Community dentistry and oral epidemiology最新文献

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: 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.

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.

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.