Kara A. Gray-Burrows, Sarab El-Yousfi, Kristian Hudson, Samantha Watt, Ellen Lloyd, Hanin El Shuwihdi, Tom Broomhead, Peter F. Day, Zoe Marshman
Objectives
Supervised toothbrushing programmes (STPs), whereby children brush their teeth at nursery or school with a fluoride toothpaste under staff supervision, are a clinically and cost-effective intervention to reduce dental caries. However, uptake is varied, and the reasons unknown. The aim was to use an implementation science approach to explore the perspectives of key stakeholders on the barriers and facilitators at each level of implementation of STPs.
Methods
This qualitative study involved individual interviews and focus groups with a purposive sample of stakeholders involved at all levels of implementation of STPs: (1) policymakers; (2) providers of STPs; (3) nursery/school staff; (4) parents/carers; and (5) children (aged 2-6 years old) across England. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR).
Results
A total of 159 stakeholders were interviewed (40 individual interviews and 17 focus groups) across all levels of implementation. Barriers and facilitators to STP implementation were identified across 35 of the 39 CFIR constructs. Four themes were identified that determined STP implementation: (1) acceptability of STPs; (2) external ‘make or break’ conditions; (3) the importance of engagement across the system; and (4) desire for centralised support.
Conclusions
This is the first study to qualitatively explore the barriers and facilitators to STP at all levels of implementation underpinned by an implementation science framework. The findings have strong implications for policymakers who wish to implement STPs, highlighting the need for careful consideration of the adaptability of the programmes, the role of formal and informal engagement systems, and the need for centralised support. This work has facilitated the co-design and piloting of a supervised toothbrushing implementation toolkit, which provides a central hub of resources and good practice to optimise implementation of STPs at scale.
{"title":"Supervised Toothbrushing Programmes: Understanding Barriers and Facilitators to Implementation","authors":"Kara A. Gray-Burrows, Sarab El-Yousfi, Kristian Hudson, Samantha Watt, Ellen Lloyd, Hanin El Shuwihdi, Tom Broomhead, Peter F. Day, Zoe Marshman","doi":"10.1111/cdoe.13026","DOIUrl":"10.1111/cdoe.13026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Supervised toothbrushing programmes (STPs), whereby children brush their teeth at nursery or school with a fluoride toothpaste under staff supervision, are a clinically and cost-effective intervention to reduce dental caries. However, uptake is varied, and the reasons unknown. The aim was to use an implementation science approach to explore the perspectives of key stakeholders on the barriers and facilitators at each level of implementation of STPs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This qualitative study involved individual interviews and focus groups with a purposive sample of stakeholders involved at all levels of implementation of STPs: (1) policymakers; (2) providers of STPs; (3) nursery/school staff; (4) parents/carers; and (5) children (aged 2-6 years old) across England. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 159 stakeholders were interviewed (40 individual interviews and 17 focus groups) across all levels of implementation. Barriers and facilitators to STP implementation were identified across 35 of the 39 CFIR constructs. Four themes were identified that determined STP implementation: (1) acceptability of STPs; (2) external ‘make or break’ conditions; (3) the importance of engagement across the system; and (4) desire for centralised support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first study to qualitatively explore the barriers and facilitators to STP at all levels of implementation underpinned by an implementation science framework. The findings have strong implications for policymakers who wish to implement STPs, highlighting the need for careful consideration of the adaptability of the programmes, the role of formal and informal engagement systems, and the need for centralised support. This work has facilitated the co-design and piloting of a supervised toothbrushing implementation toolkit, which provides a central hub of resources and good practice to optimise implementation of STPs at scale.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 3","pages":"256-264"},"PeriodicalIF":1.8,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058360","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}
Paul Brocklehurst, Joe Langley, Rebecca Wassall, Sana Daniyal, Saif Sayeed Syed, Michelle Harvey, Nia Goulden, Andrea Sherriff, Anja Heilmann, Zoe Hoare, Craig Smith, Richard Watt, Ciaran O'Neill, Frank Kee, Peter Cairns, Nat Lievesley, Gerald McKenna, Georgios Tsakos
<div> <section> <h3> Background</h3> <p>A theoretically informed process evaluation was undertaken in parallel to a study examining the feasibility of an oral health intervention based on an existing guideline for care homes. The objectives were to explore the factors that influenced the implementation of the intervention in order to understand the potential pathway to impact. The research team initially utilised Pfadenhauer et al.'s framework, which focuses on a number of different implementation factors: intervention characteristics, context, theory, process, strategy, agents, outcomes and setting.</p> </section> <section> <h3> Methods</h3> <p>Nine semi-structured interviews were undertaken with care home managers and staff, predominantly within the intervention arm of the study. Interview schedules were originally based on Pfadenhauer et al.'s framework. These were coded and analysed using thematic analysis. Given the range of themes that emerged, the research team ran a reflexive workshop to determine whether Pfadenhauer et al.'s framework was able to capture and frame the authentic voice of those interviewed.