Journal of public health dentistry最新文献

Objective: To investigate disparities in oral health and quality of life between unhoused and housed populations in Chicago, Illinois, and highlight potential areas for policy intervention.

Methods: Cross-sectional study using the modified Oral Health Impact Profile (OHIP-14), a 14-item validated survey assessing seven domains affected by oral health, such as functional limitation, pain, and social disability. Data were collected from unhoused patients at the Rush CURE Clinic and housed patients from the Rush University Department of Otolaryngology Clinic in Chicago, Illinois. Demographics, oral health, and quality of life perception data were collected through the OHIP-14 survey. Statistical analysis included descriptive statistics, binomial tests, and ANOVA.

Results: Housed patients had increased access to healthy food (97% vs. 51%, p < 0.001), health insurance (100% vs. 65%, p < 0.001), and employment (64% vs. 35%, p < 0.001). Unhoused patients reported greater challenges across multiple OHIP-14 domains, including dissatisfaction with diet (33.3% vs. 7.7%, p < 0.001), difficulty with occupational activities (22% vs. 5.2%, p < 0.001), and lower overall quality of life satisfaction (32% vs. 5.2%, p < 0.001).

Conclusions: This study underscores the intersection of homelessness, oral health, and social determinants of quality of life. Findings may guide policymakers in designing targeted, community-based preventive interventions-particularly expanding oral health services, nutritional support, and employment resources for vulnerable populations. Structurally informed public health strategies are needed to reduce oral health inequities and their downstream effects on daily functioning and overall wellbeing.

Introduction: Puerto Rico has a higher prevalence of oral diseases compared to the U.S., underscoring the urgent need for preventive measures beyond the dentist's office. In response, the Puerto Rico Oral Health Coalition (PR-OHC) adopted a collaborative approach, bringing together public and private stakeholders to promote oral health across the archipelago.

Objective: This article showcases the impact of PR-OHC's efforts in reducing oral health disparities, promoting preventive services for children, and improving access to care by implementing Law No. 63-2017 and the Oral Exam Certificate (OEC) Program.

Methods: PR-OCH analyzed oral health needs and formulated a mission that included identifying disparities, expanding preventive services, and advocating for evidence-based public health policies. Efforts culminated in legislative action, elevating oral health as a public health issue. The law tasked the Department of Health with the implementation and tracking of an obligatory OEC for students in public and private schools.

Results: The law's implementation resulted in increased preventive dental visits among 1 to 16-year-old children who are beneficiaries of the Government Health Plan (Medicaid funds), the creation of an available and adequate oral health education delivery system, collaborative policy initiatives, and collaborations among stakeholders. After 7 years, 357,867 OEC's have been submitted.

Conclusion: PR-OHC's initiatives tackled oral health disparities by promoting routine exams-ensuring early detection, prevention, and treatment-and highlighting the importance of dental homes among school-aged children. The Coalition remains actively engaged in advocating for this policy and maintains a leadership role in advancing oral health, fostering interagency collaboration, and improving access for underserved communities.

Objective: Examine the association between perceived racial discrimination and children's oral health outcomes by race-ethnicity and socioeconomic status (SES).

Methods: Using the National Survey of Children's Health (2016-2022), we examined the relationship between perceived racial discrimination (caregiver-reported child exposure) and two outcomes: a child's receipt of a dental visit and the presence of any oral health problem in the past year. Logistic regression models were estimated, stratified by race-ethnicity (Black, Hispanic, White), and adjusted for SES using the federal poverty level (FPL). We also interacted perceived racial discrimination and FPL to observe how associations differ by SES.

Results: Perceived racial discrimination was associated with lower rates of dental visits for White and Hispanic children, with no significant association for Black children. Perceived racial discrimination was associated with a higher likelihood of having an oral health problem for all three racial-ethnic groups. In interaction models, associations with dental visits were inconsistent. The association between perceived racial discrimination and having an oral health problem in the past year was primarily isolated to the lowest SES strata (< 200% FPL), with higher likelihoods of having an oral health problem for all three racial-ethnic groups among those who perceived racial discrimination.

Conclusions: Perceived racial discrimination is associated with worse oral health and inconsistently with having a dental visit. The stronger association with oral health problems among children in the lowest SES strata highlights the need for targeted interventions addressing both racial discrimination and SES disparities to improve child oral health outcomes.

