Community dentistry and oral epidemiology最新文献

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.

Objectives

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.

Objectives

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.

Objectives

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.

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.

Objectives

To assess the effect of age-period-birth cohort on mortality rates related to lip/oral and oropharyngeal cancer (LOOPC) in Brazil from 1980 to 2019 and to estimate the future mortality rate for 2042.

Materials and Methods

Mortality rate per 100 000 inhabitants, and age-standardised mortality rate (ASR) per 100 000 inhabitants were estimated. The Prais-Winsten regression model was used to estimate the trends and the annual percent change (APC%). The age-period-cohort effects were calculated using the Poisson regression model. Lee-Carter model was employed to perform projections.

Results

A total of 134 941 deaths were observed. Prais-Winsten regression model revealed a slight upward trend in lip and oral cancer mortality among men (p = 0.04) and women (p = 0.02), as well as in oropharyngeal cancer among men (p = 0.02). Significant age-period-cohort was observed for LOOPC in both sexes (p < 0.01). The risk ratio declined in recent cohorts for men (Both Cancers) but increased for women (Lip/Oral Cancer). Period analysis showed a risk increase for lip/oral cancer in recent periods in both sexes and a decrease for men and women for oropharyngeal cancer. In 2042, mortality projections decrease in lip/oral cancer for men aged between 40 and 60 years and oropharyngeal cancer in men between 35 and 60 years. For women, no significant changes are projected. The model projections mortality rate reveal varied outcomes across the diverse regions of Brazil.

Conclusion

A significant age-period cohort was observed over the 40 years assessed. Projections for 2042 indicated a significant decrease in LOOPC mortality rates for men and no change for women.

Globally, the systemic marginalisation of Indigenous Peoples has led to significant health disparities rooted in the legacy of colonisation and ongoing settler colonialism.

Objective

This scoping review aimed to collate oral health promotion training programmes tailored for Indigenous Health Workers (IHW), who play a pivotal role in improving health outcomes by bridging mainstream healthcare with Indigenous Communities, globally.

Methods

A systematic, two-step search was conducted across five databases—PubMed, Scopus, Web of Science, EMBASE and ProQuest Central—without geographic restrictions. Two independent reviewers screened studies, and additional sources were identified from reference lists. A supplementary search of grey literature was performed in Google Scholar and relevant websites.

Results

Of the 374 eligible articles, 11 programmes fulfilled the inclusion criteria. These programmes covered 10 topic areas, including: oral anatomy, early childhood oral health, and the influence of diet and chronic disease on oral health. Effective programmes were collaboratively developed with Indigenous Communities, aligning closely with Community needs and promoting self-determination. The findings emphasise the importance of involving IHW in oral health initiatives to tackle ongoing oral disease disparities and advance oral health equity for Indigenous populations.

Conclusion

By prioritising Indigenous leadership and cultural knowledge, these programs exemplify avenues for strengthening equitable, culturally centred healthcare for Indigenous Communities globally. There remains a critical need for sustainable investment in IHW oral health training, enabling Indigenous-led initiatives to meaningfully address oral health disparities.