Mariana Silveira Echeverria, Rafaela do Carmo Borges, Sarah Arangurem Karam, Gabrielle Haubert, Mariana Gonzalez Cademartori, Bernardo Antonio Agostini, Flávio Fernando Demarco
Objectives
The aim of the study was to evaluate the number of remaining teeth, use of dental prosthesis, and self-perception of oral health according to sociodemographic variables and use of dental services in a rural population of the Municipality of Pelotas, RS, through a cross-sectional population-based study.
Methods
A cross-sectional study was conducted in the rural area of Pelotas, Brazil, aiming to assess the oral health status of adults aged 18 or older. Data collection occurred through a systematic sampling process in two stages, with sociodemographic factors and oral health outcomes analysed. The number of remaining teeth, use of dental prosthesis, self-perception of oral health and dental visit patterns were among the variables examined. Prevalence ratios were estimated using Poisson regression and odds ratios were estimated using ordinal logistic regression.
Results
Out of 1519 adults surveyed, the majority were male, aged 40–59, and had incomplete elementary education. Elderly women and people in the richest income quintile exhibited lower rates of remaining teeth and higher use of prosthesis, while people with higher education and use of dental services in the last year had more teeth. Worse self-perception of oral health was more prevalent in men, at age 40–59 and who had used dental services for curative reasons.
Conclusions
The study highlights the need for targeted interventions to address oral health disparities in rural areas, emphasising the importance of preventive measures and equitable access to dental services. Strategies focusing on increasing access and reducing financial barriers can contribute to improving oral health outcomes among rural populations.
{"title":"Oral Health Outcomes and Their Sociodemographic and Service Utilisation Determinants in a Rural Population","authors":"Mariana Silveira Echeverria, Rafaela do Carmo Borges, Sarah Arangurem Karam, Gabrielle Haubert, Mariana Gonzalez Cademartori, Bernardo Antonio Agostini, Flávio Fernando Demarco","doi":"10.1111/cdoe.70024","DOIUrl":"10.1111/cdoe.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of the study was to evaluate the number of remaining teeth, use of dental prosthesis, and self-perception of oral health according to sociodemographic variables and use of dental services in a rural population of the Municipality of Pelotas, RS, through a cross-sectional population-based study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted in the rural area of Pelotas, Brazil, aiming to assess the oral health status of adults aged 18 or older. Data collection occurred through a systematic sampling process in two stages, with sociodemographic factors and oral health outcomes analysed. The number of remaining teeth, use of dental prosthesis, self-perception of oral health and dental visit patterns were among the variables examined. Prevalence ratios were estimated using Poisson regression and odds ratios were estimated using ordinal logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 1519 adults surveyed, the majority were male, aged 40–59, and had incomplete elementary education. Elderly women and people in the richest income quintile exhibited lower rates of remaining teeth and higher use of prosthesis, while people with higher education and use of dental services in the last year had more teeth. Worse self-perception of oral health was more prevalent in men, at age 40–59 and who had used dental services for curative reasons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study highlights the need for targeted interventions to address oral health disparities in rural areas, emphasising the importance of preventive measures and equitable access to dental services. Strategies focusing on increasing access and reducing financial barriers can contribute to improving oral health outcomes among rural populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 1","pages":"77-85"},"PeriodicalIF":2.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise Folker, Luna Dolezal, Astrid Pernille Jespersen, Martha Paisi, Lyndsey Withers, Christina Worle, Esben Boeskov Øzhayat
This commentary highlights dental shame as a pervasive but underexplored phenomenon with significant implications for oral health and systemic inequities. It proposes dental shame as a critical lens for understanding and addressing the complex interplay between personal, social, economic, cultural and systemic factors contributing to oral health challenges. Drawing on interdisciplinary expertise, the authors collectively propose that dental shame is both a consequence and determinant of oral health issues, leading to a self-reinforcing dynamic of avoidance, withdrawal and exacerbated inequities. They identify five key aspects of oral health where dental shame warrants deeper investigation: clinical encounters, care and social services, daily oral health behaviours, systemic inequities and psychological trauma. On this basis, the authors call for more research on dental shame and advocate for shame-sensitive practices in dentistry and other health care and social settings. This approach includes fostering shame competence in practitioners, addressing systemic barriers and designing empathetic, inclusive care environments. Ultimately, the authors state that understanding and addressing dental shame can transform oral health promotion, reduce inequities and improve overall health outcomes.
