Community Dentistry And Oral Epidemiology[JOURNAL]
Sun
200 papers
The Effect of Prematurity on the Occurrence of Caries at Four Years of Age: A Prospective Cohort Study.
Rocha MC, Sartori LRM, Mascarenhas MK … +4 more , Domingues MR, Bertoldi AD, Silveira MF, Demarco FF
Community Dent Oral Epidemiol · 2026 Jun · PMID 42334034 · Publisher ↗
OBJECTIVES: To evaluate the association between prematurity and dental caries occurrence at four years of age and to assess whether variables related to dental development, tooth eruption, and oral healthcare mediate thi...
OBJECTIVES: To evaluate the association between prematurity and dental caries occurrence at four years of age and to assess whether variables related to dental development, tooth eruption, and oral healthcare mediate this association. METHODS: A longitudinal study was conducted using data from the 2015 Pelotas (RS) Birth Cohort. The outcome was dental caries at four years, classified using ICDAS. Gestational age at birth was estimated by ultrasonography examination in 3 407 (79.7%) cases, with 3 242 (75.8%) performed during the 1st or 2nd trimester. Mediating variables included enamel defects, number of teeth at 12 months, oral hygiene practices, sugar consumption, and maternal guidance. The variables were selected using a directed acyclic graph (DAG). Associations were estimated using Poisson regression models, and mediation was assessed through structural equation modelling (SEM). Analyses were performed using STATA 18.0. RESULTS: Children born before 34 weeks had a 40% lower incidence of caries at four years compared to those born after 39 weeks, and those born between 37 and 38 weeks had a 20% lower incidence. The number of teeth mediated this relationship, indicating that lower gestational age was associated with fewer teeth at 12 months and a lower occurrence of caries. CONCLUSION: The findings highlight the importance of early dental monitoring and suggest preventive programs starting with the eruption of the first tooth, given its relevance in the occurrence of caries.
Implementation of Child Healthy Weight Guidelines in the Dental Setting: A Pilot Study.
Villarosa AR, Maneze D, Ramjan L … +5 more , Patterson-Norrie T, Srinivas R, Yaacoub A, Kumar T, George A
Community Dent Oral Epidemiol · 2026 Jun · PMID 42334025 · Publisher ↗
BACKGROUND: There has been an increasing prevalence of childhood overweight and obesity worldwide and locally, with a quarter of Australian children now considered overweight. To address this, the New South Wales governm...
BACKGROUND: There has been an increasing prevalence of childhood overweight and obesity worldwide and locally, with a quarter of Australian children now considered overweight. To address this, the New South Wales government in Australia released guidelines calling for all public dental services to identify children above a healthy weight and refer them to appropriate services. This study was part of a larger study that aimed to codesign and pilot implementation strategies to facilitate the translation of these guidelines into dental staff's practice. METHODS: A pre-post-test design was used to evaluate the strategies across two health districts in NSW. Strategies were codesigned by dental staff and parents of patients and included linguistically appropriate resources; discharge summaries from referral pathways; refresher training; involvement of dental assistants; templates for longitudinal BMI measures and growth assessment flyers for patients. A validated questionnaire measuring intention to engage in the guidelines and self-reported practice was distributed to interested staff before and after the delivery of strategies (2019-2022). Data describing dental staff's' actual practices over this time were also retrieved from patient information management systems. Descriptive and inferential statistics were used to assess the study outcomes and any differences across districts (n = 16). RESULTS: There was no improvement in behavioural determinants of providing a growth assessment as indicated by the overall intention to engage in Children's Healthy Weight guideline (iCHEW) scale scores, however attitude scores had the largest observed improvement (from 30.1 to 35.2) and this was most pronounced in District 2 (27.2-34.3). A significant improvement in adherence to children's healthy weight guidelines was also seen in District 2 (increase of 20.54%, 95% CI 14.09-27.44). In District 1, children had 1.5 times the odds of receiving a growth assessment if they were treated by a dental officer (OR = 1.54; 95% CI 1.00-1.72). Conversely, children in District 2 had significantly lower odds of receiving a growth assessment if they were treated by a dental officer (OR = 0.203; 95% CI 0.12-0.35) or if they were treated at a satellite clinic (OR = 0.572; 95% CI 0.45-0.73). CONCLUSION: Dental staff can play a key role in addressing childhood overweight and obesity, although this can be challenging. The findings suggested some improvements in behavioural determinants and self-reported behaviours following supportive strategies. Further research to confirm these findings using larger sample sizes is recommended.
Economic Evaluation of the RETURN Intervention to Increase Routine Dental Attendance Among Disadvantaged Adults: Net Health Benefit (QALYs) and Patient Cost Outcomes From a Randomised Controlled Trial.
Zabula T, Lowers V, Howdon D … +1 more , Harris R
Community Dent Oral Epidemiol · 2026 Jun · PMID 42321975 · Publisher ↗
OBJECTIVES: Routine dental attendance is associated with better health outcomes, yet those from disadvantaged backgrounds are more likely to seek problem-driven, episodic care. The RETURN intervention, a brief behavioura...
