To evaluate the accuracy of remote caries lesion assessment using the CariesCare International (CCI) system applied to images captured with smartphones and professional cameras.
A cross-sectional study was conducted with 30 children aged 5–10 years, who underwent clinical dental examinations and intraoral photography using both a digital single-lens reflex (DSLR) camera and a smartphone. Trained examiners, blinded to the imaging devices, assessed the photographs and in-person examinations, with the latter serving as the gold standard. Statistical analyses included weighted kappa () to evaluate inter-examiner reproducibility, along with sensitivity (Se), specificity (Sp), and area under the receiver operating characteristic curve (AUC) to determine detection accuracy.
Inter-examiner reproducibility was excellent across all methods ( > 0.94). The professional camera demonstrated superior accuracy (Se = 0.87, Sp = 0.98; AUC = 0.92), with strong performance even for initial lesions (AUC = 0.88). Smartphone images showed good overall accuracy (Se = 0.73, Sp = 0.92, AUC = 0.83), performing particularly well for moderate and extensive lesions (AUC ≥ 0.87) and acceptably for initial lesions (AUC = 0.77). Both imaging methods achieved high specificity, reflecting accurate identification of sound surfaces.
These findings support the use of both professional and smartphone photography as effective tools for remote caries lesion assessment using the CariesCare International (CCI) system. Smartphone-based assessments represent a cost-effective and accessible alternative, especially in settings with limited resources. Integrating standardised systems like CCI into remote diagnostic workflows enhances diagnostic accuracy and can broaden access to dental care, helping reduce global oral health disparities.
To assess the maternal and child factors associated with developmental defects of the enamel (DDE) in a cohort of 2-year-old children.
This study analysed data from the MINA-Brazil birth cohort study. A total of 800 mother-child pairs were surveyed. Oral clinical examinations were conducted using the modified DDE Index. Associated factors in the pre-, peri- and post-natal periods were collected by standardised procedures. Crude and adjusted Poisson regression models with robust variance, following a hierarchical framework selection of covariates, were used to determine the relationships between maternal and child factors and DDE.
The prevalence of DDE was 29.5% (95% CI 26.3%–32.7%), and children's mean age was 23.8 ± 1.3 months. Maternal age below 21 years at the time of delivery (PR 1.51, 95% CI 1.16–1.98), pregnant women as the head of the family (PR 1.36, 95% CI 1.03–1.80), multiparity (PR 1.41, 95% CI 1.09–1.82), large for gestational age newborns (PR 1.47, 95% CI 1.13–1.91), otitis media in the first few months of life (PR 2.43, 95% CI 1.43–4.13) and stunting at 1 year (PR 2.21, 95% CI 1.38–3.54) were all associated with DDE.
Several maternal sociodemographic and obstetric factors, as well as perinatal morbidity and nutritional factors, may be determinants of DDE in infants. This emphasises the importance of child development and sociodemographic factors for oral health. Future studies should consider both longitudinal and transdisciplinary approaches.
People with severe mental illness experience poor oral health, compared to the general population. They experience inequity in accessing dental services. This randomised controlled trial evaluated the acceptability and feasibility of a link work intervention to support people with severe mental illness to access a routine dental appointment.
This was a feasibility randomised controlled trial across three sites with 1:1 allocation to Treatment as usual (TAU) or TAU plus a link work intervention (ISRCTN13650779). Participants were adults accessing mental health services who had not attended a routine dental appointment in the past 3 years. The intervention comprised up to six sessions with a link worker. Participants completed self-report assessments and an optional dental examination at baseline and after nine months. Dental visiting data were obtained through self-report and the NHS Business Services Authority (BSA).
One hundred and sixty-one participants were referred into the trial, resulting in 79 out of the target 84 randomisations (94.0%) over 7 months. There were high levels of engagement with the intervention. Dental visiting data were available for 84.8% of participants (95% CI: 75.3%, 91.1%). Uptake of the optional dental examination within the research assessment battery was low (follow-up: 12.7%; 95% CI: 7.0%, 21.8%). There were no serious adverse events attributable to the intervention or trial procedures. There were substantially higher rates of dental attendance after nine months in the link work intervention arm, compared to TAU, in both the self-report (91.7% vs. 26.7%) and NHS BSA (55.3% vs. 12.1%) data. There was also a signal of improved self-reported oral health-related quality of life favouring the link work intervention arm.
