Community dental health最新文献

Objectives: To determine the relationship between the need for orthodontic treatment and OHRQoL in children and adolescents, and to identify potential modifying factors of this relationship.

Methods: Systematic review, starting with searches of PubMed, Scopus, and EBSCO Discovery Service. Observational studies which examined the relationship between the need for orthodontic treatment and OHRQoL, in children and adolescents, were considered eligible.

Results: Eighteen studies were included, of which, one was a prospective cohort study and 17 were cross-sectional. Twelve of 18 studies reported a relationship between the need for orthodontic treatment and OHRQoL, while the remainder failed to demonstrate a clear relationship. Gender and self-esteem were found to modify this relationship.

Conclusions: Need for orthodontic treatment is associated with OHRQoL in children and adolescents. Gender and self-esteem are potential effect modifiers of this relationship.

Over 700 oral bacterial species have been identified in human populations, with ~200 bacterial species identified in any given individual mouth. The relationship between the oral microbiome and health is evidenced in many studies, with dysbiosis (a shift from a healthy to less healthy state of microbial community) associated with dental caries, periodontitis, halitosis and oral cancer. However, oral microbiome research to date has focused primarily on European populations, particularly those in large urban centres housing academic institutions with access to research funding. Key anthropological perspectives examining the sociocultural, epidemiological, genetic and environmental factors that influence the oral microbiome have also been Euro-centric. Very little is known about how the oral microbiome mediates both oral and general disease risks specifically within Indigenous and other vulnerable populations. Undertaking oral microbiome research in under-served communities requires consideration of many issues often unfamiliar in the broader research community, including being acceptable, relevant and of perceived benefit to the communities being studied. Research materials need to be managed respectfully in a culturally safe way, sharing/translating the knowledge obtained. These approaches will likely provide unique insights into the complex connections between environment and biology, people and place, and culture and science in relation to the oral microbiome. The ongoing development of oral microbiome research must facilitate frameworks that are equitable and inclusive to better enable clinical and scientific expertise within marginalised communities.

Microbiome research is currently biased towards populations of European descent, with such populations providing a weak basis upon which to understand microbiome-health relationships in under-studied populations, many of whom carry the highest burdens of disease. Most oral microbiome studies to date have been undertaken in industrialized countries. Research involving marginalised populations should be shaped by a number of guiding principles. In the Indigenous Australian context, one useful framework is the Consolidated Criteria for Strengthening Reporting of Health Research involving Indigenous Peoples (CONSIDER) statement. This paper describes how the microbiome research field is having impacts in the Indigenous Australian health space, and describes a particular project involving Indigenous Australians in which the CONSIDER statement is used as the underlying framework.

Background: Powered toothbrushes are an effective alternative to manual toothbrushes. Previous research found parents view powered toothbrushes as fun and motivating, although are less confident using them when children demonstrate resistant behaviour. Resistant child behaviour is a recognised barrier to achieving parental supervised brushing. Parents discuss strategies to address toothbrushing resistance on online parenting forums.

Objective: To explore how those posting on an online parenting forum discuss powered toothbrushes as a potential solution to toothbrushing resistance in young children.

Design: Qualitative content analysis of threads retrieved from the UK parenting forum Mumsnet.

Results: The Mumsnet sub-forums 'Behaviour/Development', 'Parenting' and 'Children's Health' were searched in April 2022. 204 relevant threads on toothbrushing resistance were identified and analysed. A further search of these threads identified posts on powered toothbrushes, yielding a sub-sample of 245 posts from 111 threads (of which 97 focused on resistant behaviour from a child/children aged under three). A coding frame was developed and included six categories: use of powered toothbrushes, descriptions of toothbrushes, positive aspects, reasons for not using, approaches to using, and discussions on Mumsnet. Posters suggested powered toothbrushes as a solution to toothbrushing resistance. Posters use Mumsnet to discuss the appropriateness of powered toothbrushes for young children.

Conclusions: Powered toothbrushes offer a potential solution to toothbrushing resistance. Discussions on parenting forums can normalise the use of powered toothbrushes with under-threes. Further research on how parents and dental professionals use and recommend using powered toothbrushes with under-threes would be useful.

Objectives: To examine the relationship between edentulism and the progress of multimorbidity, and the role of nutritional intake and behaviours among older Americans.

Methods: We used 7 waves (2006-2018) of the Health and Retirement Study, a longitudinal survey of older Americans (number included in analysis 2,224). Edentulism was assessed in 2006 and 2012. Multimorbidity was indicated by 5 self-reported conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioural factors were smoking, excessive alcohol consumption, physical activity, and body mass index. Nutritional intake was calculated by summing 10 nutrients (Protein, Vitamins C, D, B12, E, Calcium, Zinc, Polyunsaturated fatty acids, Folate and ß- carotene). Multilevel models for analysis of longitudinal data were used to assess the association between change in repeated measures of multimorbidity (between 2006 and 2018) and edentulism (2006) adjusting for nutritional intake, behavioural and socioeconomic factors.

Results: Participants who were edentate in 2006 and 2012 had higher rate-ratios (RR) for change in multimorbidity between 2006 to 2018 (RR: 1.29 and 1.28, respectively). After adjusting for socioeconomic factors, total nutrients and behavioural factors, these RR attenuated to 1.12 (95%CI: 1.06, 1.18) and 1.10 (95%CI: 1.05, 1.16), respectively. Total nutrition was negatively associated with progress of multimorbidity, but after adjusting for socioeconomic and behavioural factors the association became insignificant. Total nutrients rates in 2013 were significantly lower among those who were edentate in 2006 and 2012.