OBJECTIVES: Routine dental attendance is associated with better health outcomes, yet those from disadvantaged backgrounds are more likely to seek problem-driven, episodic care. The RETURN intervention, a brief behavioural intervention delivered by dental nurses in urgent care, was designed to support urgent care users to take up planned dental care. This study evaluates the cost-effectiveness of the RETURN intervention. METHODS: A cost-utility analysis was conducted alongside a randomised controlled trial. Resource use and health outcomes, measured in Quality-Adjusted Life Years (QALYs) derived from the EQ-5D-5L questionnaire, were evaluated at 12 and 18 months. The primary analysis used a cost-effectiveness threshold of £20 000 per QALY. Multiple imputation was used to account for missing data. Objectives also included providing an estimated incremental cost per improved Oral health impact profile (OHIP-14) point. RESULTS: The intervention was found to be cost-effective with high confidence. At 12 months, intervention incremental cost was £18.83 with incremental Quality-Adjusted Life Year (QALY) gain of 0.014, and an incremental net health benefit (NHB) of 0.013 QALYs. The probability of cost-effectiveness was 90.5%. At 18 months, the incremental cost was £15.11 for a QALY gain of 0.009, and incremental NHB of 0.008 (probability of cost-effectiveness 70.9%). The findings were supported by complete case analysis, which showed probabilities of cost-effectiveness of 99.7% at 12 months and 98.5% at 18 months. Sub-group analysis gave the strongest evidence of cost-effectiveness in the most deprived populations. CONCLUSIONS: The RETURN intervention is highly likely to be a cost-effective use of National Health Service resources. Its impact appears particularly strong among those living in the most deprived areas, suggesting the potential to reduce inequalities in access to routine dental care. TRIAL REGISTRATION: The RETURN trial was registered at isrctn.com (ISRCTN84666712).
Preventable Dental Related Emergency Department Visits and Hospital Admissions: A Systematic Review of Economic Burden and Healthcare System Costs.
Francis UMGS, Lai JJ, Hettiarachchi RM … +4 more , Hobbs L, Ariyawardana A, Chaminda JLP, Tuffaha H
Community Dent Oral Epidemiol · 2026 Jun · PMID 42321969 · Publisher ↗
OBJECTIVES: To systematically evaluate the economic burden of preventable dental-related emergency department visits (PDEDV) and preventable dental-related hospital admissions (PDHA), identify reasons for these presentat...
OBJECTIVES: To systematically evaluate the economic burden of preventable dental-related emergency department visits (PDEDV) and preventable dental-related hospital admissions (PDHA), identify reasons for these presentations, and synthesise recommendations to reduce avoidable utilisation. METHODS: This systematic review followed the PRISMA 2020 guidelines. A comprehensive multiple database search was conducted in PubMed, Embase, Cochrane Library, EBSCOHOST, and Web of Science for studies reporting direct and/or indirect costs of PDEDV and PDHA in any age group, published in English from 2000 to March 2026. Three calibrated reviewers screened and critically appraised the identified studies. Data including patient characteristics, estimated charges/costs, reasons for PDEDV and PDHA, and recommendations to minimise the avoidable burden were extracted. Charges/costs were inflation-adjusted and standardised to 2024 US dollars. RESULTS: Of the 2600 total studies identified, 25 met the inclusion criteria. The majority were conducted in the United States and focused on direct medical costs. Uninsured individuals, public health insurance enrolees and residents of low-income areas were more likely to experience PDEDV. Mean charges per any PDEDV ranged from $409.73 to $2740.76. Mean charges per any PDHA ranged from $5234.46 to $62 298.25, while mean hospital costs ranged from $350.42 to $22 375.53. Dental caries was the commonest cause for PDEDV. Odontogenic infections were the costliest to manage, with mean charges of $2740.76 per PDEDV and $62 298.25 per PDHA. PDEDV and PDHA were primarily driven by financial barriers, socio-demographic disparities, limited access to routine dental care, and health workforce constraints. Proposed strategies focused on improving affordability and access to preventive dental care, enhancing oral health literacy, strengthening integration between medical and dental services, and expanding the dental workforce. CONCLUSIONS: PDEDV and PDHA, particularly those due to dental caries and odontogenic infections, impose a significant economic burden on healthcare systems, highlighting the need to reduce financial and access barriers to routine dental care for high-risk groups and priority conditions.
Behaviour Support in Dentistry Core Outcomes (BeSiDe-CO): A Core Outcome Set Development Study.
Mac Giolla Phadraig C, Olegário IC, Hsu S … +11 more , Al Zayer M, Fisal ABA, Dougall A, Kitchen GB, Duncan HF, Baker S, Pani S, Mallineni SK, Daly M, BeSiDe COS Collaboration, Geddis-Regan A
Community Dent Oral Epidemiol · 2026 Jun · PMID 42321959 · Publisher ↗
OBJECTIVES: To develop a Core Outcome Set suitable for adults and children for use in studies of Dental Behaviour Support (DBS) techniques, including non-pharmacological DBS, sedation and General Anaesthesia research. ME...
OBJECTIVES: To develop a Core Outcome Set suitable for adults and children for use in studies of Dental Behaviour Support (DBS) techniques, including non-pharmacological DBS, sedation and General Anaesthesia research. METHODS: Two systematic reviews generated a preliminary list of candidate outcomes that were shared with Key Stakeholders (KSG) and Public Patient Involvement (PPI) groups, who shortlisted outcomes for further exploration. Patients, carers, clinicians, and researchers were invited to participate in a Delphi panel. A modified e-Delphi was used to generate prioritisation and consensus across outcomes. A subsequent series of consensus meetings with panellists, patient groups and professional stakeholder groups determined the final outcomes within the COS. RESULTS: Twenty-three candidate outcomes were rated by 88 panellists in Round 1. The attrition rate between Rounds 1 and 3 was 21.6%. Thirty-four to 32 panellists attended the consensus meetings. The BeSiDe core outcome set for Dental Behaviour Support consisted of nine outcomes: acceptability, adverse effect, anxiety, behavioural response, cost, pain, therapeutic alliance, time and treatment completion. An additional subset of three core outcomes for use in pharmacological DBS studies was agreed upon: recovery, sedation effect and physiological monitoring. Each outcome was presented with a plain-language label and description to support consistent interpretation across stakeholders. CONCLUSIONS: A core outcome set to be used across all DBS studies was produced covering both adults and children, with supplementary additional outcomes available to use in studies exploring only pharmacological DBS approaches. The list is for use in research, though there is obvious transferability to clinical practice. TRIAL REGISTRATION: COMET Initiative database (Study ID: 2101), registered September 2022.