{"title":"Dental Shame: A Call for Understanding and Addressing the Role of Shame in Oral Health","authors":"Louise Folker, Luna Dolezal, Astrid Pernille Jespersen, Martha Paisi, Lyndsey Withers, Christina Worle, Esben Boeskov Øzhayat","doi":"10.1111/cdoe.70019","DOIUrl":"10.1111/cdoe.70019","url":null,"abstract":"<p>This commentary highlights dental shame as a pervasive but underexplored phenomenon with significant implications for oral health and systemic inequities. It proposes dental shame as a critical lens for understanding and addressing the complex interplay between personal, social, economic, cultural and systemic factors contributing to oral health challenges. Drawing on interdisciplinary expertise, the authors collectively propose that dental shame is both a consequence and determinant of oral health issues, leading to a self-reinforcing dynamic of avoidance, withdrawal and exacerbated inequities. They identify five key aspects of oral health where dental shame warrants deeper investigation: clinical encounters, care and social services, daily oral health behaviours, systemic inequities and psychological trauma. On this basis, the authors call for more research on dental shame and advocate for shame-sensitive practices in dentistry and other health care and social settings. This approach includes fostering shame competence in practitioners, addressing systemic barriers and designing empathetic, inclusive care environments. Ultimately, the authors state that understanding and addressing dental shame can transform oral health promotion, reduce inequities and improve overall health outcomes.</p>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 1","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Una Stamere, Inese Stars, Nicola Innes, Natalija Protasa, Sergio E. Uribe, Rodrigo Mariño, Ilze Maldupa
Objectives
Caries prevalence remains high in Latvia, with limited adoption of minimally invasive dentistry (MID). While provider barriers are known, parental perspectives are underexplored. This study examined Latvian parents' views on MID to identify key barriers and facilitators to its acceptance.
Methods
An inductive qualitative approach was applied to explore parents' perceptions of non-invasive and minimally invasive caries management strategies. Data were collected using semi-structured interviews, conducted with parents (n = 19) whose children had experience of either minimally invasive or traditional caries management. All interviews were recorded, transcribed verbatim and analysed with reflexive thematic analysis.
Results
Four main themes were generated: (1) ‘avoiding unnecesary discomfort and distress’ described parents' views and experiences of non-invasive and minimally invasive caries management strategies as physically and psychologically less traumatic for their child and themselves; (2) ‘prioritising treatment qualities’, explored parents' expectations and priorities regarding the qualities offered by different dental treatment options; (3) ‘the power of information’, illustrated that parents' awareness of non-invasive and minimally invasive caries management strategies contributed to a better understanding of treatments and promoted choice, but required access to that information; and (4) ‘choices of suitable options’, described parents' reflections on having a variety of options for dental treatment, rather than a single option offered.
Conclusions
Parents value effective communication, clear information and access to treatment options when considering minimally invasive caries management. Their views highlight the need for a shift towards patient-centred care models that prioritise comfort, informed decision-making and choice in paediatric dentistry.
{"title":"‘How Good to Finally Have Options!’ A Qualitative Reflexive Thematic Analysis Exploring Parents' Perceptions of Non-Invasive and Minimally Invasive Caries Management Strategies","authors":"Una Stamere, Inese Stars, Nicola Innes, Natalija Protasa, Sergio E. Uribe, Rodrigo Mariño, Ilze Maldupa","doi":"10.1111/cdoe.70025","DOIUrl":"10.1111/cdoe.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Caries prevalence remains high in Latvia, with limited adoption of minimally invasive dentistry (MID). While provider barriers are known, parental perspectives are underexplored. This study examined Latvian parents' views on MID to identify key barriers and facilitators to its acceptance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An inductive qualitative approach was applied to explore parents' perceptions of non-invasive and minimally invasive caries management strategies. Data were collected using semi-structured interviews, conducted with parents (<i>n</i> = 19) whose children had experience of either minimally invasive or traditional caries management. All interviews were recorded, transcribed verbatim and analysed with reflexive thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four main themes were generated: (1) ‘avoiding unnecesary discomfort and distress’ described parents' views and experiences of non-invasive and minimally invasive caries management strategies as physically and psychologically less traumatic for their child and themselves; (2) ‘prioritising treatment qualities’, explored parents' expectations and priorities regarding the qualities offered by different dental treatment options; (3) ‘the power of information’, illustrated that parents' awareness of non-invasive and minimally invasive caries management strategies contributed to a better understanding of treatments and promoted choice, but required access to that information; and (4) ‘choices of suitable options’, described parents' reflections on having a variety of options for dental treatment, rather than a single option offered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Parents value effective communication, clear information and access to treatment options when considering minimally invasive caries management. Their views highlight the need for a shift towards patient-centred care models that prioritise comfort, informed decision-making and choice in paediatric dentistry.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 1","pages":"86-100"},"PeriodicalIF":2.1,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maha El Tantawi, Morenike Oluwatoyin Folayan, Ahmed Bhayat
Background
The current heightened attention to oral health underscores the need to address populations who have been historically marginalised in mainstream policy and research endeavours. African countries lack sufficient data on oral health problems and potential solutions to inform decision-making.
Aim
This commentary addresses the shortcomings of oral health research in Africa and proposes a framework to foster fair and efficient research in this area.