This editorial is an invited contribution to the JPHD Supplement focused on health equity. This editorial draws on scholarly and lived experience as well as critical insights related to health equity and future directions in dental public health. This editorial aims to support the specialty in work that is needed now more than ever.

Objectives: To examine dental care utilization and health and dental care expenditures among individuals with asthma.

Methods: Data from the 2022 Medical Expenditure Panel Survey (MEPS) (n = 21,405) were used to examine dental care utilization (any dental, preventive dental, and treatment dental visit) among individuals ≥ 1 year with and without asthma, and mean expenditures were summarized.

Results: Overall, the asthma diagnosis was 13.2%, 14.7% in working-age adults compared to 9.5% in children. The percentage of treatment dental visits was higher overall (17.0% vs. 14.5%, p < 0.05) among the asthma group compared to the non-asthma group. Among individuals with asthma, those who had preventive dental visits had lower dental expenditures compared to those who had treatment dental visits for all age groups.

Conclusion: Individuals with asthma had a higher prevalence of using dental treatment services. To support oral health among individuals with asthma, healthcare providers should educate and encourage the use of preventive dental care.

Objectives: Despite decades of national and global strategies, persistent inequities in oral health outcomes, access, and service provision remain. Existing frameworks often fail to integrate clinical and behavioral factors with social, cultural, and political determinants. This study aimed to map and evaluate oral health frameworks using Hodges' Health Career-Care Domains-Model (HCM), a meta-framework that spans clinical, behavioral, sociological, and political domains. The goal was to identify conceptual gaps and opportunities for greater integration.

Methods: A structured scoping review was conducted using MEDLINE, CINAHL, EBSCO, and search engine Google Scholar (1995-2025) to identify oral health-related conceptual frameworks. Frameworks were eligible if they addressed oral health determinants, behaviors, policies, or interventions. Two reviewers independently screened records and analyzed full-text articles. Frameworks were categorized by theoretical orientation and mapped against the four HCM domains to identify patterns of emphasis or omission.

Results: Of 226 identified records, 21 frameworks met inclusion criteria. These were classified into three thematic groups: balanced (addressing all domains), clinically led (focused on clinical/behavioral aspects), and policy/public health-focused (emphasizing sociological/political factors). Seven cross cutting themes emerged, including health promotion, systems integration, social justice, and cultural safety. While many frameworks promoted equity and policy reform, few offered implementation guidance or had been empirically validated.

Conclusions: HCM proved useful for systematically comparing frameworks and revealed consistent underrepresentation of political and structural domains. It offers a practical tool for oral health professionals, educators, and policymakers developing integrated oral health models that align with equity, sustainability, and universal health coverage goals.

Objectives: To assess public attitudes about a variety of burden-reducing policies related to oral health services in the Medicaid program.

Methods: We fielded a national survey (N = 5784) using Lucid from May 7 to 15, 2024. Respondents were queried whether they supported seven burden-reducing policies for the Medicaid program focused on both beneficiaries and oral healthcare providers related to oral health services. The survey also contained an experiment that highlighted (1) the importance of dental care, (2) administrative burdens for beneficiaries, (3) dental challenges for children in poverty, (4) dental challenges for children of color, or (5) administrative burdens for dental providers. We relied on descriptive statistics as well as linear probability models to assess.

Results: Overall, we found substantial support for reducing burden, ranging from 73.2% for referral requirements for physicians to a high of 92.1% for facilitating dentist credentialing. We found no differences across the various informational treatments. Analysis of the pooled data indicated that Americans were broadly supportive of reducing burdens for both beneficiaries and providers. We identified consistent differences based on ideology, racial resentment, racial resentment, empathy, awareness of disparities, burden tolerance, administrative capital, and connection to the Medicaid program.

Conclusion: The American public broadly supports burden reductions for both beneficiaries and providers. More research is needed to assess public attitudes related to oral health services policies.

Objectives: This article examines how dental education and workforce development can be leveraged to advance health equity in oral health. Persistent disparities in access to dental care, particularly in underserved areas, highlight the urgency of transforming public health dentistry. The concept of social mission provides a framework to align institutional strategies with equitable outcomes.