Can the Relationship Between Breastfeeding and Malocclusion in Primary Dentition Change According to Pacifier Use Duration and Intensity? Evidence From a Birth Cohort Study.
Mathias FB, Goettems ML, Demarco FF … +2 more , Domingues M, Cademartori MG
Community Dent Oral Epidemiol · 2026 Jun · PMID 42298813 · Publisher ↗
OBJECTIVE: To investigate whether the association between exclusive breastfeeding and malocclusions in primary dentition is modified by pacifier use duration and intensity. METHODS: Data from a birth cohort study conduct...
OBJECTIVE: To investigate whether the association between exclusive breastfeeding and malocclusions in primary dentition is modified by pacifier use duration and intensity. METHODS: Data from a birth cohort study conducted in southern Brazil were used (n = 3591). Poisson regression with robust error variance was used to assess the association between exclusive breastfeeding and malocclusion. The exposure to exclusive breastfeeding was collected through information about breastfeeding duration at 3 and 12 months follow ups. Malocclusion outcomes were assessed at 48 months of follow up using criteria of the World Health Organization. Effect measure modification (EMM) analysis was adopted to verify the association between exclusive breastfeeding and malocclusions, which vary according to pacifier use duration and intensity. EMM was assessed by means of the relative excess risk due to interaction (RERI), which corresponds to the additional risk that would be expected if the combination of exclusive breastfeeding and pacifier use intensity and duration was fully additive. RESULTS: Children who were not exclusively breastfed for 6 months and who used a pacifier throughout the first 4 years showed a prevalence of 7.82 higher than malocclusion (95% CI 4.70-12.92). Even among children who were exclusively breastfed, pacifier use during this period was also associated with a higher prevalence of malocclusion (PR 5.98; 95% CI 3.50-10.21). When occurrence of malocclusion by pacifier use intensity at 48 months was analysed, children full-time users and those children who were not exclusively breastfed presented a malocclusion prevalence of 4.87 (95% CI 3.43-6.93), and those children who were full-time users and who were exclusively breastfed showed a prevalence of 3.96 higher for malocclusion (95% CI 32.66-5.90). Positive RERI for both duration and intensity of pacifier use were observed, suggesting that the joint effect of breastfeeding and pacifier use on malocclusion is larger than the sum of their individual values. CONCLUSION: Pacifiers use duration and intensity in the first 4 years of life modify the protective effect of exclusive breastfeeding for the first 6 months of life on the malocclusion prevalence at 48 months of life. These findings reinforce the deleterious effects of pacifier use on occlusal development, even with the practice of exclusive breastfeeding.
Understanding Rheumatoid Arthritis-Oral Health Perceptions Around Diagnosis and the Early Disease Course: A Phenomenological Approach.
Bhagwandas NI, van de Stadt LA, Kroese JM
Community Dent Oral Epidemiol · 2026 Jun · PMID 42277994 · Publisher ↗
OBJECTIVES: To explore how Dutch adults with rheumatoid arthritis (RA) perceive their oral health around the diagnostic process and the early disease course. The primary objective was to describe these perceptions in dep...
OBJECTIVES: To explore how Dutch adults with rheumatoid arthritis (RA) perceive their oral health around the diagnostic process and the early disease course. The primary objective was to describe these perceptions in depth, and a secondary objective was to identify areas for future patient-centred research. METHODS: A phenomenological qualitative study was conducted at Reade, a specialized rheumatology clinic in Amsterdam, The Netherlands. Adults (≥ 18 years) diagnosed with RA within 5 years prior to the start of recruitment, without multimorbidity and irrespective of oral complaints, were eligible. After completing brief sociodemographic/RA and oral-care questionnaires, semi-structured interviews in Dutch (face-to-face or virtual) were conducted with a trained interviewer with lived RA experience. Data were coded inductively in ATLAS.ti using thematic analysis. RESULTS: Eleven adults (7 women, 4 men; median age 68 years) were interviewed. Five themes were identified: (1) fluctuating symptoms demanded continual lifestyle adjustments and, for some, financial losses from reduced work hours; (2) the diagnosis carried a wide emotional burden-humour and symptom-downplaying helped, yet most still camped with accepting the disease, its medication and side-effects; (3) relationships with healthcare professionals varied-participants adhered to rheumatologists' recommendations but followed dental advice less consistently, and they viewed dentists and hygienists as having distinct roles; (4) oral hygiene ability varied-hand- or wrist-flare ups briefly hindered routines for some, and awareness of RA-related oral health risks (e.g., temporomandibular-joint involvement) was low; and (5) tailored information linking RA and oral health was scarce, and participants preferred clear guidance from clinicians while firmly rejecting oral hygiene guidance from friends and family. CONCLUSIONS: This exploratory study of Dutch adults with RA showed that perceptions of oral health, particularly around the diagnostic process and early disease course, highlighted five patient-centred research areas: determining the optimal timing and provider of RA-oral health information, mapping educational gaps among dental and rheumatology professionals and students, refining ergonomic toothbrush design, addressing socioeconomic barriers to dental care and validating routine TMJ screening tools. These findings may also serve as a foundation for the development of dental guidelines that reflect the patient perspective.