Materials and Methods
We present an assessment of the current state of oral health research in Africa and outline key components of the framework.
Results
The framework includes: enhancing the capacities of African researchers, cultivating leadership, prioritising locally pertinent research, establishing equitable partnerships with international researchers, and translating research findings into actionable policies and practices.
Conclusion
These pillars offer a roadmap for steering oral health research in Africa toward impactful outcomes that improve the oral health of African populations.
{"title":"Framework for Equitable and Effective Oral Health Research in Africa","authors":"Maha El Tantawi, Morenike Oluwatoyin Folayan, Ahmed Bhayat","doi":"10.1111/cdoe.70018","DOIUrl":"10.1111/cdoe.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The current heightened attention to oral health underscores the need to address populations who have been historically marginalised in mainstream policy and research endeavours. African countries lack sufficient data on oral health problems and potential solutions to inform decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This commentary addresses the shortcomings of oral health research in Africa and proposes a framework to foster fair and efficient research in this area.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We present an assessment of the current state of oral health research in Africa and outline key components of the framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The framework includes: enhancing the capacities of African researchers, cultivating leadership, prioritising locally pertinent research, establishing equitable partnerships with international researchers, and translating research findings into actionable policies and practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These pillars offer a roadmap for steering oral health research in Africa toward impactful outcomes that improve the oral health of African populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 6","pages":"609-616"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vulnerable groups, particularly those from Culturally and Linguistically Diverse (CALD) backgrounds, face heightened risks of poor oral health. There is a notable gap in systematically analysing the facilitators and challenges dental service providers face in meeting the needs of patients from CALD backgrounds. This study, therefore, sought to systematically review existing literature to address this gap and provide insights into the factors that influence dental service provision for CALD communities.
Methods
A comprehensive search of six electronic databases was conducted to identify facilitators and challenges in oral healthcare provision. Database searches covered January 1985 to May 2025 (last updated 31 May 2025). A meta-integration approach was employed to synthesise qualitative and quantitative findings. The quality of evidence was assessed using the Mixed Method Appraisal Tool (MMAT). Data organisation followed Ferlie and Shortell's healthcare model, with key themes identified via thematic analysis.
Results
Thirteen papers were included in this review, comprising three quantitative and 10 qualitative studies, sourced from diverse countries, including the United Kingdom, Australia, New Zealand, Japan, Sweden, Netherlands, Finland, Germany, the United States and Canada. Article quality varied from moderate to high. Although individual-level factors such as cultural beliefs and language barriers, impacted dental service provision and rigid organisational structures also served as a significant challenge. Structural/system-level challenges included policy implementation gaps, insufficient cross-cultural training for dental providers and affordability issues.
Conclusion
The evidence from dental service providers in diverse settings suggests they encounter several challenges when providing dental care to CALD communities. In summary, delivering culturally sensitive oral healthcare is inherently complex. Policymakers must acknowledge that addressing the needs of CALD patients necessitates establishing supportive environments and strengthening institutional capabilities.
{"title":"A Systematic Review of the Facilitators and Challenges as Perceived by Dental Service Providers in the Provision of Oral Healthcare for Culturally and Linguistically Diverse Populations","authors":"Sudheer Babu Balla, Nikolaos Angelakopoulos, Jyothi Tadakamadla, Santosh Kumar Tadakamadla","doi":"10.1111/cdoe.70021","DOIUrl":"10.1111/cdoe.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Vulnerable groups, particularly those from Culturally and Linguistically Diverse (CALD) backgrounds, face heightened risks of poor oral health. There is a notable gap in systematically analysing the facilitators and challenges dental service providers face in meeting the needs of patients from CALD backgrounds. This study, therefore, sought to systematically review existing literature to address this gap and provide insights into the factors that influence dental service provision for CALD communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search of six electronic databases was conducted to identify facilitators and challenges in oral healthcare provision. Database searches covered January 1985 to May 2025 (last updated 31 May 2025). A meta-integration approach was employed to synthesise qualitative and quantitative findings. The quality of evidence was assessed using the Mixed Method Appraisal Tool (MMAT). Data organisation followed Ferlie and Shortell's healthcare model, with key themes identified via thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen papers were included in this review, comprising three quantitative and 10 qualitative studies, sourced from diverse countries, including the United Kingdom, Australia, New Zealand, Japan, Sweden, Netherlands, Finland, Germany, the United States and Canada. Article quality varied from moderate to high. Although individual-level factors such as cultural beliefs and language barriers, impacted dental service provision and rigid organisational structures also served as a significant challenge. Structural/system-level challenges included policy implementation gaps, insufficient cross-cultural training for dental providers and affordability issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The evidence from dental service providers in diverse settings suggests they encounter several challenges when providing dental care to CALD communities. In summary, delivering culturally sensitive oral healthcare is inherently complex. Policymakers must acknowledge that addressing the needs of CALD patients necessitates establishing supportive environments and strengthening institutional capabilities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 1","pages":"7-21"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tooth loss and cardiovascular disease (CVD) share risk factors and complex pathways in disease progression and co-morbidities. To date, little research on the relationship between tooth loss and CVD has been conducted in American Indian populations. This study investigated the prevalence of edentulism among American Indian adults and its association with the incidence of CVD.