</p> </section> <section> <h3> Results</h3> <p>The research team found that a systems lens approach better fitted the data from the interviews, capturing the idiosyncrasy of the different settings and the importance of values and beliefs of the key stakeholders. It was clear that unlike the structure proposed by Pfaednhauer et al., many of the factors were interdependent and hierarchical in nature, that is, paradigm and goals within the care home had a direct impact on the system structure, which fed into how the care home was maintained, which led onto how the different actors (care home managers and staff) behaved. The process also highlighted key factors for intervention delivery: time poverty, competing needs, staff turnover, differences between shift patterns and between permanent and agency staff. Cognitive capacity of the residents and staff attitudes were also key.</p> </section> <section> <h3> Conclusions</h3> <p>Adding a reflexive workshop enabled the research to critically review the Pfadenhauer et al.'s framework and change to a systems lens approach, which better explained the interdependent and hierarchical nature of the findings. It also highlighted a number of key factors that could influence the pathway to impact for the intervention.</p> </section> <section> <h3> Trial Registration</h3> <p>ISRCTN10276613</p>
{"title":"A Theoretically Informed Process Evaluation in Parallel to a Feasibility Study of a Complex Oral Health Intervention Using NICE Guidelines in a Care Home Setting","authors":"Paul Brocklehurst, Joe Langley, Rebecca Wassall, Sana Daniyal, Saif Sayeed Syed, Michelle Harvey, Nia Goulden, Andrea Sherriff, Anja Heilmann, Zoe Hoare, Craig Smith, Richard Watt, Ciaran O'Neill, Frank Kee, Peter Cairns, Nat Lievesley, Gerald McKenna, Georgios Tsakos","doi":"10.1111/cdoe.13016","DOIUrl":"10.1111/cdoe.13016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A theoretically informed process evaluation was undertaken in parallel to a study examining the feasibility of an oral health intervention based on an existing guideline for care homes. The objectives were to explore the factors that influenced the implementation of the intervention in order to understand the potential pathway to impact. The research team initially utilised Pfadenhauer et al.'s framework, which focuses on a number of different implementation factors: intervention characteristics, context, theory, process, strategy, agents, outcomes and setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Nine semi-structured interviews were undertaken with care home managers and staff, predominantly within the intervention arm of the study. Interview schedules were originally based on Pfadenhauer et al.'s framework. These were coded and analysed using thematic analysis. Given the range of themes that emerged, the research team ran a reflexive workshop to determine whether Pfadenhauer et al.'s framework was able to capture and frame the authentic voice of those interviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The research team found that a systems lens approach better fitted the data from the interviews, capturing the idiosyncrasy of the different settings and the importance of values and beliefs of the key stakeholders. It was clear that unlike the structure proposed by Pfaednhauer et al., many of the factors were interdependent and hierarchical in nature, that is, paradigm and goals within the care home had a direct impact on the system structure, which fed into how the care home was maintained, which led onto how the different actors (care home managers and staff) behaved. The process also highlighted key factors for intervention delivery: time poverty, competing needs, staff turnover, differences between shift patterns and between permanent and agency staff. Cognitive capacity of the residents and staff attitudes were also key.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adding a reflexive workshop enabled the research to critically review the Pfadenhauer et al.'s framework and change to a systems lens approach, which better explained the interdependent and hierarchical nature of the findings. It also highlighted a number of key factors that could influence the pathway to impact for the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ISRCTN10276613</p>\u0000 ","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 2","pages":"152-159"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001496","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}
Jennifer Kettle, Jenny Porritt, Sarah R. Baker, Helen Rodd, Elizabeth Cross, Zoe Marshman
Aim
To explore the views of patients, caregivers, and dental professionals on the factors that influence implementation, processes, and effectiveness of a guided self-help cognitive behavioural therapy (CBT) intervention, ‘Your teeth, you are in control’ (YTYAIC), in the CALM trial.
Methods
Semi-structured interviews were conducted as part of this qualitative component of the process evaluation, and data were analysed using a framework approach based on the Consolidated Framework for Implementation Research (CFIR) and the Five Areas Model of CBT.
Results
Thirty-seven participants were recruited. Potential mechanisms of action were identified using the Five Areas Model of CBT. Participants felt the intervention may exert change through targeting unhelpful thoughts and feelings (e.g., building trust and perceptions of control) and behaviours (e.g., encouraging effective communication and coping strategies) and facilitating a more positive situational context (e.g., developing more supportive relationships). Enablers (e.g., adaptability, design and delivery) and barriers (e.g., time/resource constraints, cost) to implementation were identified using the CFIR.
Conclusions
This study revealed multiple potential mechanisms of action which could reduce dental anxiety and examined how implementation and contextual factors may influence this change process. The results of the research revealed that the intervention could be implemented in primary dental care and identified the potential barriers which should be addressed to aid successful implementation of the intervention in real world contexts.