Investigation Into the Effectiveness of Community Water Fluoridation and Dental Caries Experience in 4-Year-Old Aotearoa New Zealand Children: A National Repeated Cross-Sectional Study From 2010 to 2022.
Chambers T, Schluter PJ, Dean F … +2 more , Hobbs M, Broadbent J
Community Dent Oral Epidemiol · 2026 Jun · PMID 42277964 · Publisher ↗
OBJECTIVES: To provide contemporary national evidence on the effectiveness of community water fluoridation (CWF) for the prevention of early childhood caries (ECC) among 4-year-old children in Aotearoa New Zealand (NZ),...
OBJECTIVES: To provide contemporary national evidence on the effectiveness of community water fluoridation (CWF) for the prevention of early childhood caries (ECC) among 4-year-old children in Aotearoa New Zealand (NZ), and to examine potential effect modification by ethnicity and other sociodemographic characteristics. METHODS: A national repeated cross-sectional study was conducted using routinely collected B4 School Check data (2010-2022). Children aged 4 years were linked to a national spatial dataset of water distribution zones and council-reported fluoridation histories to classify exposure over the assessment year and preceding 3 years. ECC was identified via the 'lift-the-lip' screening. Multilevel mixed-effects modified Poisson regression models, with children nested within meshblocks, estimated incidence rate ratios (IRRs), adjusting for ethnicity, area-level deprivation, age, sex, rurality, and assessment year. Two-factor interactions were examined. RESULTS: Among 630 926 children, 14.2% had ECC. In crude analyses, ECC appeared more common in fluoridated areas; however, after adjustment for sociodemographic characteristics, CWF was associated with a lower rate of ECC (IRR = 1.13; 95% CI: 1.11-1.15 for non-fluoridated vs. fluoridated). A significant interaction between CWF and ethnicity was observed. The protective association was strongest among European/Other children (IRR = 1.25; 95% CI: 1.21-1.29) and attenuated among Māori and Asian children, with minimal effect among Pacific children. The ethnicity-weighted population attributable fraction was 4.4%, equating to approximately 282 ECC cases annually. CONCLUSION: Findings are consistent with CWF being an effective population-level oral health intervention. However, its association with caries experience varies by ethnicity, highlighting the importance of addressing structural inequities alongside universal preventive strategies.
Advancing Global Oral Health Research Through Community and Academic Partnerships: An Overview of the CORE Programme.
Guarnizo-Herreño CC, Stennett M, Mutave R … +7 more , Goes PSA, Chatterjee M, Mathur M, Mehta A, Ross A, Conway DI, Watt RG
Community Dent Oral Epidemiol · 2026 Jun · PMID 42261076 · Publisher ↗
BACKGROUND: The increasing burden of oral diseases in low- and middle-income countries (LMICs) and limited access to and affordability of oral care disproportionately impact disadvantaged groups. Oral health research has...
BACKGROUND: The increasing burden of oral diseases in low- and middle-income countries (LMICs) and limited access to and affordability of oral care disproportionately impact disadvantaged groups. Oral health research has been dominated by professional academic perspectives with limited contribution from the communities involved. The aim of this commentary is to provide a broad overview of the aims and objectives, principles, values, and study design of the CORE programme. PROGRAMME AIMS: The CORE (Community focused Oral health Research for Equity) programme is a multinational research initiative which aims to reduce oral health inequalities and improve access to dental services through collaborations between disadvantaged communities and academic and community partners in Brazil, Colombia, India and Kenya. Public health research interventions will be co-created and tested with local communities through a participatory action research approach and active community engagement and involvement. In addition, the programme aims to strengthen local oral health research capacity and advocacy. GENERAL PROGRAMME DESIGN: The CORE programme is comprised of three elements: (1) Programme management and governance; (2) Research components focused on oral health inequalities, commercial determinants and oral health system reform; (3) Overarching components including (i) community engagement and involvement, (ii) training and capacity building, (iii) monitoring, evaluation and learning. Through a collaborative community-based approach, the CORE programme will undertake high-quality research in LMICs to inform future pro-equity and health system reform policies.
Factors Associated With Parent-Reported Caries in Preschool Children From the KUNO-Kids Health Study-Repeated Cross-Sectional Analysis.
Lennon ÁM, Fluch-Maier K, Hiller KA … +9 more , Schenke I, Gade N, Buchalla W, Brandstetter S, Köninger A, Melter M, Apfelbacher C, Kabesch M, KUNO‐Kids Study group
Community Dent Oral Epidemiol · 2026 Jun · PMID 42253094 · Publisher ↗
OBJECTIVES: This questionnaire-based study aimed to assess parent-reported caries (PRC) at ages 2-5 years and identify potential influencing factors using an exploratory, repeated cross-sectional analysis within an ongoi...