Methods: This article synthesizes data on dental workforce composition, enrollment trends, and representative case examples from U.S. dental schools. It reviews how dental education institutions have implemented comprehensive programs to diversify the workforce and improve care delivery in socioeconomically deprived communities.

Results: Despite incremental increases in enrollment of learners from underrepresented communities in healthcare, the dental workforce remains insufficiently diverse relative to population demographics. Schools/programs integrating admissions reforms, community-based training, socially accountable leadership, inclusive environments for faculty and students, and culturally responsive curricula demonstrated measurable outcomes, including increased provider representation in underserved areas and improved patient engagement. However, recent shifts in legislative policy have already been associated with threats to social mission areas in some programs, such as declining school diversity.

Conclusions: Transforming public health dentistry requires intentional strategies that embed social mission into the core functions of dental schools. Institutional leadership, innovative partnerships, and policy advocacy are critical to building a workforce capable of addressing structural inequities in oral health. Comprehensive, data-driven approaches can guide institutional progress toward more equitable dental care access and outcomes through the power of dental education reform.

Purpose: Few studies have explored dental hygienists' views on health behaviors like food insecurity or recommending preventive care such as the HPV vaccine. This study examined current practices, barriers, and readiness to implement screenings for food insecurity (FI), HPV risk, and vaccine recommendation.

Methods: A cross-sectional survey was conducted (August 2024) among Oklahoma dental hygienists. Using concepts from the Transtheoretical Model and the Theory of Planned Behavior (TPB), an embedded mixed-methods survey evaluated respondent readiness to conduct FI screenings and HPV risk assessment/vaccine recommendation. Analyses included descriptive statistics and χ² tests to determine associations between intent and constructs of TPB. Additionally, content analysis of open-ended questions identified barriers and facilitators to adopting these practices.

Results: Among respondents (n = 92), the majority were not yet considering (precontemplation) screening for FI (67%), risk assessment for HPV (58%), or providing the HPV vaccine recommendation (78%). Most hygienists displayed a positive attitude toward these practices, yet lacked intent due to low perceived behavioral control and subjective norms (p < 0.001). Qualitative content analysis revealed barriers, including a lack of knowledge (41%) and awareness (18%), low confidence (10%), and considering such practices outside the scope of dental care (15%). Despite this, hygienists reported education (13%) and access to resources (10%) as facilitators in initiating HPV and FI related conversations.

Implications: Despite the low readiness, hygienists reported a willingness to engage in these critical public health issues with appropriate training and support. A stage-based training program in Oklahoma may enhance dental hygienists' knowledge and confidence, thereby improving preventive care and health outcomes.

Objectives: Community water fluoridation (CWF) is an effective public health intervention for preventing dental caries. However, the widespread dissemination of misinformation on social media platforms, such as Twitter (now "X"), threatens public acceptance and may exacerbate oral health inequities. This study aimed to develop, evaluate, and deploy machine learning (ML) and deep learning (DL) models to identify misinformation about CWF on Twitter and assess implications for public health communication and surveillance.

Methods: We collected 19,960 English-language tweets about CWF posted between 2014 and 2024 using keyword-based queries. Tweets originated globally; however, only US-based geotagged tweets were used for sociodemographic analysis because reliable demographic and oral health surveillance data (e.g., US Census, BRFSS, NHANES) were available for linkage. Veracity was determined using authoritative public health criteria from the CDC, WHO, and ADA, with a subset of tweets manually annotated as factually correct or misinformation. Six machine learning and deep learning models were trained and evaluated. Additional analyses included sentiment scoring, thematic content coding, and geospatial-demographic comparisons.

Results: The Support Vector Classifier achieved the highest accuracy (91.6%). A hybrid BERT + XGBoost model (89.9% accuracy) was selected for deployment due to its strong performance and interpretability. Overall, 78.8% of tweets were classified as misinformation, with dominant themes including fluoride toxicity, distrust of government, and individual autonomy. Misinformation tweets were shorter, more engaging, and concentrated in socioeconomically disadvantaged areas with a high prevalence of misinformation tweets, where poverty rates and untreated dental caries were also greater. Sentiment analysis showed pro-CWF tweets were, on average, more positive.

Conclusions: ML and DL models can effectively detect CWF-related misinformation on social media. Integrated with equity-focused communication strategies, these tools may help sustain public trust in CWF and reduce misinformation-related oral health inequities.