Trial Registration
This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420)
{"title":"Your Teeth, You Are in Control: A Process Evaluation of the Implementation of a Cognitive Behavioural Therapy Intervention for Reducing Child Dental Anxiety","authors":"Jennifer Kettle, Jenny Porritt, Sarah R. Baker, Helen Rodd, Elizabeth Cross, Zoe Marshman","doi":"10.1111/cdoe.13025","DOIUrl":"10.1111/cdoe.13025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the views of patients, caregivers, and dental professionals on the factors that influence implementation, processes, and effectiveness of a guided self-help cognitive behavioural therapy (CBT) intervention, ‘Your teeth, you are in control’ (YTYAIC), in the CALM trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted as part of this qualitative component of the process evaluation, and data were analysed using a framework approach based on the Consolidated Framework for Implementation Research (CFIR) and the Five Areas Model of CBT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-seven participants were recruited. Potential mechanisms of action were identified using the Five Areas Model of CBT. Participants felt the intervention may exert change through targeting unhelpful thoughts and feelings (e.g., building trust and perceptions of control) and behaviours (e.g., encouraging effective communication and coping strategies) and facilitating a more positive situational context (e.g., developing more supportive relationships). Enablers (e.g., adaptability, design and delivery) and barriers (e.g., time/resource constraints, cost) to implementation were identified using the CFIR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study revealed multiple potential mechanisms of action which could reduce dental anxiety and examined how implementation and contextual factors may influence this change process. The results of the research revealed that the intervention could be implemented in primary dental care and identified the potential barriers which should be addressed to aid successful implementation of the intervention in real world contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420)</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 2","pages":"224-234"},"PeriodicalIF":1.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945594","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}
Clarissa Nachtigall Fôlha, Andreia Morales Cascaes, Marcos Britto Correa, Mariana Gonzalez Cademartori, Alicia Matijasevich, Iná S. Santos, Aluísio J. D. Barros, Maria Beatriz Junqueira Camargo
Objective
To examine the association between the lifetime utilisation of dental services and dental caries experience in mixed dentition among adolescents participating in the 2004 Pelotas Birth Cohort, Southern Brazil.
Methods
This longitudinal study analysed a sample of 996 adolescents aged 12–13 years. Dental caries experience and untreated dental caries were the outcomes, assessed by the mean of decayed, missed and filled in deciduous (dmfs index) and in permanent (DMFS index) teeth, based on World Health Organization criteria. The main exposure was lifetime use of dental services, defined as: always have gone to the dentist for preventive reason; have gone to the dentist at times for preventive reason, at times for problem-oriented reason; always have gone to the dentist for problem-oriented reason (reference category). Family income mobility during the first 4 years of the child's life, maternal schooling, adolescent sex and skin colour were the confounders. Crude and adjusted analyses were conducted using negative binomial regression, estimating mean ratios (MR), and 95% confidence intervals (95% CI).
Results
In the adjusted analysis, adolescents who consistently utilised dental services for preventive reasons exhibited a mean 49% lower dental caries indexes (MR = 0.51; 95% CI 0.35–0.76) and 56% lower mean of untreated dental caries (MR = 0.44; 95% CI 0.26–0.74) compared to their counterparts who consistently sought dental care for problem-oriented reasons. The utilisation of dental services occasionally for preventive reasons and occasionally for problem-oriented reasons was also associated with lower caries indexes.
Conclusion
The lifetime utilisation of dental services, whether always or occasionally for preventive reasons, was found to be a protective factor for dental caries in adolescence. These findings reinforce the importance of raising awareness among the public regarding the preventive use of dental services. Additionally, there is a need to organise dental services to facilitate the provision of preventive dental care since early childhood.
目的：研究2004年巴西南部佩洛塔斯出生队列中参加混合牙列的青少年终身牙科服务利用与龋齿经历之间的关系。方法：对996名12-13岁青少年进行纵向分析。根据世界卫生组织的标准，通过乳牙（dmfs指数）和恒牙（dmfs指数）的蛀牙、缺牙和补牙的平均值来评估蛀牙经历和未治疗的蛀牙。主要暴露是终生使用牙科服务，定义为：出于预防原因经常去看牙医；有时为了预防，有时为了问题导向，去看牙医；总是因为问题而去看牙医（参考类别）。孩子出生前四年的家庭收入流动性、母亲受教育程度、青少年性别和肤色是影响因素。采用负二项回归进行粗分析和校正分析，估计平均比率（MR）和95%置信区间（95% CI）。结果：在调整后的分析中，由于预防原因而持续使用牙科服务的青少年龋齿指数平均降低49% (MR = 0.51；95% CI 0.35-0.76)，未经治疗的龋齿平均降低56% (MR = 0.44；95%可信区间为0.26-0.74)，与那些因为问题导向的原因而一直寻求牙科护理的人相比。偶尔出于预防原因和偶尔出于问题导向原因使用牙科服务也与较低的龋齿指数有关。结论：终生接受牙科服务，无论是经常还是偶尔的预防，都是青少年龋齿的保护因素。这些发现加强了提高公众对预防性使用牙科服务的认识的重要性。此外，政府亦有需要安排牙科服务，以方便市民从幼儿开始接受预防性牙科护理。