OBJECTIVES: This questionnaire-based study aimed to assess parent-reported caries (PRC) at ages 2-5 years and identify potential influencing factors using an exploratory, repeated cross-sectional analysis within an ongoing birth-cohort study. METHODS: Parental factors included health, socioeconomic status, maternal age and dental check-up attendance. Child factors included birth mode and weight, antibiotic, probiotic, bottle use, early dentition, weaning age, oral hygiene, diet, body mass index (BMI) and mouth-breathing. Environmental factors included sibling caries, contact with other children, pets, or farms. Families (n = 1296) who completed the 2-year caries questionnaire were included, corresponding numbers were 1276 at 3 years, 993 at 4 years, and 768 at 5 years. A subgroup comprised children who had visited a dentist since their last birthday (n = 735, at 2 years, n = 951, 891 and 662 at 3, 4 and 5 years respectively). RESULTS: PRC rate was 0.4%, 1.3%, 2.7% and 4.4% for ages 2-5. Rates were 0.4%, 1.6%, 3.3% and 4.7% for the subgroup at the same ages. At Age 2, maternal migration background, lower paternal education and unemployment, late weaning, infrequent maternal dental check-ups and pet contact were associated with PRC. Except for paternal education, the same factors remained associated in the subgroup. At Age 3, single-parent status, maternal physical health, late weaning, sibling caries and pet contact were significantly associated with PRC. With the addition of infrequent maternal dental check-ups, the same factors remained associated in the subgroup. At Age 4, early dentition, mouth-breathing aged 1 were associated with PRC. Including late weaning, the same factors remained significantly associated in the subgroup. At Age 5, poor dietary and toothbrushing behaviour aged 2, younger mother, low BMI aged 1, infrequent maternal dental check-ups, pet contact, and pacifier hygiene were associated with PRC. Except dietary behaviour aged 2, with the addition of paternal employment, the same factors were significantly associated in the subgroup. CONCLUSIONS: This study identifies key parental, child, and environmental risk factors for early childhood caries, revealing novel factors for further investigation and targeted prevention.
Public Dental Expenditure and Dental Visits in Europe and Japan.
Inoue Y, Aida J, Watt RG … +1 more , Heilmann A
Community Dent Oral Epidemiol · 2026 May · PMID 42219790 · Publisher ↗
BACKGROUND: Dental care is important for oral health, but access to dental services is subject to social inequalities and varies between countries. Despite this, few cross-national studies have examined how public dental...
BACKGROUND: Dental care is important for oral health, but access to dental services is subject to social inequalities and varies between countries. Despite this, few cross-national studies have examined how public dental expenditure relates to dental service use among older adults. This study aimed to investigate the associations between public dental expenditure and dental visits among older adults using an international comparative design. METHODS: Data were obtained from the Survey of Health, Ageing and Retirement in Europe (SHARE, Wave 8, 2019), covering 25 European countries and Israel, and the Japanese Gerontological Evaluation Study (JAGES, 2019). The final sample included 48 497 adults aged 65 years or older. The outcome was any dental visit in the past year, while the explanatory variable was country-level annual per capita public dental expenditure on outpatient dental care in 2019 (USD), obtained from the OECD database and adjusted for purchasing power parity. A multilevel modified Poisson regression model was used to estimate prevalence ratios (PRs), accounting for between-country variability. Interaction terms between household income and public dental expenditure were included to examine effect modification. RESULTS: The overall dental visit rate was 59.5%, with higher rates among women, those with higher education, and those in higher income groups. Each $10 increase in per capita public dental expenditure at the country level was associated with higher dental visit rates (PR: 1.05, 95% CI: 1.03-1.07). The association was stronger among lower-income groups, suggesting that income-related inequalities in dental visits were smaller in countries with higher public dental expenditure. CONCLUSIONS: Public expenditure on dental care was associated with higher dental visit rates, particularly among low-income groups. These findings suggest that public financing of dental care may help reduce income-related inequalities in dental visits among older adults.
Do Temporal Changes in Complete Tooth Loss Point to Cohort Effects?
Mejia GC, McCormick KM, Chrisopoulos S … +2 more , Amarasena N, Luzzi L
Community Dent Oral Epidemiol · 2026 May · PMID 42210046 · Publisher ↗
OBJECTIVES: Complete tooth loss is more common among older adults; however, its prevalence has declined significantly over time. It is currently unknown whether age and period effects act independently or whether they in...
OBJECTIVES: Complete tooth loss is more common among older adults; however, its prevalence has declined significantly over time. It is currently unknown whether age and period effects act independently or whether they interact to produce differential effects by birth cohorts. This study aimed to examine temporal changes in the prevalence of complete tooth loss in Australia, examine the effects of age, period and cohort and assess life course changes within birth cohorts. METHODS: The study used data from three repeated cross-sectional waves of Australia's National Dental Telephone Interview Survey (2005, 2013 and 2021), each comprising independent samples. The prevalence of edentulism among adults aged 41 years and older was described. The independent effects of age and period and examined cohort effects were estimated using an Age-Period-Cohort Interaction (APC-I) model. RESULTS: The prevalence of complete tooth loss among adults aged 41 years and older declined from 12% in 2005 to 6% in 2021. The analysis shows that while edentulism increased with age, it decreased significantly over time across most age groups. Despite the low prevalence of edentulism, younger generations showed higher-than-expected levels of complete tooth loss. Significant cohort effects were observed, with older cohorts showing high tooth loss and younger cohorts exhibiting concerning trends. CONCLUSION: Despite overall progress in reducing edentulism, the increase in complete tooth loss among younger generations poses a threat to long-term oral health outcomes in Australia. Ongoing surveillance and targeted public health interventions are critical in preventing a resurgence in tooth loss, particularly among younger populations. Comprehensive oral health programs and equitable access to care are essential to maintaining Australia's progress in oral health and in addressing emerging challenges.
Prospective Association Between Brazilian Primary Oral Health Care Models and Preventive Dental Visits and Risk Behaviours: A 5-Year Cohort Study Among Young Adults.
