Community Dentistry And Oral Epidemiology[JOURNAL]
Sun
200 papers
Does Oral Health Status Predict Incident Frailty Over the 13-Year Follow-Up in Older Adults in England?
Petrauskiene E, Zaninotto P, Heilmann A … +2 more , Peasey A, Tsakos G
Community Dent Oral Epidemiol · 2026 Mar · PMID 41918268 · Publisher ↗
OBJECTIVES: This study aimed to assess longitudinal associations between oral health and incident frailty, assessed by a multidimensional frailty index, in a national sample of older adults in England with participant mo...
OBJECTIVES: This study aimed to assess longitudinal associations between oral health and incident frailty, assessed by a multidimensional frailty index, in a national sample of older adults in England with participant mortality and drop out considered as competing risks. METHODS: A nationally representative sample of adults aged ≥ 50 from the English Longitudinal Study of Ageing (ELSA) was analysed. Oral health was assessed using edentulousness, self-rated oral health and the Oral Impacts on Daily Performances (OIDP) measures. Frailty was evaluated with the Rockwood frailty index. Competing risks regression models assessed the association between oral health at Wave 3 (2006/7) and incident frailty up to Wave 9 (2018/19), sequentially adjusting for demographic characteristics, socioeconomic factors and smoking, and accounting for participants' mortality and dropout. RESULTS: Of 5760 non-frail respondents at baseline, 1395 (24.2%) became frail during the 13-years follow-up. Edentate males had 1.40 (1.12-1.76) times higher risk of incident frailty than dentate males, whereas the association was not significant among females. Respondents with fair or poor self-rated oral health had 1.48 (1.29-1.70) times and those that reported oral impacts had 1.85 (1.54-2.21) times higher risk of incident frailty than those reporting better oral health and no oral impacts respectively. Oral impacts on functional aspects (i.e., difficulties eating and speaking) were associated with increased incident frailty risk. CONCLUSIONS: Poor oral health can serve as a 'canary in the coal mine' and act as an early marker of frailty development among older adults in England. Future research should investigate whether public health strategies, such as oral health promotion and disease prevention, can help reduce the risk of frailty in later life.
Impact of a Culturally Adapted Intervention on Early Childhood Caries Among Immigrants-A Cluster-Randomised Trial.
Reda M, Jensen KHM, Sen A … +2 more , Åstrøm AN, Mustafa M
Community Dent Oral Epidemiol · 2026 Mar · PMID 41906192 · Publisher ↗
OBJECTIVES: Early Childhood Caries (ECC) is reported to be more common among immigrant children than their native counterparts. There are no community-based studies that assess the effectiveness of an intervention in red...
OBJECTIVES: Early Childhood Caries (ECC) is reported to be more common among immigrant children than their native counterparts. There are no community-based studies that assess the effectiveness of an intervention in reducing the risk of ECC among immigrant children in Norway. This study aimed to assess the effect of a culturally adapted intervention on ECC, plaque, feeding and oral hygiene habits in immigrant children, as well as on their parents' oral health behaviours. METHODS: Seven primary health centres in Bergen, Norway, were randomly assigned to either an intervention or a control group. Immigrant parents of newborns participated in the baseline study (n = 345). Self-reported data were collected via questionnaires at baseline (infants aged 0-6 months) and at follow-up (18-24 months following baseline). The intervention group received a culturally adapted intervention, which consisted of two one-to-one motivational interviews, MI-informed counselling (MI), toothbrushing demonstrations and pamphlets in the participants' native languages at baseline and after 6 months. The control group received only the routine dental information provided at the primary health centres. Clinical oral examinations were performed to assess the presence or absence of ECC and plaque in the children at follow-up. Differences in outcomes were assessed and compared between intervention and control groups using generalised linear mixed models. Odds ratios with corresponding 95% confidence intervals were reported. RESULTS: A lower prevalence of carious lesions was observed in the intervention group (7.7%) than in the control group (10.6%), while plaque accumulation was higher in the intervention group (19.2%) than in the control group (17.3%). The intervention group exhibited lower odds of night-time feeding, not brushing day and night, or not using fluoride. Conversely, the intervention group showed higher odds of sugar intake in feeding bottles. Parents in the intervention group had higher odds of irregular flossing, mouthwash use and frequent sweet intake. However, none of the findings were statistically significant, indicating no true effect of the intervention. CONCLUSIONS: The present study suggests that the intervention had no impact on ECC, plaque, feeding or oral hygiene habits of the immigrant children or on the parents' dietary and oral hygiene habits. These findings underscore the necessity for community-based, comprehensive interventions with extended follow-up periods to effectively address the needs of this diverse population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05758454.
