Community dentistry and oral epidemiology最新文献

Objectives

Oral diseases are the most prevalent diseases globally, affecting almost half of the world's population with a disproportionate burden on the most vulnerable groups. Despite growing attention on the social and commercial determinants of health, there is still a largely unexplored area in understanding the political determinants of health and oral health. The aim of this paper is to describe national policy development processes for policies impacting population oral health.

Methods

A multiple case study approach was used to analyse six case studies focused on national policy development processes targeting oral health. Kingdon's Multiple Streams Model was used to examine how problems, policy solutions, and political factors aligned to influence policymaking.

Results

Some of the most common barriers to policy adoption and implementation were misinformation strategies, legal challenges, industry lobbying, ideological opposition to state intervention, and lack of transparency regarding conflicts of interest. Important common facilitators included robust scientific evidence presented in an accessible manner to the appropriate audiences, identification of key decision-makers, support from parties from across the political spectrum, intersectoral collaboration, and ongoing policy monitoring and evaluation.

Conclusions

This study provides novel insights into how political determinants influence social and commercial determinants of health, demonstrating how political contexts and power dynamics shape national public health policy development processes. Understanding these dynamics is essential for ensuring that evidence-based public health interventions are politically feasible and resilient to opposition from certain private industry and ideological interests. In a time of growing inequalities, neutrality in the face of structural injustice risks entrenching a status quo that favours those with the greatest influence. To address these problems sustainably, public health practitioners must recognise and engage with the political nature of policymaking.

Objectives

The global impact of health care on the human environmental burden is enormous, but medical care is currently not realising the potential of sustainable practice. Similarly, dentistry and the various forms of dental treatment are not provided in a sustainable manner. This study focussed on quantifying the environmental burden of a standard dental treatment, specifically a tooth extraction, and on identifying the environmental impact of the process.

Methods

A life cycle analysis was performed, simulating the entire process of a tooth extraction—including patient and staff travel, materials and washing/sterilisation procedures—using the software OpenLCA 1.11.0 and the database ecoinvent 3.9.1. The facilities, instruments and items used were those of Charité – Universitätsmedizin Berlin. For travel impact estimations, questionnaire data on travel modalities were gathered from patients and clinic staff. To evaluate possible approaches for more environmentally friendly processes, a change of the information/consent meeting from face-to-face to an online meeting was simulated.

Results

The greatest single contributors to the environmental impact of an extraction procedure were travel, the production of steam (e.g., for sterilisation), electricity, soap, and waste. After normalisation, the process impact was highest on the categories: human toxicity (cancer effects and non-cancer effects), freshwater ecotoxicity, resource use (energy carriers) and ionising radiation (human health). The total environmental impact was 13.8 kg CO₂ equivalents, which compares to driving a distance of 56.3 km with a gasoline-powered vehicle. The implementation of a digital consent process could reduce greenhouse gas emissions by 36.1% to 8.8 kg CO₂ equivalents.

Conclusions

Modelling the environmental impact of a dental extraction in a university hospital setting provided a detailed account of absolute and relative environmental impact contributions. The reduction of treatment-related travel is the most effective measure to reduce the environmental impact of dental practice.

Objectives

This systematic review aimed to evaluate the performance of deep learning (DL) models in detecting dental plaque and gingivitis from red, green, and blue (RGB) intraoral photographs.

Methods

A comprehensive literature search was conducted across Medline, Scopus, Embase, and Web of Science databases up to January 31, 2025. The methodological characteristics and performance metrics of studies developing and validating DL models for classification, detection, or segmentation tasks were analysed. The risk of bias was assessed using the quality assessment of diagnostic accuracy studies 2 (QUADAS-2) tool, and the certainty of the evidence was evaluated with the grading of recommendations assessment, development, and evaluation (GRADE) framework.

Results

From 3307 identified records, 23 studies met the inclusion criteria. Of these, 10 focused on dental plaque, 11 on gingivitis, and two addressed both outcomes. The risk of bias was low in all QUADAS-2 domains for 11 studies, with low applicability concerns in nine. For dental plaque, DL models showed robust performance in the segmentation task, with intersection over union (IoU) values ranging from 0.64 to 0.86 (median 0.74). Three studies indicated that DL models outperformed dentists in identifying dental plaque when disclosing agents were not used. For gingivitis, the models demonstrated potential but underperformed compared to dental plaque, with IoU values ranging from 0.43 to 0.72 (median 0.63). The certainty of the evidence was moderate for dental plaque and low for gingivitis.