{"title":"Lifetime Use of Dental Services and Dental Caries in Adolescents in 2004 Pelotas Birth Cohort","authors":"Clarissa Nachtigall Fôlha, Andreia Morales Cascaes, Marcos Britto Correa, Mariana Gonzalez Cademartori, Alicia Matijasevich, Iná S. Santos, Aluísio J. D. Barros, Maria Beatriz Junqueira Camargo","doi":"10.1111/cdoe.13023","DOIUrl":"10.1111/cdoe.13023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the association between the lifetime utilisation of dental services and dental caries experience in mixed dentition among adolescents participating in the 2004 Pelotas Birth Cohort, Southern Brazil.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This longitudinal study analysed a sample of 996 adolescents aged 12–13 years. Dental caries experience and untreated dental caries were the outcomes, assessed by the mean of decayed, missed and filled in deciduous (dmfs index) and in permanent (DMFS index) teeth, based on World Health Organization criteria. The main exposure was lifetime use of dental services, defined as: always have gone to the dentist for preventive reason; have gone to the dentist at times for preventive reason, at times for problem-oriented reason; always have gone to the dentist for problem-oriented reason (reference category). Family income mobility during the first 4 years of the child's life, maternal schooling, adolescent sex and skin colour were the confounders. Crude and adjusted analyses were conducted using negative binomial regression, estimating mean ratios (MR), and 95% confidence intervals (95% CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the adjusted analysis, adolescents who consistently utilised dental services for preventive reasons exhibited a mean 49% lower dental caries indexes (MR = 0.51; 95% CI 0.35–0.76) and 56% lower mean of untreated dental caries (MR = 0.44; 95% CI 0.26–0.74) compared to their counterparts who consistently sought dental care for problem-oriented reasons. The utilisation of dental services occasionally for preventive reasons and occasionally for problem-oriented reasons was also associated with lower caries indexes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The lifetime utilisation of dental services, whether always or occasionally for preventive reasons, was found to be a protective factor for dental caries in adolescence. These findings reinforce the importance of raising awareness among the public regarding the preventive use of dental services. Additionally, there is a need to organise dental services to facilitate the provision of preventive dental care since early childhood.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 2","pages":"198-204"},"PeriodicalIF":1.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909348","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}
Daisuke Tadokoro, Kazue Honda, Taro Kusama, Kenji Takeuchi, Ken Osaka, Jun Aida
Objectives
The prevalence of dental caries is high in Japan, leading to a huge burden of overall expenditure on dental caries treatment for the population. School-based fluoride mouth-rinse (S-FMR) has been implemented as a public health intervention. However, its cost-effectiveness remains unclear, where universal health insurance covers a broad range of dental treatments at relatively low cost. The aim of the study was to determine whether S-FMR is associated with lower dental caries treatment expenditure in Japan, where the universal health insurance system widely covers dental treatments. In addition, the cost-benefit of S-FMR was estimated.
Methods
This ecological study examined the association between S-FMR coverage and dental caries treatment expenditure in all 47 prefectures of Japan. Data were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data (NDB Open Data Japan), national survey data on the prevalence of S-FMR, and other census data for each prefecture. The outcome variable was the average annual treatment expenditure of for children aged 5–14 per child. The explanatory variable was the S-FMR coverage of children per prefecture, divided into quartiles: (Q1) 0.0%–0.48%, (Q2) 0.54%–6.9%, (Q3) 7.2%–25.0% and (Q4) 26.9%–80.4%. Linear regression analysis was performed with adjustment for the number of dental clinics per 100 000 individuals, per capita prefectural income, and percentage of the population aged between 5 and 14 years.
Results
The dental caries treatment expenditure was lower in prefectures with higher S-FMR coverage: (Q1) 2378 JPY, (Q2) 2215 JPY, (Q3) 2217 JPY and (Q4) 2065 JPY. Linear regression analysis showed that, compared to the prefectures with the lowest S-FMR coverage, the prefectures with the highest coverage exhibited significantly lower per person dental caries treatment expenditure by 186.0 (95% CI = 96.6, 275.4) JPY. When annual cost of S-FMR per person was lower, 200 JPY, S-FMR would save 0.9 billion JPY if all prefectures change from Q1 to Q4 (approximately 8.2 million USD).
Conclusions
Although public healthcare insurance in Japan covers most dental treatments at a relatively low cost, the current findings suggest that S-FMR could still be a cost-effective public health intervention.
目的：在日本，龋齿的患病率很高，导致了人口龋齿治疗总体支出的巨大负担。学校氟化物漱口水（S-FMR）已作为一项公共卫生干预措施实施。然而，其成本效益仍不清楚，因为全民健康保险以相对较低的费用涵盖了广泛的牙科治疗。该研究的目的是确定S-FMR是否与日本较低的龋齿治疗费用有关，在日本，全民健康保险系统广泛覆盖牙科治疗。此外，估计了S-FMR的成本效益。方法：本生态研究调查了日本所有47个县的S-FMR覆盖率与龋齿治疗费用之间的关系。数据来自日本开放数据的国家健康保险索赔和特定健康检查数据库（NDB open Data Japan）、关于S-FMR患病率的全国调查数据以及每个县的其他普查数据。结果变量为5-14岁儿童的平均年治疗支出。解释变量为各县儿童S-FMR覆盖率，分为四分位数：（Q1） 0.0%-0.48%, (Q2) 0.54%-6.9%, (Q3) 7.2%-25.0%, (Q4) 26.9%-80.4%。对每10万人牙科诊所数量、县人均收入、5 - 14岁人口比例进行调整后进行线性回归分析。结果：在S-FMR覆盖率较高的县，龋齿治疗费用较低：（第一季度）2378日元，（第二季度）2215日元，（第三季度）2217日元，（第四季度）2065日元。线性回归分析显示，与S-FMR覆盖率最低的县相比，覆盖率最高的县的人均龋齿治疗费用显著降低186.0日元（95% CI = 96.6, 275.4）。当人均S-FMR年成本低于200日元时，如果所有县从第一季度改为第四季度，S-FMR将节省9亿日元（约820万美元）。结论：尽管日本的公共医疗保险以相对较低的成本覆盖了大多数牙科治疗，但目前的研究结果表明，S-FMR仍然是一种具有成本效益的公共卫生干预措施。
{"title":"School-Based Fluoride Mouth-Rinse Programs and Dental Caries Treatment Expenditure: An Ecological Study of the NDB Open Data Japan","authors":"Daisuke Tadokoro, Kazue Honda, Taro Kusama, Kenji Takeuchi, Ken Osaka, Jun Aida","doi":"10.1111/cdoe.13024","DOIUrl":"10.1111/cdoe.13024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The prevalence of dental caries is high in Japan, leading to a huge burden of overall expenditure on dental caries treatment for the population. School-based fluoride mouth-rinse (S-FMR) has been implemented as a public health intervention. However, its cost-effectiveness remains unclear, where universal health insurance covers a broad range of dental treatments at relatively low cost. The aim of the study was to determine whether S-FMR is associated with lower dental caries treatment expenditure in Japan, where the universal health insurance system widely covers dental treatments. In addition, the cost-benefit of S-FMR was