Conclusion: There was a longitudinal association between edentulism and progress of multimorbidity. The relationship appeared to be mediated be behaviours and nutrition.

The adoption of Universal Health Coverage for oral health care will not be sufficient to ensure that health care resources are accessible in accordance with needs for care. Government intervention in planning and allocating resources will be required to replace traditional market forces if market failure is not to be replaced by government failure. In this paper we explore the limitations of current 'fixed in time' approaches to planning the oral health care workforce and present an enhanced dynamic model for workforce planning that responds directly to changes in population, evidence-based best practice and new models of care.

Objective: To investigate patients' preference for extraction or preservation for toothache and hypothetical anterior tooth pain along with the specific reason for their choice.

Basic research design: Cross-sectional analytical semi-structured interview study.

Participants: A sample of 703 adult dental outpatients visiting secondary and tertiary government health centres with toothache due to dental caries in Eastern India.

Main outcome measures: Patients preferring restorative or extraction services for toothache, specific reason, and socio-demographic background factors for anterior and posterior teeth.

Results: Half (50.1%) choose preservation for present toothache and 79.9% for hypothetical front tooth pain. Immediate relief from toothache for extraction and the motive to preserve natural teeth for preservation were the main reasons expressed. In logistic regression, participants preferring extraction were more likely to be aged 25-34 years (OR = 1.94), 55+ years (OR=33.32), have primary and below education level (OR=1.99), have had a previous extraction (OR=1.99) and be unaware of preservation options (OR=2.34). For assumed anterior tooth pain, those between 25-34 years (OR=0.39) were more likely to choose preservation. Participants with primary and below education levels (OR=1.99) and unaware of preservation options (OR=1.95) chose extraction of the front tooth irrespective of their choice of treatment for the present toothache.

Conclusion: Notable differences between the choices to preserve or extract a posterior tooth were not found. There was greater preference towards preserving anterior teeth. Future research should identify additional barriers to the preference and utilization of restorative services.

Introduction: Dental settings were considered high risk settings for COVID-19. A Dental Public Health Team in East Scotland worked to risk assess each situation timeously to break chains of transmission.

Aim: To present learning from routine data collected from contact tracing COVID-19 cases in the dental setting.

Design: Retrospective analysis of a routine data set of COVID-19 cases associated with a dental setting reported via the national contact tracing system for two health board areas in the East of Scotland.

Methods: Descriptive statistics summarise the data collected over a 13-month period (Oct 2020-Dec 2021) during which all included COVID-19 cases were confirmed by PCR. A narrative presents output from contact tracing of all cases and includes themes identified during contact tracing that led to transmission within a dental setting. A case study illustrates impact of transmission.

Results: 752 cases are included. No evidence of staff to patient transmission or vice versa was found in this study. Staff to staff transmission occurred in non-clinical areas contributing to 33% of total staff cases with the remainder assessed to result from community transmission.

Conclusion: Transmission of COVID-19 in a dental setting, in the context of this study, appears to be confined to non-clinical areas with the majority of staff cases resulting from community transmission. Future pandemic plans should include tools to aid with implementation of guidance in non-clinical areas.

Objective: To conduct a capacity and needs assessment identifying important factors for the successful implementation of an oral health coach (OHC) at well-baby clinics. This Toddler Oral Health Intervention (TOHI) provides oral health promotion to parents to prevent early childhood caries.

Methods: A two-round Delphi study was conducted with an expert panel consisting of OHCs and paediatric staff. The survey was based on the Consolidated Framework for Implementation Research (CFIR), consisting of 39 constructs divided over 5 domains: intervention characteristics (8), inner setting (14), outer setting (4), characteristics of individuals (5) and the process of implementation (8).

Results: Constructs relating to the inner setting, outer setting and implementation process were identified as essential. Availability of resources, information on how to execute or facilitate the intervention, and the integration of the intervention into existing work tasks were also essential. Alignment and partnership between OHCs and paediatric staff, along with the prioritization of parents' and children's needs were emphasized. A formally appointed internal implementation leader within each organization, capable of transferring their enthusiasm to the team, and regular meetings for progress and experience sharing were considered essential.

Conclusion: Specific strategies are needed in the implementation phase to increase the adoption, implementation and maintenance of the TOHI, ultimately leading to improved oral health in children. This study provides valuable insights into important factors for implementation of an oral health intervention in a public health setting.

Chronic oral diseases, such as caries and periodontal disease, may, in future, be treated by oral microbiome transplant (OMT) technology. OMT therapy would involve collecting a donor oral microbiome and transplanting into a recipient to either prevent or treat oral diseases linked to a change (i.e., dysbiosis) in the oral microbiome. Given the great promise of this technology, we must consider the ethical and practical implications of how it is developed to maximise its accessibility and affordability. Here, we examine ways that OMT technology might be commercialized in the context of equity and accessibility in both clinical or do-it-yourself settings. We do this while assuming that the technology can be developed for humans in ways that are safe and effective at the individual and population-levels. We highlight the need for OMT therapy to be 1) cost-effective, 2) understood by end users and clinicians, 3) easy to access even in rural or remote communities, and 4) providing donors equitable compensation for their microbiomes. These key elements will only be achieved through partnerships between scientists, clinicians, investors and stakeholders throughout development. Therefore, proper acknowledgement and equitable evaluation of contributions in this team will also be critical to ensuring that this technology can be globally accessed. While OMT is likely to reshape how we prevent or treat oral disease, consciously guiding its development toward equity and accessibility to all people may significantly aid in improving health for those without access to dental care.