Translating Observational Data Into Public Health Action: Reducing Early Childhood Caries Burden Related to Socioeconomic Disparities.
Dao ATM, Do LG, Schuch HS … +2 more , Nguyen HV, Ha DH
Community Dent Oral Epidemiol · 2026 Mar · PMID 41872675 · Publisher ↗
OBJECTIVES: The "valley of death" between research and practice remains a major challenge. The five-stage Translational Research framework (TR1-TR5) provides a pathway, moving evidence into real-world impact. Traditional...
OBJECTIVES: The "valley of death" between research and practice remains a major challenge. The five-stage Translational Research framework (TR1-TR5) provides a pathway, moving evidence into real-world impact. Traditionally, Randomised Controlled Trials (RCTs) dominate TR stages, yet they are often impractical in public health. Longitudinal observational studies (LOSs), combined with advanced causal statistics, can emulate RCTs. Using the relationship between socioeconomic status (SES) and early childhood caries (ECC) as a case study, where SES is a complex, upstream determinant lacking trial evidence, this study illustrates how LOSs paired with causal statistics, within the TR framework, can generate policy-relevant action, highlighting a promising yet underused strategy. METHODS: This paper first reviewed causal inference gaps identified in a published scoping review of 85 LOSs (TR1), focusing on a subset of 20 studies presented in this paper that examined the relationship between SES and dental caries. The review analysed SES construction, gaps in SES-oral health behaviour-caries pathways, and the use of advanced causal statistics. Findings from TR2 (published) were then summarised to highlight key modifiable mediators linking SES and ECC, followed by TR3-4 (published), which examined interventions targeting these mediators across populations. Finally, this paper presented TR5 for the first time, extending the analysis to estimate population-level impact metrics. RESULTS: TR1 highlighted that most LOSs remained focused on associations rather than causal inference. SES construction was inconsistent and the mechanisms linking SES to dental caries have not been comprehensively examined. TR2 identified free sugar intake (FSI) as a key modifiable mediator. TR3-4 emphasised on reducing FSI to < 10% lowered ECC risk in the general population and suggested < 5% for the high-risk groups. TR5 highlighted that stricter FSI thresholds produced substantial population-level gains. CONCLUSION: The TR framework supported by advanced causal statistics enables translating LOSs into effective public health evidence in the absence of RCTs.
Aboriginal and Torres Strait Islander Peoples' Experiences With Culturally Safe Dental Research: A Qualitative Exploration.
Nath S, Aiyar R, Groundwater J … +5 more , Hedges J, Guzzo GL, Kapellas K, Pham A, Jamieson L
Community Dent Oral Epidemiol · 2026 Mar · PMID 41866724 · Publisher ↗
OBJECTIVES: The engagement and retention of Indigenous participants are critical factors in the success of oral health research, particularly in longitudinal studies. However, participant experiences and perceptions of I...