The trial procedures and link work intervention were found to be feasible, acceptable and safe. The intervention showed promise in terms of clinical outcomes. The effectiveness of the intervention requires evaluation in a larger trial.
NCT05545228
This study examined the relationship between early-life violent victimisation and dental care utilisation patterns from adolescence to middle adulthood (ages 11–43).
Data were from Waves I through V of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Group-based trajectory modelling (GBTM) was used to examine patterns of dental care use across five waves, spanning ages 11–43. Multinomial logistic regression was used to assess the relationship between violent victimisation experiences in adolescence and dental care use trajectory group membership, adjusting for demographic, socioeconomic and health-related covariates.
Four dental care trajectories were identified: High Dental Care Use (22.8%), Intermittent Decreasing Dental Care Use (38.6%), Intermittent Increasing Dental Care Use (21.8%) and Low Dental Care Use (16.9%). Higher violent victimisation in adolescence was associated with an increased relative risk of belonging to the Intermittent Dental Care Use (RRR = 1.09, 95% CI = 1.02–1.41) and Low Dental Care Use (RRR = 1.21, 95% CI = 1.01–1.46) compared to the High Dental Care Use group.
Early-life violent victimisation serves as a risk factor for less regular dental care use over the life course. Addressing the cumulative effects of violent victimisation through trauma-informed care and targeted interventions may improve dental care access and mitigate disparities over the life course.
Good oral health is integral to maintaining overall health. Yet little is known about the breadth of factors that affect dental visits. The objective of this study was to test for associations between reported dental visits and factors that may be related to dental visits: predisposing (demographics, educational attainment, marital status, employment and smoking status); enabling (income, insurance status, rurality, primary care and dental healthcare provider shortage areas (D-HPSA)) and need (overall health status and emotional wellbeing).
Survey data were collected 2018–2020 for the Virginia Living Well (VALW) Registry, a convenience sample (n = 528) of largely rural (79.2%) panel of adult Virginians. Cross-sectional analyses included multilevel logistic regression models with the outcome of dental visits in the past 12 months that controlled for nesting of participants within geography.
Overall, 65% reported dental visits in the last 12 months. Models showed smoking (OR 0.51; 95% CI 0.29, 0.87), Medicaid coverage (OR 0.29; 95% CI 0.14–0.58), living in an area with a higher DHPSA score (OR 0.54; 95% CI 0.31–0.2) and lower overall health (OR 0.64; 95% CI 0.50–0.82) were associated with lower odds of having seen a dentist in the past 12 months.
Health factors and healthcare provider shortages appeared to be associated with reported dental visits for Virginian participants of the VALW registry. Participants with Medicaid coverage and those living in a high D-HPSA coverage had lower reports of dental visits. More work is needed to improve equity in access to oral healthcare providers and coverage for dental care to align with recommended care guidelines.
Social condition mobility refers to an individual's ability to move up or down the social ladder during their lifetime. The aim of this study was to explore the relationship between social conditions and periodontitis in an adult Norwegian population, specifically the role of social mobility and employment status.
The study was cross-sectional, based on data collected from a subset (n = 3717) of 21 083 participants in a population health study (The Tromsø Study: Tromsø7) aged 40–99 years. Data were collected through questionnaires and clinical examinations. Periodontitis was assessed by periodontal probing depth and radiographic bone loss, according to the 2017 case definition of periodontitis. Current social conditions were measured by participants' own income, education and employment status. Early life social conditions were measured by perceived financial situation as a child and their parents' education. Social condition mobility for educational and economic status was categorised as stable high, upward mobility, downward mobility and stable low.
The prevalence of Stage III–IV periodontitis was lowest among those with persistently high educational and economic status (12% and 16%, respectively) and among leaders/academics (11%), and highest among those with persistently low educational and economic status (25% and 28%, respectively) and unemployed participants (25%). After adjusting for age, sex, smoking and BMI, educational and economic status were no longer significantly associated with periodontitis. Being unemployed increased the odds of having Stage III–IV periodontitis by 2.2 times (p = 0.012), independently of other risk factors for periodontitis.
While stable high educational and economic status appears protective against severe periodontitis, unemployment emerged as a significant independent risk factor. These findings highlight the importance of addressing unemployment and related social determinants in efforts to reduce the burden of periodontitis. Programmes aimed at improving oral health literacy and access to dental care in these populations, along with a common risk factor approach addressing smoking cessation and other lifestyle factors contributing to periodontitis, could help reduce disparities.
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.
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.
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.
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.
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.
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.
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.
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.
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