Vione JV, Comim LD, de Castro NC … +3 more , Zenkner JEDA, do Amaral Júnior OL, Alves LS
Community Dent Oral Epidemiol · 2026 May · PMID 42171377 · Publisher ↗
OBJECTIVE: To evaluate the prospective association between the absence and different models of primary oral health care in Brazil (traditional units and Family Health Strategy [FHS] teams) and preventive dental visits an...
OBJECTIVE: To evaluate the prospective association between the absence and different models of primary oral health care in Brazil (traditional units and Family Health Strategy [FHS] teams) and preventive dental visits and risk behaviours (smoking initiation and increase in alcohol consumption) among young individuals. METHODS: This 5-year prospective cohort study derived from a population-based cross-sectional survey conducted in 2018 that evaluated the oral health conditions of 1197 15- to 19-year-old adolescents from southern Brazil. In 2022-2024, follow-up assessments were conducted (mean time interval 5 ± 0.5 years). Socio-demographic characteristics, the use of dental services (including the reason for the last dental visit), behavioural habits (smoking and alcohol consumption) and participants' address were collected at baseline and follow-up. The outcomes were last dental visit for prevention, smoking initiation and increase in alcohol consumption. The main predictor variable was public dental services coverage in the neighbourhood (absent, primary health care or FHS including a dental team) obtained from official data. Unadjusted and adjusted multilevel Poisson regression models were performed to estimate relative risk (RR) and 95% confidence intervals (CI). RESULTS: Five hundred and seventy individuals were re-evaluated (47.6% retention). After adjusting for individual-level variables, participants residing in neighbourhoods with FHS including a dental team were more likely to visit a dentist for preventive purposes (RR: 1.59; 95% CI: 1.29-1.97), and had a lower risk for smoking initiation (RR: 0.45; 95% CI: 0.21-0.97), and an increase in alcohol consumption (RR: 0.80; 95% CI: 0.67-0.97) compared to areas without coverage. Coverage by traditional primary health care showed no significant association with the study outcomes. CONCLUSION: Brazil's FHS model with integrated oral health teams outperforms traditional dental services in promoting preventive care and reducing risk behaviours among young adults.
Comprehensive Dental Treatment and Glycemic Control in Primary Health Care Patients With Type 2 Diabetes: A Retrospective Cohort Study.
Oviedo Contreras C, Cornejo Ovalle M
Community Dent Oral Epidemiol · 2026 May · PMID 42089456 · Publisher ↗
INTRODUCTION: Type 2 diabetes mellitus (T2DM) and periodontal disease are linked through a bidirectional inflammatory relationship that can impair glycaemic control. This study aimed to evaluate the association between c...
INTRODUCTION: Type 2 diabetes mellitus (T2DM) and periodontal disease are linked through a bidirectional inflammatory relationship that can impair glycaemic control. This study aimed to evaluate the association between comprehensive dental treatment and glycaemic control in adults with T2DM enrolled in Chile´s Cardiovascular Health Programme (CVHP). METHODS: This retrospective cohort study was based on routine electronic health records from primary care services in La Reina, Chile, between 2021 and 2023. The exposure variable was the completion of comprehensive dental treatment, and the outcome was final glycated haemoglobin (HbA1c), analysed both as a continuous measure and as a binary indicator of glycaemic compensation. Multivariable linear and logistic regression models were fitted, adjusted for baseline HbA1c, age, sex and body mass index (BMI). RESULTS: The final analytical cohort included 392 participants (196 treated and 196 untreated). The balanced group sizes resulted from the inclusion of all eligible individuals with complete HbA1c data from each exposure category rather than from sampling or matching. Comprehensive dental treatment was associated with lower mean final HbA1c values (β = -0.94; 95% CI: -1.15 to -0.72; p < 0.001) and was also associated with lower odds of final glycaemic decompensation in the adjusted logistic model (OR = 0.19; 95% CI: 0.10-0.34). CONCLUSION: Comprehensive dental treatment was significantly associated with improved glycaemic control among adults with T2DM. These findings reinforce the relevance of integrating oral health care into chronic disease management and align with person-centred, multimorbidity care frameworks. Further prospective research is warranted to confirm causality and inform public health policy.
Decolonising Global Oral Health for Health Equity: A Scoping Review of the Global North Literature.
Fathi H, Benzian H, Bedos C … +1 more , Kearns C
Community Dent Oral Epidemiol · 2026 May · PMID 42076817 · Publisher ↗
OBJECTIVES: Dentistry presents itself as neutral and technical, yet its institutions and curricula remain shaped by colonial legacies. Decolonisation is both a concept and a process that seeks to dismantle these legacies...
OBJECTIVES: Dentistry presents itself as neutral and technical, yet its institutions and curricula remain shaped by colonial legacies. Decolonisation is both a concept and a process that seeks to dismantle these legacies and restore legitimacy to marginalised histories, knowledge, and cultures. This review mapped literature on colonial impacts and decolonisation pathways in global oral health, providing a foundation for future dialogue. METHODS: A scoping review was conducted. Searches across four databases (Medline, Embase, Scopus, CINAHL) yielded 3263 records, of which 65 articles were eligible. The review included metadata analysis (publication trends, author affiliations, decolonial frameworks) and qualitative thematic analysis in MAXQDA to identify relevant themes. RESULTS: Most of the 65 studies were published after 2020 and were authored predominantly by women from Global North institutions. While 58 studies critiqued colonialism, only 21 explicitly engaged with decolonisation. Thematic analysis highlighted three domains where colonial dynamics persist in global oral health: (1) marginalised populations and communities, (2) systems of education, research, and workforce, and (3) discursive forces and narratives-including historical erasures, neoliberal framings, and power structures. CONCLUSIONS: Dentistry has been slower than other health fields to engage with decolonisation and existing efforts are fragmented, rhetorical, and prone to co-optation, leaving the field in an early and uneven stage. Preventing the concept from becoming a hollow buzzword requires epistemic plurality, Indigenous and community leadership, and structural reforms in education, research, and practice. The field's future hinges on whether it continues to perpetuate colonial inequities or redefines itself as a justice-oriented force in global health.