estimated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This ecological study examined the association between S-FMR coverage and dental caries treatment expenditure in all 47 prefectures of Japan. Data were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data (NDB Open Data Japan), national survey data on the prevalence of S-FMR, and other census data for each prefecture. The outcome variable was the average annual treatment expenditure of for children aged 5–14 per child. The explanatory variable was the S-FMR coverage of children per prefecture, divided into quartiles: (Q1) 0.0%–0.48%, (Q2) 0.54%–6.9%, (Q3) 7.2%–25.0% and (Q4) 26.9%–80.4%. Linear regression analysis was performed with adjustment for the number of dental clinics per 100 000 individuals, per capita prefectural income, and percentage of the population aged between 5 and 14 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The dental caries treatment expenditure was lower in prefectures with higher S-FMR coverage: (Q1) 2378 JPY, (Q2) 2215 JPY, (Q3) 2217 JPY and (Q4) 2065 JPY. Linear regression analysis showed that, compared to the prefectures with the lowest S-FMR coverage, the prefectures with the highest coverage exhibited significantly lower per person dental caries treatment expenditure by 186.0 (95% CI = 96.6, 275.4) JPY. When annual cost of S-FMR per person was lower, 200 JPY, S-FMR would save 0.9 billion JPY if all prefectures change from Q1 to Q4 (approximately 8.2 million USD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although public healthcare insurance in Japan covers most dental treatments at a relatively low cost, the current findings suggest that S-FMR could still be a cost-effective public health intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 2","pages":"216-223"},"PeriodicalIF":1.8,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892703","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}
The study aimed to estimate the effect of a periodontal treatment policy that would restrict the receipt of periodontal therapy to no more than once every second year, on the 10-year risk of tooth extraction among Danish adults.
Methods
Data from linked nationwide Danish registers consisted of a random sample of 20 000 50-year-olds who were followed from the beginning of 1990 to the end of 2021. The longitudinal modified treatment policies’ causal inference framework was used. In each of two slightly different counterfactual scenarios, the receipt of supragingival or subgingival periodontal therapy was restricted to no more than once every second year. The cumulative incidence of tooth extraction from 2012 to 2021 was compared between the counterfactual scenarios and the observed periodontal visiting pattern, while informative censoring, and time-varying and time-invariant confounding were accounted for using the social, economic and dental service utilisation history.
Results
During the 10-year follow-up period, 5021 (25.1%) individuals received at least one tooth extraction. In the two counterfactual scenarios, the number of years receiving supragingival or subgingival periodontal therapy was 30%–50% lower than in the observed data. The 10-year cumulative incidence of tooth loss was practically the same in the two counterfactual scenarios as under the observed periodontal visiting patterns.
Conclusion
The findings indicate that a considerable decrease in the number and frequency of periodontal care visits would not have significant impact on the incidence of tooth loss in Denmark.
{"title":"Restricting Periodontal Treatment Frequency: Impact on Tooth Loss in Danish Adults","authors":"Eero Raittio, Rodrigo Lopez, Vibeke Baelum","doi":"10.1111/cdoe.13022","DOIUrl":"10.1111/cdoe.13022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The study aimed to estimate the effect of a periodontal treatment policy that would restrict the receipt of periodontal therapy to no more than once every second year, on the 10-year risk of tooth extraction among Danish adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from linked nationwide Danish registers consisted of a random sample of 20 000 50-year-olds who were followed from the beginning of 1990 to the end of 2021. The longitudinal modified treatment policies’ causal inference framework was used. In each of two slightly different counterfactual scenarios, the receipt of supragingival or subgingival periodontal therapy was restricted to no more than once every second year. The cumulative incidence of tooth extraction from 2012 to 2021 was compared between the counterfactual scenarios and the observed periodontal visiting pattern, while informative censoring, and time-varying and time-invariant confounding were accounted for using the social, economic and dental service utilisation history.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the 10-year follow-up period, 5021 (25.1%) individuals received at least one tooth extraction. In the two counterfactual scenarios, the number of years receiving supragingival or subgingival periodontal therapy was 30%–50% lower than in the observed data. The 10-year cumulative incidence of tooth loss was practically the same in the two counterfactual scenarios as under the observed periodontal visiting patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings indicate that a considerable decrease in the number and frequency of periodontal care visits would not have significant impact on the incidence of tooth loss in Denmark.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 2","pages":"205-215"},"PeriodicalIF":1.8,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881648","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}
Aachal Devi, Lourdes S. Martinez, Donna Kritz-Silverstein, Jerel P. Calzo, David R. Strong, Kristin S. Hoeft, Tracy L. Finlayson
Objective
Engagement in preventive dental care is a complex health behaviour and is determined by multiple factors. The study aimed to understand the association of psychosocial determinants with poor dental attendance.