Methods
The ongoing longitudinal Strong Heart Study (SHS) is being conducted in rural American Indian communities in North Dakota, South Dakota and Oklahoma since 1989. This cohort study included SHS participants who had available tooth loss data during the 1997–1999 wave, which serves as the baseline for this analysis. Data analysis was performed in August 2023. Anthropometric, health and behaviour data were obtained from physical exams and interviews. Participants who reported no natural teeth were considered edentulous. CVD events were obtained from continuous mortality and morbidity surveillance through 2019. Crude and adjusted Cox proportional hazards regression models were fit to examine the association of edentulism with CVD events.
Results
Of 1982 participants, 29% (n = 584) were edentulous at baseline, and 41% (n = 822) developed CVD during up to 22 years follow-up. When adjusting for site, age, sex, education, smoking, diabetes, BMI and hypertension, the hazard ratio for developing CVD was 1.36 (95% CI: 1.15, 1.60) for the participants who were edentulous when compared to those reporting natural teeth present.
Conclusions
The findings confirm the high burden of oral diseases and CVD among this sample of American Indians and suggest a significant positive association between edentulism and incidence of CVD that was partially explained by shared risk factors. The study highlights the need for interventions that address risk factors for non-communicable diseases to improve both oral health and cardiovascular health of American Indians.
{"title":"Strong Heart, Strong Smile: Tooth Loss and Incidence of CVD in American Indian Populations","authors":"Lindsey Montileaux Mabbutt, Paul Jensen, Amanda Fretts, Lyle Best, Joana Cunha-Cruz","doi":"10.1111/cdoe.70020","DOIUrl":"10.1111/cdoe.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Tooth loss and cardiovascular disease (CVD) share risk factors and complex pathways in disease progression and co-morbidities. To date, little research on the relationship between tooth loss and CVD has been conducted in American Indian populations. This study investigated the prevalence of edentulism among American Indian adults and its association with the incidence of CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The ongoing longitudinal Strong Heart Study (SHS) is being conducted in rural American Indian communities in North Dakota, South Dakota and Oklahoma since 1989. This cohort study included SHS participants who had available tooth loss data during the 1997–1999 wave, which serves as the baseline for this analysis. Data analysis was performed in August 2023. Anthropometric, health and behaviour data were obtained from physical exams and interviews. Participants who reported no natural teeth were considered edentulous. CVD events were obtained from continuous mortality and morbidity surveillance through 2019. Crude and adjusted Cox proportional hazards regression models were fit to examine the association of edentulism with CVD events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1982 participants, 29% (<i>n</i> = 584) were edentulous at baseline, and 41% (<i>n</i> = 822) developed CVD during up to 22 years follow-up. When adjusting for site, age, sex, education, smoking, diabetes, BMI and hypertension, the hazard ratio for developing CVD was 1.36 (95% CI: 1.15, 1.60) for the participants who were edentulous when compared to those reporting natural teeth present.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings confirm the high burden of oral diseases and CVD among this sample of American Indians and suggest a significant positive association between edentulism and incidence of CVD that was partially explained by shared risk factors. The study highlights the need for interventions that address risk factors for non-communicable diseases to improve both oral health and cardiovascular health of American Indians.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 1","pages":"61-68"},"PeriodicalIF":2.1,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander Pham, Joanne Hedges, Emma Flanagan, Tiyanna Mastrosavas, Lisa Jamieson, Sonia Nath
<div> <section> <h3> Objective</h3> <p>Over the last 20 years, the disparity in oral health between Aboriginal and Torres Strait Islander Australians and other Australians has continued to grow. This suggests that further programmes and programme improvements are needed to reach equitable oral health outcomes for Aboriginal and Torres Strait Islander Peoples. This mixed methods systematic review aims to assess Aboriginal and Torres Strait Islander Dental Programme Evaluations by measuring outcomes and cultural safety via the Lowitja Institute Evaluation Framework to Improve Aboriginal and Torres Strait Islander Health.</p> </section> <section> <h3> Methods</h3> <p>Databases searched were PubMed, Embase, Dentistry & Oral Sciences Source, Public Health Database and Scopus. All years were included. The date of the last search was the 1 May 2025. Published articles researching dental health programmes with Aboriginal and Torres Strait Islander participants in Australia were identified. Quantitative, qualitative and mixed methods studies were included. The Joanna Briggs Institute approach to Mixed-Methods Systematic Reviews was followed, except for a deviation in critical appraisal, which utilised the Quality Assessment for Diverse Studies (QuADs) instead. This review protocol was registered in PROSPERO (CRD42025637868) a priori.