Are We Listening or Just Delivering? A Critical Inquiry Into the Implementation Failures of Global Dental Reforms.
Mathur MR, Khan SKN
Community Dent Oral Epidemiol · 2026 Apr · PMID 42057446 · Publisher ↗
OBJECTIVES: Globally, dental reforms have gained momentum through enhanced policy dialogues, the rise of digital health, artificial intelligence and outreach initiatives. Yet the burden of oral disease remains disproport...
OBJECTIVES: Globally, dental reforms have gained momentum through enhanced policy dialogues, the rise of digital health, artificial intelligence and outreach initiatives. Yet the burden of oral disease remains disproportionately high among vulnerable populations, particularly in low- and middle-income countries, even as reforms continue to evolve. METHODS: This critical narrative review draws on existing disease burden data, documented reform strategies and an examination of structural gaps in care and prevention delivery. It interprets these through two established frameworks, epistemic humility and implementation realism, to interrogate how reforms are designed. It further proposes epidemiological humility as a new conceptual lens to question how data are interpreted and whose reality remains excluded. RESULTS: The review identifies four recurring patterns: digital innovations that outpace infrastructure and trust, standalone interventions lacking continuity, prevention strategies deployed without curative care and a growing divide between private provision and deteriorating public systems. These gaps not only hinder impact but distort the visibility of oral disease, shaping policies around what is seen rather than what is suffered. CONCLUSIONS: Oral health must be integrated into primary care and embedded in community-based delivery. Reform requires beginning with inclusion, listening before delivering and building systems that centre people's unmet needs.
De-Implementing Low-Value Care in Dentistry: The Case for Choosing Wisely Campaigns.
Arriola-Pacheco F, Bomfim RA, Born K … +1 more , Lawrence HP
Community Dent Oral Epidemiol · 2026 Apr · PMID 42050759 · Publisher ↗
De-implementation refers to the practice within implementation science that targets reducing low-value care; that is practices that have been proven to be outdated, unnecessary, potentially harmful and in some cases not...
De-implementation refers to the practice within implementation science that targets reducing low-value care; that is practices that have been proven to be outdated, unnecessary, potentially harmful and in some cases not cost-efficient. Reducing and removing habitual practices, as well as introducing new care, is not easy, as there are multiple provider, patient and system related factors that can hinder these efforts. The Choosing Wisely campaigns have been one of the ways that de-implementation of low-value care has been targeted. Choosing Wisely campaigns consist of recommendations that are implemented through specialty-specific guidance that can be used by providers, patients and the healthcare systems. While Choosing Wisely campaigns have gained widespread traction in medicine, the spread to oral health has been comparatively limited. This commentary explores some of the existing Choosing Wisely campaign recommendations within dentistry and takes a close look at how overprescription, overtreatment, overtesting, and the inclusion and prioritization of care are addressed through these campaigns. Current Choosing Wisely recommendations provide a useful basis that can be utilized to foster a broader movement towards the de-implementation of low-value care in dentistry, thereby facilitating substantive changes in oral health practice, policy, and service delivery.
Examining the Psychometric Properties of the Ultra-Short Version of the Oral Health Impact Profile in Australia.
Khor B, Soares GH, Haag DG … +4 more , Mejia G, Luzzi L, Jamieson L, Santiago PHR
Community Dent Oral Epidemiol · 2026 Apr · PMID 42009632 · Publisher ↗
OBJECTIVES: The Oral Health Impact Profile (OHIP) is the most widely used instrument to measure the subjective impact of oral conditions. This study reports the shortening and psychometric evaluation of an ultra-short ve...
OBJECTIVES: The Oral Health Impact Profile (OHIP) is the most widely used instrument to measure the subjective impact of oral conditions. This study reports the shortening and psychometric evaluation of an ultra-short version (OHIP-7A) from the OHIP-14 in a large national Australian population. METHODS: Cross-sectional data included 2734 participants from Australia's National Study of Adult Oral Health (NSAOH) 2017-2018. The sample was divided into training (n = 1367) and test sample (n = 1367). Exploratory statistical procedures (redundancy analysis, Ant Colony Optimisation, dimensionality analysis) used in the establishment of ultra-short versions were employed in the training sample. Confirmatory procedures involving the examination of model fit, criterion validity and reliability were employed in the test sample. The establishment of ultra-short versions from an expert opinion ('Expert-derived OHIP-7') and exploratory ('Exploratory-derived OHIP-7') perspectives were investigated. RESULTS: Both Expert-derived and Exploratory-derived ultra-short versions displayed a unidimensional structure with good item performance based on network loadings. Both models displayed excellent model fit in terms of Comparative Fit Index (CFI ≥ 0.950) and Root Mean Square Error of Approximation (RMSEA ≤ 0.050), good criterion validity with variables such as self-rated dental health and good reliability (ω 0.70). However, based on individual items' ability to capture 'impact' according to item content and distribution of responses across item categories, the Exploratory-derived OHIP-7 (OHIP-7A) was considered superior. CONCLUSION: The good psychometric properties of the OHIP-7A in terms of validity and reliability allow aspects of oral health that are meaningful to patients to be captured with a small number of items. This is the first and largest study to comprehensively validate an ultra-short version of the OHIP in an Australian population.
