Community dental health最新文献

Objectives: In England, around 10% of the population receive optimally fluoridated water. This coverage has evolved through a combination of historical local decision-making and natural geography, rather than being strategically targeted at the national level. It is important to understand if the current distribution is equitable according to indicators of oral health need and to identify any population-level differences in socio-demographic characteristics that could introduce bias to studies evaluating the effectiveness of water fluoridation.

Basic research design: Descriptive analysis comparing the census characteristics of populations that received optimally fluoridated (=/⟩ 0.7 mg F/L) and non-fluoridated water (⟨0.7 mg F/L) between 2009 and 2020.

Results: Populations receiving fluoridated water between 2009-2020 were on average slightly younger, more urban, more deprived, with lower education levels, higher unemployment and lower car and home ownership than the populations who received non-fluoridated water. They are more ethnically diverse, with a higher proportion of Asian ethnicity and a lower proportion of White ethnicity, compared to the non-fluoridated population.

Discussion: This descriptive analysis provides evidence that water fluoridation coverage within England is targeted reasonably equitably in relation to population-level indicators of need. It also confirms the need to consider the impact of underlying differences in age, deprivation, rurality, and ethnicity when evaluating the impact of water fluoridation on health outcomes in England.

Objective: To assess the impact of caries, Molar Incisor Hypomineralization (MIH), and fluorosis on the Oral Health-Related Quality of Life (OHRQoL) of schoolchildren aged 8-10 years living in area with different fluoride levels in the drinking water.

Subject and methods: The prevalence of caries and fluorosis were assessed among 663 Mexican schoolchildren using the International Caries Detection and Assessment System (ICDAS II) and the Thylstrup and Fejerskov Index (TFI), respectively. MIH was recorded using the European Academy of Pediatric Dentistry (EAPD) criteria and OHRQoL using the Child Perceptions Questionnaire (CPQ8-10). Poisson regression models were used in data analysis.

Results: Schoolchildren presenting two of the three conditions (cavitated lesions and TFI≥4, cavitated lesions and MIH or TFI≥4 and MIH) experienced worse quality of life than children who did not [RR=4.18; (95% CI 3.83, 4.56)]. Children with all three conditions had worse quality of life than children who did not [RR=5.64; (95% CI 5.13, 6.20)].

Conclusions: Fluorosis, MIH, and caries have a negative impact on the OHRQoL of schoolchildren living in area with a high concentration of fluoride in their drinking water.

Background: Individuals with a stronger sense of coherence (SOC) often show healthier behaviors. As parents, especially mothers, are behavioral role models for their children, this study aimed to explore the role of the mothers' SOC in prediction of the risk of dental caries in a sample of children aged 11-12 years old.

Design: Cross-sectional study with 173 mother-child pairs enrolled by multi-stage sampling from four public schools in Torbat-e-Heydarieh, Iran. The data were obtained, using a demographic-health information sheet and the SOC-13 scale. Dental examinations of children were performed using the decay, missing and filled teeth index for primary (dmft) and permanent teeth (DMFT). Poisson regression analyses estimated the role of the mothers' SOC in predicting the relative risk (RR) of children's dental caries.

Results: Mean dmft and DMFT were 3.4 ± 3.1 and 2.7 ± 2.9 respectively (medium severity). After controlling for demographic and health variables in regression models, greater maternal SOC indicated a protective effect against dental caries in primary (RR: 0.96; 95% CI:0.96-0-97) and permanent teeth (RR: 0.96; 95% CI: 0.95-0.97) of their children.

Conclusions: With greater maternal SOC, the risk of children's dental caries decreased. Whilst this relationship was not as strong as in previous studies in other countries, it can be a platform for further research and perhaps planning to identify children who are at a greater risk of dental caries before starting dental examinations in schools.

Objectives: Inequalities have been reported between high, middle and low socioeconomic position (SEP) children. However, the effect of contextual and individual SEP on existing inequalities among socioeconomically deprived children varies between local contexts. The aim of this study was to assess the impact of contextual and individual SEP on individual caries experience among socioeconomically deprived children in Chile.

Methods: Cross-sectional multilevel analysis of data from the 2015 electronic register of the National Board of School Aid and Scholarships (JUNAEB) of Chile. The contextual variables were the municipality Human Development Index (HDI) and rurality index. Individual variables included gender, living in extreme poverty and school grade. Multilevel negative binomial models assessed their impact on DMFT/dmft.

Results: 112,429 children in 255 municipalities were included. Overall, contextual SEP (HDI) was not associated with caries experience in the primary or permanent dentition. Individual SEP (living in extreme poverty) was associated with caries experience in both dentitions. The proportion of children living in extreme poverty with caries experience in the primary teeth was 17% higher than children not living in extreme poverty (PR 1.17; 95% CI 1.15-1.19), while for children with permanent teeth it was 9% higher (PR 1.09; 95% CI 1.08-1.11).