OBJECTIVES: The engagement and retention of Indigenous participants are critical factors in the success of oral health research, particularly in longitudinal studies. However, participant experiences and perceptions of Indigenous research involvement remain underexplored. The objective of this qualitative study was to explore Indigenous participants' experiences of culturally safe oral health research. METHODS: The longitudinal intervention study involved Indigenous adults who received culturally safe dental care. The intervention included home-based dental checks, flexible appointment scheduling, regular follow-up and financial support for dental treatment at a local dental clinic. Following dental treatment, semi-structured interviews were conducted using a yarning-based approach to document participants' experiences of both the intervention and the study processes. Interviews were audio-recorded, transcribed and analysed thematically. RESULTS: Four themes were developed from 136 participants' experiences of culturally safe dental research: (1) research and clinical team characteristics including positive interactions with team members and personalised care; (2) participation in a research intervention that breaks down barriers to dental care including home visits, flexible scheduling and financial support; (3) research participation as a means of supporting personal and community health; and (4) a community-driven recruitment strategy that improved trust and retention. CONCLUSIONS: Culturally safe, community-driven dental research centred on Indigenous representation, personalised care and home-based dental service delivery can effectively reduce barriers to dental care and improve engagement and retention among Indigenous participants in oral health research.
Oral Health Care Services, Barriers and Enablers to Maintaining Good Oral Health in Motor Neurone Disease: A Scoping Review.
Khokhar MA, O'Malley LA, Glenny AM … +1 more , Chen X
Community Dent Oral Epidemiol · 2026 Mar · PMID 41814515 · Publisher ↗
OBJECTIVES: The objective of this scoping review was to map existing literature on oral health and related care in individuals with Motor Neurone Disease (MND). Specifically, the review aimed to identify barriers and fac...
OBJECTIVES: The objective of this scoping review was to map existing literature on oral health and related care in individuals with Motor Neurone Disease (MND). Specifically, the review aimed to identify barriers and facilitators to maintaining oral hygiene, summarise available clinical guidelines and patient-facing resources, and examine how oral health care is integrated within multidisciplinary management of MND. METHODS: The review focused on oral health practices without restrictions on language, publication date or study type, excluding studies unrelated to MND or oral health. Data sources included MEDLINE, Embase, CINAHL, and grey literature such as clinical guidelines and patient resources. Screening and data extraction were performed independently by two reviewers to ensure rigor. RESULTS: Of 847 studies screened, eleven primary studies met the inclusion criteria, comprising case reports, case series, self-reports, cross-sectional studies and letters. The grey literature search identified three clinical guidelines and eight patient information leaflets/resources. The included studies spanned diverse populations, including Amyotrophic Lateral Sclerosis (ALS) patients with varying disease subtypes and care needs, and explored oral hygiene difficulties, care barriers and unique insights from the case studies. Identified gaps highlighted the lack of integration of dental professionals into multidisciplinary care teams. Barriers such as physical limitations, caregiver dependency and limited-service accessibility were prevalent. However, caregiver involvement, multidisciplinary collaboration and innovative solutions like antimicrobial photodynamic therapy and adaptive oral aids emerged as enablers. Poor oral health was strongly associated with increased pain, aspiration pneumonia and diminished well-being, emphasising the need for targeted interventions. CONCLUSION: Embedding oral health management within multidisciplinary care frameworks for MND patients, enhancing caregiver training, improving access to dental services and adopting innovative strategies will improve patient outcomes and inform future research.
Pathways Linking Socioeconomic Circumstances to Childhood Dental Caries: The Mediating Role of Parenting and Oral Health Behaviours Before and After Childsmile Implementation.
Cousins K, de Aquino Goulart M, Bradshaw P … +2 more , Conway DI, Sherriff A
Community Dent Oral Epidemiol · 2026 Mar · PMID 41803384 · Publisher ↗
OBJECTIVES: To determine the extent that parenting styles and oral health behaviours mediate the relationship between socioeconomic circumstances (SEC) and childhood dental caries experience: pre-/post-national roll-out...