</p> </section> <section> <h3> Results</h3> <p>There were 54 studies included. New South Wales, South Australia, Queensland, Northern Territory and Western Australia were the states with the most data. The research designs included qualitative, quantitative and mixed-methods approaches. Most studies were of relatively high quality, as assessed by the QuADS criteria. Evaluations of dental programs for Aboriginal and Torres Strait Islander communities largely adhered to the Lowitja Framework, particularly in shared responsibility, partnerships and active engagement with Aboriginal and Torres Strait Islander peoples and their communities. Program effectiveness was primarily assessed through reductions in dental decay and participant feedback. Findings may be limited because the Lowitja Framework was developed via evaluation tenders, and the studies included were sourced from research articles.</p> </section> <section> <h3> Conclusions</h3> <p>Strong partnerships between programs, evaluation teams and Aboriginal and Torres Strait Islander communities are critical for cultural safety. Effective study designs should be used, and culturally relevant and holistic outcome measures should be chosen. Lessons learnt from this systematic
目的：在过去20年中，澳大利亚土著和托雷斯海峡岛民与其他澳大利亚人之间的口腔健康差距继续扩大。这表明需要进一步的方案和方案改进，以实现土著和托雷斯海峡岛民公平的口腔健康结果。这项混合方法系统评价旨在通过洛维贾研究所改善土著和托雷斯海峡岛民健康评估框架衡量结果和文化安全，评估土著和托雷斯海峡岛民牙科方案评估。方法：检索PubMed、Embase、Dentistry & Oral Sciences Source、Public Health Database和Scopus数据库。所有年份都包括在内。最后一次搜索的日期是2025年5月1日。已发表的研究澳大利亚土著居民和托雷斯海峡岛民参加的牙齿保健方案的文章被确认。包括定量、定性和混合方法研究。采用了Joanna Briggs研究所的混合方法系统评价方法，除了在关键评价上有偏差，而是使用了多样化研究的质量评估（QuADs）。该审查方案在PROSPERO （CRD42025637868）中先验注册。结果：共纳入54项研究。新南威尔士州、南澳大利亚州、昆士兰州、北领地和西澳大利亚州是数据最多的州。研究设计包括定性、定量和混合方法。根据QuADS标准，大多数研究的质量相对较高。对土著居民和托雷斯海峡岛民社区牙科项目的评估基本上遵循了洛维贾框架，特别是在与土著居民和托雷斯海峡岛民及其社区的共同责任、伙伴关系和积极参与方面。项目的有效性主要通过减少蛀牙和参与者反馈来评估。结果可能有限，因为Lowitja框架是通过评估招标制定的，所纳入的研究来自研究论文。结论：项目、评估小组、原住民和托雷斯海峡岛民社区之间强有力的伙伴关系对文化安全至关重要。应采用有效的研究设计，并选择与文化相关的整体结果测量方法。从这一系统审查中吸取的经验教训可用于提高土著和托雷斯海峡岛民牙科方案评价的有效性。
{"title":"Aboriginal and Torres Strait Islander Dental Program Evaluations: A Mixed-Methods Systematic Review","authors":"Alexander Pham, Joanne Hedges, Emma Flanagan, Tiyanna Mastrosavas, Lisa Jamieson, Sonia Nath","doi":"10.1111/cdoe.70023","DOIUrl":"10.1111/cdoe.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Over the last 20 years, the disparity in oral health between Aboriginal and Torres Strait Islander Australians and other Australians has continued to grow. This suggests that further programmes and programme improvements are needed to reach equitable oral health outcomes for Aboriginal and Torres Strait Islander Peoples. This mixed methods systematic review aims to assess Aboriginal and Torres Strait Islander Dental Programme Evaluations by measuring outcomes and cultural safety via the Lowitja Institute Evaluation Framework to Improve Aboriginal and Torres Strait Islander Health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Databases searched were PubMed, Embase, Dentistry & Oral Sciences Source, Public Health Database and Scopus. All years were included. The date of the last search was the 1 May 2025. Published articles researching dental health programmes with Aboriginal and Torres Strait Islander participants in Australia were identified. Quantitative, qualitative and mixed methods studies were included. The Joanna Briggs Institute approach to Mixed-Methods Systematic Reviews was followed, except for a deviation in critical appraisal, which utilised the Quality Assessment for Diverse Studies (QuADs) instead. This review protocol was registered in PROSPERO (CRD42025637868) a priori.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 54 studies included. New South Wales, South Australia, Queensland, Northern Territory and Western Australia were the states with the most data. The research designs included qualitative, quantitative and mixed-methods approaches. Most studies were of relatively high quality, as assessed by the QuADS criteria. Evaluations of dental programs for Aboriginal and Torres Strait Islander communities largely adhered to the Lowitja Framework, particularly in shared responsibility, partnerships and active engagement with Aboriginal and Torres Strait Islander peoples and their communities. Program effectiveness was primarily assessed through reductions in dental decay and participant feedback. Findings may be limited because the Lowitja Framework was developed via evaluation tenders, and the studies included were sourced from research articles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Strong partnerships between programs, evaluation teams and Aboriginal and Torres Strait Islander communities are critical for cultural safety. Effective study designs should be used, and culturally relevant and holistic outcome measures should be chosen. Lessons learnt from this systematic","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 6","pages":"713-723"},"PeriodicalIF":2.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study was to investigate the link between prolonged breastfeeding (≥ 12 months) and early childhood caries (ECC) using propensity score matching (PSM) to account for observed confounders, reduce bias, and provide a more reliable estimate of this relationship.