Repeated Use of Emergency Departments for Nontraumatic Dental Conditions: Factors Associated With Being a Superutilizer.
Santoro M, Heaton LJ, Sonnek AC … +3 more , Preston RA, O'Malley JJ, Tranby EP
Community Dent Oral Epidemiol · 2026 Apr · PMID 41981824 · Publisher ↗
BACKGROUND: Due to inadequate access to regular, affordable dental care, many patients turn to emergency departments (EDs) for the treatment of nontraumatic dental conditions (NTDCs). NTDC ED visits are a large burden on...
BACKGROUND: Due to inadequate access to regular, affordable dental care, many patients turn to emergency departments (EDs) for the treatment of nontraumatic dental conditions (NTDCs). NTDC ED visits are a large burden on the U.S. healthcare system, with over 1.3 million visits each year and over $1 billion in associated charges. This study examines the characteristics of ED visitors and superutilizers (4+ ED visits in a calendar year) for non-dental (general) and dental reasons; investigates the cost of care for ED visitors and superutilizers; and estimates associations between patient characteristics and the likelihood of superutilization. METHODS: Data obtained from the State Emergency Department Databases was used to summarise trends in visits by general and dental ED visitors and superutilizers, including visit rates and costs, across 14 states and 5 years. Logistic regression models were developed to estimate the likelihood of being dental superutilizers and superutilizers (for dental and non-dental visits) based on the characteristics of their first ED visit (age, gender, race/ethnicity, income quartile, insurance type, presence of comorbidities and state in which ED visit occurred). RESULTS: Of the total number of ED visitors (N = 25 905 031), the majority (92.4%) were general (non-dental) visitors; 6.4% were general superutilizers; 1.2% were dental visitors; and less than 1% (n = 2617) were dental superutilizers; dental superutilizers made up 0.2% of all superutilizers. Individuals who sought ED care for dental or non-dental reasons four or more times in a year were more likely to be white, be in the second or third quartile in terms of income, and have insurance coverage through Medicaid, other dental insurance, or to be uninsured. Finally, mean and median treatment costs for general and dental superutilizers were considerably higher than for both general and dental visitors to the ED. DISCUSSION: Individuals seeking ED care for NTDCs four or more times in a year are more likely to be white, have insurance coverage through Medicaid, Medicare or to be uninsured, and have one or more medical comorbidities. Cost of care for superutilizers is also considerably higher than for other ED visitors. Expansion of dental services for adults, particularly those on Medicaid, is needed to ensure they can access timely preventative and restorative services and avoid the burden of dental crisis requiring a visit to the ED.
Oral Health Interventions for People Living With Diabetes From a Public Health Perspective: A Mapping Review.
Bitencourt FV, Varenne B, Rendell N … +6 more , Singh S, Harada Y, Knudsen OS, Martins-Pfeifer C, Stefani CM, Botelho J
Community Dent Oral Epidemiol · 2026 Apr · PMID 41968468 · Publisher ↗
OBJECTIVES: Despite growing concerns about the oral health-diabetes link, there is a lack of dental health interventions focused on people with diabetes. This mapping review synthesised the current landscape of oral heal...
OBJECTIVES: Despite growing concerns about the oral health-diabetes link, there is a lack of dental health interventions focused on people with diabetes. This mapping review synthesised the current landscape of oral health interventions for people with diabetes and identified future opportunities. METHODS: A systematic search of electronic databases (Embase, PubMed, Scopus, Web of Science, and the Cochrane Library) and grey literature was conducted without language or publication-year restrictions. Eligible evidence was restricted to review-level studies, including systematic reviews (with or without meta-analysis), network meta-analyses, and umbrella reviews, that focused on populations living with diabetes (type 1, type 2, or gestational) and reported at least one WHO core oral health outcome. Paired reviewers screened studies, extracted data, and assessed methodological quality using AMSTAR 2. A thematic map categorised interventions based on WHO-defined core oral health outcomes (periodontitis, dental caries, tooth loss, and oral cancer). Network maps were developed at three levels of action (patient, population, and policymaker), and the findings were stratified by World Bank income classification (2024-2025). RESULTS: A total of 3527 records were identified. After screening titles and abstracts and assessing 107 full texts, 76 reviews were included (62 systematic reviews, seven umbrella reviews, six network meta-analyses, and one meta-epidemiological study), with the majority originating from high-income countries (54.5%). Most interventions were conducted in clinical settings (n = 50), followed by community (n = 14) and institutional settings (n = 12). Follow-up periods ranged from two weeks to 20 years. At the patient level, interventions predominantly focused on non-surgical periodontal therapy and scaling and root planing (71 studies, 89.0%), often combined with adjunctive antimicrobial or anti-inflammatory therapies (39 studies, 51.3%), and oral hygiene or lifestyle education (25 studies, 32.9%). Population-level strategies were less frequently reported and included community oral health education, fluoride-based prevention, and primary care integration (26 studies, 34.2%). Policymaker-level evidence was limited (one study, 1.3%), emphasising the integration of periodontal care into diabetes management pathways and interdisciplinary healthcare models. The studies from low- and lower-middle income countries were underrepresented (9 of 44 countries, 20.5%). CONCLUSIONS: Despite growing evidence, gaps persist in population-level and policy-oriented interventions, particularly within primary care and in low- and lower-middle-income country contexts. Future priorities include integrating oral health into diabetes care pathways, strengthening interdisciplinary care models, and expanding preventive strategies in low- and middle-income countries.
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