OBJECTIVES: To determine the extent that parenting styles and oral health behaviours mediate the relationship between socioeconomic circumstances (SEC) and childhood dental caries experience: pre-/post-national roll-out in 2011 of Childsmile, the child oral health improvement programme for Scotland. METHODS: A longitudinal design linked 2798 participants from Birth Cohort-1 (following from age 10 months in 2005/06 to age 5 years in 2009/10) and 3015 from Birth Cohort-2 (following from age 10 months in 2011 to age 5 years in 2015) of the Growing Up in Scotland study with caries experience at age five from the National Dental Inspection Programme. Two Structural Equation Models (Birth Cohort-1 and 2) tested an a priori framework to explain the social gradient (SEC: Income Poverty, Area-based Deprivation, Household Education, Household Employment) in caries experience, considering proximal behaviours (toothbrushing, cariogenic diet, regular dental attendance) before introducing validated parenting styles (Parental Responsiveness/Demandingness). RESULTS: Models for both the pre-/post-Childsmile cohorts illustrated similar pathways. Dental attendance and parenting had no direct effect on caries experience. Responsiveness partially mediated the SEC-toothbrushing relationship, while demandingness partially mediated the SEC-diet relationship. Cariogenic diet directly increased caries experience prevalence (β = 0.33/0.24), while increased toothbrushing persistently decreased caries (β = -0.18/-0.13). Total mediated effect of SEC decreased from 58.8% to 39.1%, with the largest relative decrease being directly via toothbrushing (9.5%/4.0%). The effect mediated through parenting pathways remained minimal (4.8%/3.5%). CONCLUSIONS: Pathways between SEC and childhood caries were unchanged after Childsmile roll-out, with minimal effects from parenting styles. The diminishing SEC effects via toothbrushing may be positively attributed to Childsmile interventions. The persistent unexplained effect of SEC on caries experience highlights the need for equity-focused structural approaches that address broader socioeconomic inequalities.
Intersections of Class and Colonisation: Access to Dental Care for Indigenous Peoples in Canada.
Bashir NZ, Nascimento GG
Community Dent Oral Epidemiol · 2026 Feb · PMID 41761877 · Publisher ↗
OBJECTIVES: Inequitable access to healthcare is a central driver of the disproportionate burden of disease in Indigenous peoples. The aim of this study is to investigate inequities in access to dental care, accounting fo...
OBJECTIVES: Inequitable access to healthcare is a central driver of the disproportionate burden of disease in Indigenous peoples. The aim of this study is to investigate inequities in access to dental care, accounting for supra-additive effects at the intersections of educational attainment, household income, and Indigeneity. METHODS: Data were extracted from the 2017 to 2018 Canadian Community Health Survey, a national survey of Canada's ten provinces and three territories. A multilevel analysis of individual heterogeneity and discriminatory accuracy was performed, defining 18 intersectional strata by educational attainment, household income, and Indigenous status. Three outcomes pertaining to dental care access were assessed: (i) dental attendance in the past 12 months, (ii) attending the dentist never or only for emergencies, and (iii) avoiding attending the dentist due to cost. RESULTS: There was evidence of substantial between-stratum heterogeneity in access to dental care. Fixed effects of age, sex, educational attainment, household income, and Indigeneity explained 91.0%-98.2% of the between-stratum variance. The median odds ratio (MOR) indicated that, depending on intersectional identity, the odds increased by 80% for having visited the dentist in the past 12 months (MOR: 1.80; 95% CI: 1.71-2.08), 118% for attending never or only for emergencies (MOR: 2.18; 95% CI: 2.04-2.50), and 83% for avoiding visits due to cost (MOR: 1.83; 95% CI: 1.68-2.22). CONCLUSION: Indigenous status and socioeconomic position greatly concentrate the risk of poor access to dental care, but there is little evidence for supra-additive interactions between these factors.
Constituting Global Oral Health: Toward a Policy-Relevant and Action-Oriented Science.