Methods
This study utilised data from the French Longitudinal Study of Children (ELFE Cohort), comprising 11 718 participants. PSM was employed to pair children who were breastfed for 12 months or longer with those breastfed for less than 12 months or not at all, controlling for shared risk factors such as socioeconomic status and dietary habits. Logistic regression models were conducted to examine the association between ECC, reported by the parents at 3.5 years, and prolonged breastfeeding.
Results
Infants (7.6%) who were breastfed for 12 months or more exhibited twice the odds of developing ECC at 3.5 years compared to those breastfed for less than 12 months or not at all (OR = 2.20, 95% CI: 1.39, 3.47).
Conclusion
Children breastfed for 12 or more months are at increased risk of developing ECC. Further research is needed to investigate specific breastfeeding practices that may contribute to this increased risk, with the aim of promoting prolonged breastfeeding while ensuring optimal oral health.
{"title":"Association of Prolonged Breastfeeding With Early Childhood Caries Using Propensity Score Matching in the French Longitudinal Study of Children (ELFE Cohort)","authors":"Untray Brown, Sylvie Azogui-Levy, Cathy Nabet, Marie-Noëlle Dufourg, Marie-Aline Charles, Joséphine Kerguen, Monique Kaminski, Laetitia Marchand-Martin, Alice Germa","doi":"10.1111/cdoe.70012","DOIUrl":"10.1111/cdoe.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this study was to investigate the link between prolonged breastfeeding (≥ 12 months) and early childhood caries (ECC) using propensity score matching (PSM) to account for observed confounders, reduce bias, and provide a more reliable estimate of this relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study utilised data from the French Longitudinal Study of Children (ELFE Cohort), comprising 11 718 participants. PSM was employed to pair children who were breastfed for 12 months or longer with those breastfed for less than 12 months or not at all, controlling for shared risk factors such as socioeconomic status and dietary habits. Logistic regression models were conducted to examine the association between ECC, reported by the parents at 3.5 years, and prolonged breastfeeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Infants (7.6%) who were breastfed for 12 months or more exhibited twice the odds of developing ECC at 3.5 years compared to those breastfed for less than 12 months or not at all (OR = 2.20, 95% CI: 1.39, 3.47).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Children breastfed for 12 or more months are at increased risk of developing ECC. Further research is needed to investigate specific breastfeeding practices that may contribute to this increased risk, with the aim of promoting prolonged breastfeeding while ensuring optimal oral health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 6","pages":"655-666"},"PeriodicalIF":2.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Objectives</h3> <p>From the perspective of Universal Health Coverage (UHC) to reduce health inequalities, health insurance plays a crucial role. This study examined the mediating effect of health insurance on the economic and educational inequalities in dental utilisation patterns among Indonesian adults.</p> </section> <section> <h3> Methods</h3> <p>This cross-sectional study analysed self-reported data from participants (<i>n</i> = 26 351) of the Indonesian Family Life Survey-5 (IFLS-5) conducted during the transition of Indonesia's health financing system in 2014–2015. Economic and educational inequalities in dental utilisation were measured and examined using the relative concentration index (RCI). A multinomial logistic regression, adjusted for confounders (sex, age, ethnicity, religion, marital status, household size and residency based on province and rural–urban), examined the association of economic status (quintiles of adjusted monthly household expenditure) and educational status (unschooled to higher education) with dental utilisation patterns (never/irregular/regular). The extent to which the association was explained by health insurance ownership (public and private insurance) was assessed using the Karlson–Holm–Breen mediation method.</p> </section> <section> <h3> Results</h3> <p>Among participants, 12.9% of individuals utilise dental visits irregularly and 1.4% regularly, with the utilisation concentrated among those with higher economic status (RCI: 0.30, standard error [SE]: 0.01) and educational status (RCI: 0.34, SE: 0.01). Compared to those with the lowest economic quintile, the highest economic quintile showed higher odds of irregular utilisation (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.89–2.48) and regular utilisation (OR: 4.28; 95% CI: 2.50–7.34). People with higher education were more likely to utilise dental care, with higher odds ratios of irregular utilisation (OR: 6.80; 95% CI: 5.04–9.18) and regular utilisation (OR: 7.34; 95% CI: 2.24–24.04) compared to unschooled individuals. Private insurance partly mediated the association with regular dental utilisation: stronger indirect effects were observed at the highest economic level (proportion mediated [PM]: 10.6%) and highest educational level (PM: 9.2%). In contrast, the mediation effects of public insurance were less remarkable.</p> </section> <section> <h3> Conclusion</h3> <p>Education and economic status play a significant role in determining dental utilisation patterns, with limited mediating effects for public insurance on these as