Methods
Survey data from 333 Mexican-identifying adults in California aged 21–40-year were analysed. Poor dental attendance was a composite of time since last dental visit and reason for visit. Responses of ‘more than 1 year ago’ for last dental visit, or ‘something was wrong, bothering or hurting/emergency dental problem’ as the reason for last dental visit were categorised as poor dental attendance. Psychosocial determinants including dental anxiety assessed using the Modified Dental Anxiety Scale, participant reported quality of provider interactions, and perceived social support were assessed. Logistic regression analyses examined associations after accounting for covariates.
Results
Over half (58%) had poor dental attendance. Among those with poor dental attendance, 22% had high dental anxiety, 41% perceived low quality of dental explanation, and 48% reported provider occasionally/never checked patient understanding. Participants with high anxiety had twice the odds of poor dental attendance (OR = 2.07, 95% CI = 1.01–4.22) than those with low dental anxiety. Additionally, those reporting that providers did not explain oral health status or treatments well had two times higher odds of poor dental attendance than those reporting adequate explanation (OR = 2.06, 95% CI = 1.11–3.83). Checking patient understanding or perceived social support was not significantly associated with dental attendance.
Conclusion
Dental anxiety and poor provider interactions affect use of dental services. Interventions targeting dental staff should prioritise enhancing communication skills and checking patient understanding to improve their dental attendance.
目的：参与预防性牙科保健是一种复杂的健康行为，由多种因素决定。这项研究的目的是了解心理社会因素与糟糕的看牙率之间的关系。方法：对加州333名年龄在21-40岁的墨西哥裔成年人的调查数据进行分析。不良的牙科服务是由上次看牙的时间和看牙的原因组成的。最后一次看牙的原因如回答“超过一年以前”，或回答“牙齿有问题、困扰或疼痛/紧急问题”，均属不常看牙。心理社会决定因素包括使用改良牙科焦虑量表评估牙科焦虑，参与者报告的提供者互动质量和感知的社会支持进行评估。逻辑回归分析在考虑协变量后检验了相关性。结果：超过一半（58%）的患者就诊情况不佳。在就诊率较低的患者中，22%的人有高度的牙科焦虑，41%的人认为牙科解释质量低，48%的人报告提供者偶尔或从未检查过患者的理解程度。高度焦虑的受试者出现牙科护理不良的几率是低焦虑患者的两倍（OR = 2.07, 95% CI = 1.01-4.22）。此外，那些报告提供者没有很好地解释口腔健康状况或治疗的人比报告解释充分的人有两倍的几率出现不良的牙科护理（or = 2.06, 95% CI = 1.11-3.83）。检查病人的理解或感知到的社会支持与看牙医没有显著的关系。结论：牙科焦虑和提供者不良互动影响牙科服务的使用。针对牙科工作人员的干预措施应优先加强沟通技巧和检查病人的理解，以提高他们的牙科就诊率。
{"title":"Psychosocial Determinants of Poor Dental Attendance Among Young Mexican-Identifying Adults in California","authors":"Aachal Devi, Lourdes S. Martinez, Donna Kritz-Silverstein, Jerel P. Calzo, David R. Strong, Kristin S. Hoeft, Tracy L. Finlayson","doi":"10.1111/cdoe.13021","DOIUrl":"10.1111/cdoe.13021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Engagement in preventive dental care is a complex health behaviour and is determined by multiple factors. The study aimed to understand the association of psychosocial determinants with poor dental attendance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Survey data from 333 Mexican-identifying adults in California aged 21–40-year were analysed. Poor dental attendance was a composite of time since last dental visit and reason for visit. Responses of ‘more than 1 year ago’ for last dental visit, or ‘something was wrong, bothering or hurting/emergency dental problem’ as the reason for last dental visit were categorised as poor dental attendance. Psychosocial determinants including dental anxiety assessed using the Modified Dental Anxiety Scale, participant reported quality of provider interactions, and perceived social support were assessed. Logistic regression analyses examined associations after accounting for covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over half (58%) had poor dental attendance. Among those with poor dental attendance, 22% had high dental anxiety, 41% perceived low quality of dental explanation, and 48% reported provider occasionally/never checked patient understanding. Participants with high anxiety had twice the odds of poor dental attendance (OR = 2.07, 95% CI = 1.01–4.22) than those with low dental anxiety. Additionally, those reporting that providers did not explain oral health status or treatments well had two times higher odds of poor dental attendance than those reporting adequate explanation (OR = 2.06, 95% CI = 1.11–3.83). Checking patient understanding or perceived social support was not significantly associated with dental attendance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Dental anxiety and poor provider interactions affect use of dental services. Interventions targeting dental staff should prioritise enhancing communication skills and checking patient understanding to improve their dental attendance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 2","pages":"190-197"},"PeriodicalIF":1.8,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827620","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}
Sarab El-Yousfi, Nicola Innes, Ian Kellar, Caroline Fairhurst, Hannah Ainsworth, Ivor Chestnutt, Peter Day, Donna Dey, Sue Pavitt, Mark Robertson, Katie Whiteside, Zoe Marshman
Objectives
The aim was to conduct a process evaluation of a multicomponent behaviour change intervention to reduce dental caries in secondary school children in the UK. The intervention was evaluated in the BRIGHT randomised controlled trial which investigated clinical and cost-effectiveness. The trial involved 4680 participants from 42 schools with a follow-up period of 2.5 years. Schools with an above-average proportion of free school meal (FSM) eligibility, an indicator of low household income, were recruited. The intervention, an oral health classroom-based session (CBS) delivered by school staff and twice-daily text messages aimed to improve toothbrushing frequency with fluoride toothpaste.