Conclusion: These findings could support the development of health strategies focused on individual SEP to efficiently reduce oral health inequalities among socioeconomically deprived children.

Over the last years, the COVID-19 pandemic has introduced a major public health crisis globally that societies have struggled to address irrespective of the approach followed. The different aspects of the crisis and how it has been handled from the point of view of social epidemiology, do not offer a positive reading. One key "message" has been that we are "all in it together". This implies a socially neutral phenomenon, yet there is clear evidence of stark socioeconomic and ethnic inequalities with disproportionate burden of the pandemic among the more deprived groups in the society (Marmot, 2020). And this has taken place in the background of already well-established health inequalities that have further increased over the last decade (Marmot et al., 2020). At the same time, addressing inequalities has been a central piece of government and societal health policy objectives.

In the UK, the incidence of oral cavity cancer continues to rise, with an increase of around 60% over the past 10 years. Many patients still present with advanced disease, often resulting in locoregional recurrence and poor outcomes, which has not changed significantly for over four decades. Changes in aetiology may also be emerging, given the decline of smoking in developed countries. Therefore, new methods to better target prevention, improve screening and detect recurrence are needed. High-throughput 'omics' technologies appear promising for future individual-level diagnosis and prognosis. However, given this is a relatively rare cancer with significant intra-tumour heterogeneity and variation in patient response, reliable biomarkers have been difficult to elucidate. From a public health perspective, implementing these novel technologies into current services would require substantial practical, financial and ethical considerations. This may be difficult to justify and implement at present, therefore focus remains on early detection using new patient-led follow-up strategies. This paper reviews the latest evidence on epidemiological trends in oral cavity cancer to help identify at risk groups, population-based approaches for prevention, in addition to potential cutting-edge approaches in the diagnosis and prognosis of this disease.

Objective: To identify any association between the psychosocial impact of malocclusion and academic performance in adolescents.

Methods: Cross-sectional study in a sample of 297 adolescents aged 10 to 14 years old enrolled in public schools. A self-complete questionnaire enquiring about socioeconomic, demographic, and psychological characteristics and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was administered in classrooms. The school provided documents related to School Performance (average grade in the Portuguese subject and absences). A conceptual structure was built, and independent variables were inserted hierarchically into logistic models for school performance (outcome). Independent variables were: Gender, age, caries status (DMFT), orthodontic treatment need (IOTN-DHC), psychological impact (PIDAQ) and school commitment (class absences and missed classes).

Results: Boys (OR = 3.56; 95% CI: 1.54-8.21) with caries experience (OR = 2.77; 95% CI: 1.23-6.23), need for orthodontic treatment (OR = 0.40; 95% CI; 0.18-0.91) and adolescents who reported a psychological impact (OR = 2.70; 95% CI: 1.16-6.30) had worse school performance.

Conclusion: Boys with caries and malocclusion experience who reported the psychological impact of the need for orthodontic treatment are more likely to have worse school performance.

Background: The circumstances of the area where people live may affect their health and ethnic minority groups are often overrepresented in deprived areas. This study explored ethnic inequalities in adult oral health and the contribution of area deprivation to explain such inequalities.

Methods: Data from 15667 adults across 8 ethnicities (White British, Irish, Black Caribbean, Black African, Indian, Pakistani, Bangladeshi, Chinese) in the Health Survey for England 2010/2011 were analysed. Oral health was indicated by having a non-functional dentition, poor self-rated oral health and oral impacts on daily activities. Survey logistic regression and the Blinder-Oaxaca decomposition method were used.

Results: There were ethnic inequalities in the non-functional dentition, but not in self-rated oral health or oral impacts. Compared to White British adults (19.7%, 95% CI: 18.9, 20.6), a non-functional dentition was more common in Irish (33.1%, 95% CI: 25.9, 41.2) and less common in Black Caribbean (14.9%, 95% CI: 9.9, 21.7), Black African (6.9%, 95% CI: 3.9, 11.9), Indian (10.5%, 95% CI: 6.3, 17.2), Pakistani (7.2%, 95% CI: 4.5, 11.5), Bangladeshi (12.7%, 95% CI: 4.3, 32.3) and Chinese (2.2%, 95% CI: 0.6, 7.9) adults. In decomposition analysis, observed population characteristics explained over half of the ethnic inequalities in the non-functional dentition. Age, area deprivation and SEP were the main contributors, although results varied by ethnicity.

Conclusion: Ethnic inequalities in adult oral health varied according to oral health measure and ethnicity. Area deprivation and SEP contributed to, but did not fully, explain such inequalities.

Health Education England (HEE) is responsible for educating and training the health workforce in England, ensuring the workforce has the right numbers, skills, values, and behaviours to support patients. This includes developing a multi-professional dental care workforce able to meet the needs of current and future service requirements. The recognised challenge will be to train and develop clinicians to address the changing needs concomitant with the population demographics.