{"title":"Mediating Role of Health Insurance on Socioeconomic Inequalities in Dental Utilisation Patterns Among Indonesian Adults","authors":"Safira Khairinisa, Yusuke Matsuyama, Sakura Kiuchi, Diah Ayu Maharani, Jun Aida","doi":"10.1111/cdoe.70013","DOIUrl":"10.1111/cdoe.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>From the perspective of Universal Health Coverage (UHC) to reduce health inequalities, health insurance plays a crucial role. This study examined the mediating effect of health insurance on the economic and educational inequalities in dental utilisation patterns among Indonesian adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study analysed self-reported data from participants (<i>n</i> = 26 351) of the Indonesian Family Life Survey-5 (IFLS-5) conducted during the transition of Indonesia's health financing system in 2014–2015. Economic and educational inequalities in dental utilisation were measured and examined using the relative concentration index (RCI). A multinomial logistic regression, adjusted for confounders (sex, age, ethnicity, religion, marital status, household size and residency based on province and rural–urban), examined the association of economic status (quintiles of adjusted monthly household expenditure) and educational status (unschooled to higher education) with dental utilisation patterns (never/irregular/regular). The extent to which the association was explained by health insurance ownership (public and private insurance) was assessed using the Karlson–Holm–Breen mediation method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among participants, 12.9% of individuals utilise dental visits irregularly and 1.4% regularly, with the utilisation concentrated among those with higher economic status (RCI: 0.30, standard error [SE]: 0.01) and educational status (RCI: 0.34, SE: 0.01). Compared to those with the lowest economic quintile, the highest economic quintile showed higher odds of irregular utilisation (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.89–2.48) and regular utilisation (OR: 4.28; 95% CI: 2.50–7.34). People with higher education were more likely to utilise dental care, with higher odds ratios of irregular utilisation (OR: 6.80; 95% CI: 5.04–9.18) and regular utilisation (OR: 7.34; 95% CI: 2.24–24.04) compared to unschooled individuals. Private insurance partly mediated the association with regular dental utilisation: stronger indirect effects were observed at the highest economic level (proportion mediated [PM]: 10.6%) and highest educational level (PM: 9.2%). In contrast, the mediation effects of public insurance were less remarkable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Education and economic status play a significant role in determining dental utilisation patterns, with limited mediating effects for public insurance on these as","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 6","pages":"685-695"},"PeriodicalIF":2.1,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fatemeh Vida Zohoori, Marilia Afonso Rabelo Buzalaf, Anne Maguire, Roy Sanderson, Rodrigo A. Giacaman, Stefania Martignon, Edgar O. Beltran, Fatemeh Eskandari, Jelena Kronic, Karla Gambetta-Tessini, Flavia Mauad Levy
Objectives
Fluoride exposure in children is commonly estimated using questionnaires or urinary biomarkers. However, no study has yet compared these methods for classifying participants into five intake categories ranging from low to high. This study aimed to estimate the extent of agreement and classification consistency between questionnaire- and urinary-based methods for assessing total daily fluoride intake (TDFI) in children aged 4–7 years.
Methods
A total of 104 healthy children across three countries (UK, Brazil, Chile) receiving one of three fluoridation modalities (non-fluoridated-water, fluoridated-water, or fluoridated-milk) provided a 24-h urine sample and completed validated dietary and oral hygiene questionnaires. TDFI was estimated from dietary sources and toothpaste ingestion, adjusted for body weight. Urinary fluoride concentration was measured and 24 h-UFE determined by multiplying urine volume by fluoride concentration. TDFI was predicted from 24 h-UFE using the WHO's recommended method. Method agreement was assessed using paired t-tests and Bland–Altman analysis to evaluate continuous fluoride intake estimates. Cohen's kappa was used to assess agreement between categorical intake classifications, while descriptive statistics reported the percentage of children in each intake group.