Conclusions

DL models demonstrate promising potential for detecting dental plaque and gingivitis from intraoral photographs, with superior performance in plaque detection. Leveraging accessible imaging devices such as smartphones, these models can enhance teledentistry and may facilitate early screening for periodontal disease. However, the lack of external testing, multicenter studies, and reporting consistency highlights the need for further research to ensure real-world applicability.

Objective

The study aimed to test the efficacy of an online cognitive-behavioural therapy dental anxiety intervention (o-CBT) that could be easily implemented in dental healthcare settings.

Methods

An online cognitive-behavioural protocol based on psychoeducation, exposure to feared dental procedures and cognitive restructuring was developed. A randomised controlled trial was conducted (N = 499) to test its efficacy. Consenting adult dental patients (18–75 years old) who met inclusion criteria (e.g., high dental anxiety) were randomised to one of three arms, (a) intervention assisted by psychology staff (PI) (n = 162), (b) intervention assisted by dental staff (DI) (n = 167), or (c) a control condition (C) (n = 170). Primary outcome measures were the Modified Dental Anxiety Scale (MDAS) and the Anxiety and Related Disorders Interview Schedule DSM-V (ADIS) rating of fear. Generalised linear models for repeated measures based on intention to treat analyses were used to compare the three groups on dental anxiety, fear, avoidance and overall severity of dental phobia.

Results

Dental anxiety was significantly lower in both PI and DI groups when compared to the control condition. Interestingly, reductions in dental anxiety favoured the DI group at 6 (p = 0.008) and 12 months only (p = 0.009). Overall, equivalency was observed between the two intervention groups (PI and DI), as there were no significant differences in dental anxiety when the dental arm was compared to the psychology arm across all time points (p > 0.05).

Conclusion

The online cognitive-behavioural intervention was efficacious in reducing dental anxiety when compared to a control condition in an urban sample of patients receiving treatment in a dental school setting. Examination of its effectiveness when administered in dental offices under less controlled conditions is warranted.

Trial Registration: NCT03680755

Objective

The objective of this research was to determine if the ratio of family income to poverty index is a modifier in the relationship of sugar-sweetened beverages (SSB) and dental caries in U.S. children.

Methods

A cross-sectional study design of NHANES 2015–2020 for ages 1 to < 18 years (n = 6212) was conducted. The What We Eat in America interview was used for classification and categorization (0, 1, and ≥ 2) of SSB in the NHANES daily dietary file. Untreated dental caries were determined by Centers for Disease Control and Prevention dental examiners and categorised as yes (untreated) or no. The poverty index was categorised as < 200% of the poverty line (low income, < 2), ≥ 200% to less than 400% (moderate ≥ 2 to < 4), and ≥ 400% (high ≥ 4). Chi Square and Logistic regression analyses were conducted.

Results

There were 11.6% of children with dental caries; 46.7% with a low income; and 43.0% who consumed no SSB. In subgroup analysis by income, among the children whose family had a moderate income (n = 1541), the unadjusted odds ratio for ≥ 2 SSB on dental caries was 2.70 (95% CI: 1.57, 4.67) and the adjusted odds ratio was 2.61 (95% CI: 1.48, 4.60) as compared with no SSB consumption. The relationship failed to reach significance among children whose family had a low or high income.

Conclusion

Family income was a modifier in this research comparing SSB consumption and dental caries. This study highlights the complicated relationship of SSB consumption and family income on dental caries among children in the U.S.

Objectives

Poor oral health is a considerable burden for older adults in care homes. The National Institute for Health and Care Excellence (NICE) issued guideline NG48 on “Improving oral health in care homes”. However, empirical evidence for oral health interventions among care home residents is weak, and the feasibility of the NG48 recommended interventions is not established. This study aimed to determine the feasibility of delivering a co-designed oral health intervention, based on NG48 recommendations, in care homes in two sites in the UK.