Methods
Key components of process evaluations were examined: Implementation (fidelity, dose delivered, adaptations and reach), mechanisms of impact (acceptability and dose received) and influential contextual factors. Data collection ran alongside that of the outcome evaluation. Mixed-methods data collection comprised pupil self-reported questionnaires, staff feedback questionnaires, CBS and text message delivery logs and semi-structured interviews/focus groups with school staff and pupils. Quantitative data were summarised descriptively, while framework analysis was applied to the qualitative data.
Results
The intervention was generally implemented as intended, albeit with some schools not confirming CBS delivery and a technical problem resulting in text messages being stopped prematurely. Some adaptations to the CBS were made by school staff. In terms of reach, 21.9% (n = 1025) of participants were FSM-eligible. At baseline, 77.6% (n = 3631) of randomised participants reported brushing at least twice daily with no difference over time in the social cognitive determinants of toothbrushing behaviour. The intervention was generally found to be acceptable with varying levels of participant responsiveness reported. The actual dose received was unclear; some schools did not provide a CBS attendance register, and some participants reported blocking or muting the text messages.
Conclusions
This evaluation raises the question of whether the intervention dose and quality of delivery were sufficient to support the required behaviour change mechanisms. Moreover, a high proportion of participants brushed twice daily at baseline; this also calls into question the intervention's ability to bring about significant ch
目的：目的是对一项旨在减少英国中学生龋齿的多成分行为改变干预措施进行过程评估。该干预措施在 BRIGHT 随机对照试验中进行了评估，该试验调查了临床和成本效益。该试验有来自 42 所学校的 4680 名参与者参加，跟踪期为 2.5 年。试验招募了免费校餐（FSM）资格比例高于平均水平的学校（FSM是家庭收入较低的一个指标）。干预措施是由学校教职员工开展的口腔健康课堂教学（CBS）和每天两次的短信，旨在提高使用含氟牙膏刷牙的频率：方法：研究了过程评估的主要内容：方法：研究了过程评估的主要内容：实施（保真度、提供的剂量、适应性和到达率）、影响机制（可接受性和收到的剂量）以及有影响的环境因素。数据收集与结果评估同时进行。混合方法的数据收集包括学生自我报告问卷、教职员工反馈问卷、CBS 和短信发送记录，以及与学校教职员工和学生的半结构化访谈/焦点小组。对定量数据进行了描述性总结，对定性数据进行了框架分析：干预措施总体上按预期实施，尽管有些学校没有确认 CBS 的发送，而且技术问题导致短信过早停止。学校教职员工对 CBS 做了一些调整。就覆盖范围而言，21.9%（n = 1025）的参与者符合家庭支助服务资格。在基线阶段，77.6%（n = 3631）的随机参与者表示每天至少刷牙两次，刷牙行为的社会认知决定因素在不同时期没有差异。人们普遍认为干预措施是可以接受的，但参与者的反应程度各不相同。实际收到的剂量并不清楚；一些学校没有提供 CBS 出勤登记册，一些参与者报告说他们屏蔽了短信或将短信静音：这项评估提出了一个问题：干预措施的剂量和实施质量是否足以支持所需的行为改变机制。此外，有很高比例的参与者在基线时每天刷牙两次；这也让人怀疑干预措施能否带来显著的改变。试验结果并不支持在学校环境中实施由两部分组成的干预措施（社区健康服务和短信）。不过，由于口腔健康是普通健康学校课程的一部分，BRIGHT CBS可以在英国的课程中采用，因为它是与年轻人共同开发的，学生和老师都能接受：试验注册：ISRCTN 编号：12139369。
{"title":"Process Evaluation of a Secondary School-Based Digital Behaviour Change Intervention to Improve Toothbrushing: The BRIGHT Randomised Controlled Trial","authors":"Sarab El-Yousfi, Nicola Innes, Ian Kellar, Caroline Fairhurst, Hannah Ainsworth, Ivor Chestnutt, Peter Day, Donna Dey, Sue Pavitt, Mark Robertson, Katie Whiteside, Zoe Marshman","doi":"10.1111/cdoe.13019","DOIUrl":"10.1111/cdoe.13019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim was to conduct a process evaluation of a multicomponent behaviour change intervention to reduce dental caries in secondary school children in the UK. The intervention was evaluated in the BRIGHT randomised controlled trial which investigated clinical and cost-effectiveness. The trial involved 4680 participants from 42 schools with a follow-up period of 2.5 years. Schools with an above-average proportion of free school meal (FSM) eligibility, an indicator of low household income, were recruited. The intervention, an oral health classroom-based session (CBS) delivered by school staff and twice-daily text messages aimed to improve toothbrushing frequency with fluoride toothpaste.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Key components of process evaluations were examined: Implementation (fidelity, dose delivered, adaptations and reach), mechanisms of impact (acceptability and dose received) and influential contextual factors. Data collection ran alongside that of the outcome evaluation. Mixed-methods data collection comprised pupil self-reported questionnaires, staff feedback questionnaires, CBS and text message delivery logs and semi-structured interviews/focus groups with school staff and pupils. Quantitative data were summarised descriptively, while framework analysis was applied to the qualitative data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The intervention was generally implemented as intended, albeit with some schools not confirming CBS delivery and a technical problem resulting in text messages being stopped prematurely. Some adaptations to the CBS were made by school staff. In terms of reach, 21.9% (<i>n</i> = 1025) of participants were FSM-eligible. At baseline, 77.6% (<i>n</i> = 3631) of randomised participants reported brushing at least twice daily with no difference over time in the social cognitive determinants of toothbrushing behaviour. The intervention was generally found to be acceptable with varying levels of participant responsiveness reported. The actual dose received was unclear; some schools did not provide a CBS attendance register, and some participants reported blocking or muting the text messages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This evaluation raises the question of whether the intervention dose and quality of delivery were sufficient to support the required behaviour change mechanisms. Moreover, a high proportion of participants brushed twice daily at baseline; this also calls into question the intervention's ability to bring about significant ch","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 2","pages":"180-189"},"PeriodicalIF":1.