Results
The questionnaire method estimated a higher mean TDFI (0.072 mg/kgbw/day) than the urine-based method (0.058 mg/kgbw/day, p = 0.01). Bland–Altman analysis showed good agreement for lower mean TDFI values (< 0.10 mg/kgbw/day) but increasing variability at higher fluoride intake levels. The questionnaire classified a larger proportion of children as high exposure (≥ 0.1 mg/kgbw/day) than the urine method (19.2% vs. 11.5%), with the greatest discrepancy observed in the fluoridated milk group (46.2% vs. 7.7%). Despite these classifications, Cohen's kappa revealed minimal agreement between methods (κ = 0.034, p = 0.508), suggesting that classification concordance was likely due to chance.
Conclusion
This first study comparing questionnaire and urinary methods for assessing TDFI in children found significant discrepancies and minimal agreement, especially in higher exposure groups, highlighting the risk of misclassification and the need for research into combined assessment approaches.
目的：通常使用问卷调查或尿液生物标志物来估计儿童的氟化物暴露。然而，目前还没有研究将这些方法进行比较，将参与者分为从低到高的五个摄入量类别。本研究旨在评估问卷法和尿法在评估4-7岁儿童每日总氟摄入量（TDFI）方面的一致性程度和分类一致性。方法：来自三个国家（英国、巴西、智利）的104名健康儿童接受了三种氟化方式（非氟化水、氟化水或氟化牛奶）中的一种，提供了24小时尿液样本，并完成了经过验证的饮食和口腔卫生问卷。TDFI是根据饮食来源和牙膏摄入量估算的，并根据体重进行调整。测定尿氟浓度，用尿量乘以氟化物浓度测定24h - ufe。使用世界卫生组织推荐的方法从24 h-UFE预测TDFI。使用配对t检验和Bland-Altman分析来评估连续氟化物摄入量估计，评估方法一致性。Cohen’s kappa被用于评估分类摄入之间的一致性，而描述性统计报告了每个摄入组中儿童的百分比。结果：问卷法估计的TDFI平均值（0.072 mg/kgbw/d）高于尿法（0.058 mg/kgbw/d, p = 0.01）。Bland-Altman分析显示较低的平均TDFI值具有良好的一致性(结论：这是第一个比较问卷调查和尿液方法评估儿童TDFI的研究，发现显著差异和最小的一致性，特别是在高暴露组，突出了错误分类的风险和研究联合评估方法的必要性。
{"title":"Assessing Total Fluoride Intake in Children: Reliability of Commonly Used Methods","authors":"Fatemeh Vida Zohoori, Marilia Afonso Rabelo Buzalaf, Anne Maguire, Roy Sanderson, Rodrigo A. Giacaman, Stefania Martignon, Edgar O. Beltran, Fatemeh Eskandari, Jelena Kronic, Karla Gambetta-Tessini, Flavia Mauad Levy","doi":"10.1111/cdoe.70015","DOIUrl":"10.1111/cdoe.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Fluoride exposure in children is commonly estimated using questionnaires or urinary biomarkers. However, no study has yet compared these methods for classifying participants into five intake categories ranging from low to high. This study aimed to estimate the extent of agreement and classification consistency between questionnaire- and urinary-based methods for assessing total daily fluoride intake (TDFI) in children aged 4–7 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 104 healthy children across three countries (UK, Brazil, Chile) receiving one of three fluoridation modalities (non-fluoridated-water, fluoridated-water, or fluoridated-milk) provided a 24-h urine sample and completed validated dietary and oral hygiene questionnaires. TDFI was estimated from dietary sources and toothpaste ingestion, adjusted for body weight. Urinary fluoride concentration was measured and 24 h-UFE determined by multiplying urine volume by fluoride concentration. TDFI was predicted from 24 h-UFE using the WHO's recommended method. Method agreement was assessed using paired t-tests and Bland–Altman analysis to evaluate continuous fluoride intake estimates. Cohen's kappa was used to assess agreement between categorical intake classifications, while descriptive statistics reported the percentage of children in each intake group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The questionnaire method estimated a higher mean TDFI (0.072 mg/kgbw/day) than the urine-based method (0.058 mg/kgbw/day, <i>p</i> = 0.01). Bland–Altman analysis showed good agreement for lower mean TDFI values (< 0.10 mg/kgbw/day) but increasing variability at higher fluoride intake levels. The questionnaire classified a larger proportion of children as high exposure (≥ 0.1 mg/kgbw/day) than the urine method (19.2% vs. 11.5%), with the greatest discrepancy observed in the fluoridated milk group (46.2% vs. 7.7%). Despite these classifications, Cohen's kappa revealed minimal agreement between methods (κ = 0.034, <i>p</i> = 0.508), suggesting that classification concordance was likely due to chance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This first study comparing questionnaire and urinary methods for assessing TDFI in children found significant discrepancies and minimal agreement, especially in higher exposure groups, highlighting the risk of misclassification and the need for research into combined assessment approaches.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 6","pages":"667-675"},"PeriodicalIF":2.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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