significant global burden, oral health continues to be excluded from global health systems, policies and discourse. This exclusion reflects more than institutional neglect; it reflects entrenched structural, epistemic and professional dynamics that have marginalised oral health both externally and internally. This commentary makes the case for constituting global oral health as a distinct science and action discipline. Grounded in dental public health and oral epidemiology but extending beyond them, global oral health needs to address transnational determinants, apply systems thinking and pursue equity through a decolonial lens. We advance four core arguments: that the field lacks a coherent scientific identity; that building a functional discipline requires strategic, epistemic and institutional alignment; that oral health's exclusion is reinforced by both global health structures and professional self-isolation; and that a distinct disciplinary identity is essential for systemic integration and relevance. A comparative delineation and a working definition help clarify the scope of this reconfigured field. Moving beyond symbolic inclusion requires building an intellectually grounded, politically conscious and structurally engaged discipline capable of actively shaping the future of global oral health.

Objectives: Inequitable access to healthcare is a central driver of the disproportionate burden of disease in Indigenous peoples. The aim of this study is to investigate inequities in access to dental care, accounting for supra-additive effects at the intersections of educational attainment, household income, and Indigeneity.

Methods: Data were extracted from the 2017 to 2018 Canadian Community Health Survey, a national survey of Canada's ten provinces and three territories. A multilevel analysis of individual heterogeneity and discriminatory accuracy was performed, defining 18 intersectional strata by educational attainment, household income, and Indigenous status. Three outcomes pertaining to dental care access were assessed: (i) dental attendance in the past 12 months, (ii) attending the dentist never or only for emergencies, and (iii) avoiding attending the dentist due to cost.

Results: There was evidence of substantial between-stratum heterogeneity in access to dental care. Fixed effects of age, sex, educational attainment, household income, and Indigeneity explained 91.0%-98.2% of the between-stratum variance. The median odds ratio (MOR) indicated that, depending on intersectional identity, the odds increased by 80% for having visited the dentist in the past 12 months (MOR: 1.80; 95% CI: 1.71-2.08), 118% for attending never or only for emergencies (MOR: 2.18; 95% CI: 2.04-2.50), and 83% for avoiding visits due to cost (MOR: 1.83; 95% CI: 1.68-2.22).

Conclusion: Indigenous status and socioeconomic position greatly concentrate the risk of poor access to dental care, but there is little evidence for supra-additive interactions between these factors.

Objectives: Nutritional disorders and dental caries share common risk factors, including diet and socioeconomic position, but the association between these two conditions remains unclear. The aim of this study was to investigate the potential association between overweight/obesity and the occurrence of dental caries in primary dentition.

Methods: This longitudinal study, conducted using data from the 2015 Pelotas Birth Cohort, utilised information collected at birth, 24 months and 4 years of age. The exposure variable was the obesity collected by BMI (body mass index), at 24 months, using anthropometric measures (weight and height) and classified according to WHO guidelines. Covariates included sex, child's and maternal age, socioeconomic factors (family income and maternal education) and sugar consumption data. The outcome was dental caries at the age of four, assessed using several variables: early childhood caries (ECC), encompassing all activity including white spots and restorations; severe early childhood caries (S-ECC), which refers exclusively to cavitated lesions; and the dmft (Decayed, Missing and Filled Teeth) index. Descriptive analysis was carried out and regression models were tested.

Results: From the 4275 eligible participants, 3374 children (50.5% boys and 49.5% girls) composed the analytical sample. At 24 months, 2474 (73.3%) children were healthy weight (95% CI 71.8; 74.8) and 900 (26.7%) presented overweight/obesity (18.8% overweight and 7.9% obese). Concerning dental caries at the age of four, 37.6% had ECC (including white spots and restorations) and 21.4% had S-ECC. Among children classified as healthy weight at 24 months, 38.6% presented ECC at 4 years of age. Among obese children, the prevalence of ECC was 34.8%. A similar pattern was observed for S-ECC: the prevalence was 22.0% among healthy weight children, 19.9% among overweight and 19.1% among obese children. The Poisson regression analysis adjusting for confounding factors showed no difference between groups.

Conclusions: In conclusion, this cohort study in Brazilian children at the age of four did not observe meaningful associations between overweight/obesity and dental caries in primary dentition. The findings suggest that obesity in childhood should not be considered a risk factor for caries development in children.

Objectives: The aim of this mixed methods systematic review was to identify oral health interventions in rural areas of high-income countries and synthesise the evidence on how access is addressed.

Methods: Searches were conducted in Cochrane, CINAHL, Dentistry and Oral Sciences Source, PsycINFO and PubMed, with the last search in January-February 2025. All study types published in English since 2000 were included that reported oral health interventions aimed at addressing access to dental services. The Mixed Methods Appraisal Tool was used to assess study quality. The Penchansky and Thomas model of access, with Saurman's adaptation, guided the thematic synthesis.

Results: The final dataset was 73 articles. Most authors reported small-scale interventions delivered by dental and primary health providers. Fluoride varnish application, treatments and health promotion were most reported in clinics, community settings and schools. Lack of service availability and accessibility caused by geographic distance required alternative service models, including telehealth. Free or minimal cost interventions were needed in low-income settings. Stakeholder partnerships and understanding of local context were critical. Evaluations of community acceptability and awareness were rare. There was a dearth of studies addressing the six dimensions of access, with wide variation in study quality.

Conclusions: There is an absence of robust, well evaluated studies, with lack of homogeneity preventing meta-analysis. Rural oral health interventions should be informed by comprehensive frameworks of access, be grounded in equity, involve communities in design, development and evaluation, should reduce silos between oral and general healthcare, and should prioritise prevention. Access to high quality oral health is a fundamental human rights and equity issue for rural people.

Objectives: Dental care-related fear and anxiety, involving emotional reactions to dental situations, can negatively impact children's quality of life, oral and systemic health. Recognising maternal characteristics as key determinants of child health, this study examined the intergenerational relationship between dental fear/anxiety and early childhood dental service utilisation.

Methods: Data were drawn from the baseline (birth), 12-month, and four-year follow-ups of the 2015 Pelotas Birth Cohort Study (Brazil). Outcomes included child dental fear/anxiety and dental service use (frequency and reasons) at age four. Exposures were maternal dental fear/anxiety at 12-month and maternal assessment of child dental fear/anxiety. Covariates, including maternal education and family income, were collected perinatally. All variables were obtained through questionnaires administered to mothers at each follow-up. Analyses used Poisson and multinomial logistic regression models.

Results: The sample included 3809 mother-child dyads; 79.7% of mothers and 64.2% of children had no reported dental fear/anxiety, yet 64.0% of children had never visited a dentist. Adjusted analyses showed that maternal dental fear/anxiety was associated with a 1.20 times higher prevalence of childhood dental fear/anxiety (PR = 1.20, 95% CI = 1.09; 1.32). Children with dental fear/anxiety had a 1.89 times higher prevalence of visits for curative reasons (PR = 1.89, 95% CI = 1.45; 2.48) and a 2.10 times higher prevalence of never visiting a dentist (PR = 2.10, 95% CI = 1.78; 2.48), adjusting for maternal dental fear/anxiety.

Conclusion: Early and regular preventive visits may help mitigate dental fear/anxiety. This study highlights the intergenerational link between maternal and childhood dental fear and its impact on dental service utilisation.