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715631","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}
Aderonke A. Akinkugbe, Vishal Midya, Michael A. Crane, Dina T. Garcia, Uraina S. Clark, Rosalind J. Wright
Objectives
Posttraumatic stress disorder (PTSD) is a disabling mental health condition arising from experiencing serious traumatic events. This study investigated if PTSD secondary to the World Trade Center terrorist attack on 11 September 2001 (9/11) is associated with self-reported doctor's diagnosis of periodontitis and count of missing teeth.
Methods
Data from the World Trade Center Health Registry, 2003–2020 (n = 20 826) were used to prospectively examine the rate of periodontitis and cross-sectionally the odds of missing teeth among enrolees with/without PTSD post-9/11 using a modified Poisson regression and generalised logit model, respectively, adjusted for covariates.
Results
Approximately 17% reported a doctor's diagnosis of PTSD post-9/11 and 7.4% a doctor's diagnosis of periodontitis. There were 355 new cases of periodontitis (incidence rate = 7.6 per 1000 person-years) among those with PTSD and a rate of 4.3 per 1000 person-years among those without PTSD. The covariate-adjusted rate ratio for periodontitis comparing those with and without PTSD = 1.52 (95% CI: 1.33, 1.74). The adjusted odds ratio (OR) (95% CI) comparing those with and without PTSD were, respectively, OR = 1.15 (95% CI: 1.05, 1.25) and OR = 1.41 (95% CI: 1.09, 1.83) for missing 1–5 teeth and all teeth missing, respectively, as compared to no missing teeth.
Conclusions
PTSD post-9/11 appears to be associated with poorer oral health outcomes, underscoring the far-reaching consequences of traumatic events on oral health.
{"title":"Long-Term Oral Health Effects of Traumatic Events Among World Trade Center Health Registry Enrolees, 2003–2020","authors":"Aderonke A. Akinkugbe, Vishal Midya, Michael A. Crane, Dina T. Garcia, Uraina S. Clark, Rosalind J. Wright","doi":"10.1111/cdoe.13020","DOIUrl":"10.1111/cdoe.13020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Posttraumatic stress disorder (PTSD) is a disabling mental health condition arising from experiencing serious traumatic events. This study investigated if PTSD secondary to the World Trade Center terrorist attack on 11 September 2001 (9/11) is associated with self-reported doctor's diagnosis of periodontitis and count of missing teeth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the World Trade Center Health Registry, 2003–2020 (<i>n</i> = 20 826) were used to prospectively examine the rate of periodontitis and cross-sectionally the odds of missing teeth among enrolees with/without PTSD post-9/11 using a modified Poisson regression and generalised logit model, respectively, adjusted for covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Approximately 17% reported a doctor's diagnosis of PTSD post-9/11 and 7.4% a doctor's diagnosis of periodontitis. There were 355 new cases of periodontitis (incidence rate = 7.6 per 1000 person-years) among those with PTSD and a rate of 4.3 per 1000 person-years among those without PTSD. The covariate-adjusted rate ratio for periodontitis comparing those with and without PTSD = 1.52 (95% CI: 1.33, 1.74). The adjusted odds ratio (OR) (95% CI) comparing those with and without PTSD were, respectively, OR = 1.15 (95% CI: 1.05, 1.25) and OR = 1.41 (95% CI: 1.09, 1.83) for missing 1–5 teeth and all teeth missing, respectively, as compared to no missing teeth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PTSD post-9/11 appears to be associated with poorer oral health outcomes, underscoring the far-reaching consequences of traumatic events on oral health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 2","pages":"170-179"},"PeriodicalIF":1.8,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709500","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}
{"title":"Reviewer list 2024","authors":"","doi":"10.1111/cdoe.13017","DOIUrl":"https://doi.org/10.1111/cdoe.13017","url":null,"abstract":"","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"52 6","pages":"919-920"},"PeriodicalIF":1.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142664861","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}
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