Methods

This was a pragmatic cluster randomised controlled feasibility study with a 12-month follow-up, undertaken in 22 care homes across two sites (11 each in London and Northern Ireland). Care homes were randomised to an intervention arm (n = 11), and a control arm (n = 11) that continued with usual routine practice. The complex intervention contained materials were co-designed with care home staff and consisted of: care home staff training package; Oral Health Assessment Tool (OHAT) administered by trained care home staff; and a support worker assisted twice daily tooth-brushing regimen with 1500 ppm fluoride toothpaste. Rates of recruitment and retention, data completion, and intervention fidelity were recorded to determine feasibility.

Results

One-hundred-and-nineteen residents from 22 care homes were recruited and 82 residents from 19 care homes completed the study (retention: 86% for care homes and 69% for residents). Twenty residents were lost to follow-up and another 17 withdrew throughout the study. Data completion rates ranged between 88% and 97% at baseline and between 91% and 96% at the 12-month follow-up. Intervention fidelity records showed high completion rates for oral care plans (90%), and lower rates for weekly oral hygiene records (73%) and the OHAT (61%).

Conclusions

This study documented the feasibility of an oral health intervention in care homes, while also highlighting issues to consider for a definitive trial to assess the effectiveness of the co-designed intervention.

Trial Registration

Clinical Trial Registration: ISRCTN10276613

Objective

This study aimed to explore the longitudinal impact of changes in household income poverty and area-based socioeconomic deprivation on dental caries prevalence in early childhood.

Methods

Data from the Growing Up in Scotland (GUS) longitudinal study (2005/6-2009/10) were linked to dental caries experience data at age 5 from Scotland's National Dental Inspection Programme. Latent Class Analysis identified trajectories of household poverty (income below 60% of the national median) and area-based deprivation across multiple time points between birth and age 5. Cumulative exposure scores were also calculated, and modified Poisson regression assessed associations between socioeconomic pathways and caries experience in 2893 children.

Results

Children living in persistent household poverty or in socioeconomically deprived areas had the highest caries experience risk compared to children never in poverty or deprivation. Elevated caries risk was also observed in children falling into poverty (aRR = 1.4; 95% CI = [1.1–1.8]) and escaping poverty (aRR = 1.6; 95% CI = [1.3–2.1]). Children moving into more deprived areas had higher caries risk (aRR = 1.6; 95% CI = [1.2–2.2]), while moving out of deprived areas did not increase risk (aRR = 1.1; 95% CI = [0.8–1.7]). Caries risk increased with years spent in household poverty and in deprived areas.

Conclusions

Unstable poverty and downward socioeconomic deprivation mobility were associated with greater caries risk in early childhood, underscoring the importance of considering the duration and persistence of socioeconomic disadvantage in relation to oral health outcomes and should inform early-years focused policies to address these. Longitudinal data linkage combining representative surveys and routine data is a powerful way to uncover these issues.

Background

Individuals with serious mental illness (SMI) are disproportionally affected by oral diseases, contributing to already poor physical health outcomes. Young adults are particularly vulnerable, with high psychological distress and greater health service engagement barriers. Early adulthood is a key opportunity to change the trajectory of poor oral health among youth with SMI (YSMI) by supporting oral hygiene self-care routines and timely access to oral healthcare.

Objective

To explore factors that promote or inhibit Healthy Smiles: engagement in oral healthcare among Australian YSMI.

Methods

Exploratory interviews and a focus group were conducted. Purposeful sampling recruited 11 YSMI, a carer, peer support workers (n = 2) and oral and mental health practitioners (n = 3) providing health for YSMI (total = 17).

Results

Key strategies to improve oral health and access to services for YSMI were outlined: ensuring oral health practitioners had the mental health literacy, confidence and skills to work with this population and mental health practitioners had the oral health literacy and skills to support YSMI to practice oral hygiene self-care and access services; developing a range of youth-friendly promotional resources and communication channels to improve prevention awareness and reduce dental fear. A crucial element was the need for trusted relationships.

Conclusion

To prevent negative and life-impacting consequences of untimely oral healthcare access in early adulthood, systematic and targeted strategies for YSMI that focus on co-designed innovative models of care are urgently required.