Benzian H, Naidoo S
Community Dent Oral Epidemiol · 2026 Feb · PMID 41761861 · Publisher ↗
Despite its significant global burden, oral health continues to be excluded from global health systems, policies and discourse. This exclusion reflects more than institutional neglect; it reflects entrenched structural,...
Despite its significant global burden, oral health continues to be excluded from global health systems, policies and discourse. This exclusion reflects more than institutional neglect; it reflects entrenched structural, epistemic and professional dynamics that have marginalised oral health both externally and internally. This commentary makes the case for constituting global oral health as a distinct science and action discipline. Grounded in dental public health and oral epidemiology but extending beyond them, global oral health needs to address transnational determinants, apply systems thinking and pursue equity through a decolonial lens. We advance four core arguments: that the field lacks a coherent scientific identity; that building a functional discipline requires strategic, epistemic and institutional alignment; that oral health's exclusion is reinforced by both global health structures and professional self-isolation; and that a distinct disciplinary identity is essential for systemic integration and relevance. A comparative delineation and a working definition help clarify the scope of this reconfigured field. Moving beyond symbolic inclusion requires building an intellectually grounded, politically conscious and structurally engaged discipline capable of actively shaping the future of global oral health.
Is Obesity Associated With Dental Caries in Primary Dentition? Findings From a Birth Cohort in Southern Brazil.
Martins Corrêa Y, Fonseca Araujo C, Silveira Echeverria M … +4 more , Dâmaso Bertoldi A, van der Heijden GJMG, Fernando Demarco F, Silveira Schuch H
Community Dent Oral Epidemiol · 2026 Feb · PMID 41721473 · Publisher ↗
OBJECTIVES: Nutritional disorders and dental caries share common risk factors, including diet and socioeconomic position, but the association between these two conditions remains unclear. The aim of this study was to inv...
OBJECTIVES: Nutritional disorders and dental caries share common risk factors, including diet and socioeconomic position, but the association between these two conditions remains unclear. The aim of this study was to investigate the potential association between overweight/obesity and the occurrence of dental caries in primary dentition. METHODS: This longitudinal study, conducted using data from the 2015 Pelotas Birth Cohort, utilised information collected at birth, 24 months and 4 years of age. The exposure variable was the obesity collected by BMI (body mass index), at 24 months, using anthropometric measures (weight and height) and classified according to WHO guidelines. Covariates included sex, child's and maternal age, socioeconomic factors (family income and maternal education) and sugar consumption data. The outcome was dental caries at the age of four, assessed using several variables: early childhood caries (ECC), encompassing all activity including white spots and restorations; severe early childhood caries (S-ECC), which refers exclusively to cavitated lesions; and the dmft (Decayed, Missing and Filled Teeth) index. Descriptive analysis was carried out and regression models were tested. RESULTS: From the 4275 eligible participants, 3374 children (50.5% boys and 49.5% girls) composed the analytical sample. At 24 months, 2474 (73.3%) children were healthy weight (95% CI 71.8; 74.8) and 900 (26.7%) presented overweight/obesity (18.8% overweight and 7.9% obese). Concerning dental caries at the age of four, 37.6% had ECC (including white spots and restorations) and 21.4% had S-ECC. Among children classified as healthy weight at 24 months, 38.6% presented ECC at 4 years of age. Among obese children, the prevalence of ECC was 34.8%. A similar pattern was observed for S-ECC: the prevalence was 22.0% among healthy weight children, 19.9% among overweight and 19.1% among obese children. The Poisson regression analysis adjusting for confounding factors showed no difference between groups. CONCLUSIONS: In conclusion, this cohort study in Brazilian children at the age of four did not observe meaningful associations between overweight/obesity and dental caries in primary dentition. The findings suggest that obesity in childhood should not be considered a risk factor for caries development in children.
Oral Health Interventions to Improve Access in Rural Areas of High-Income Countries: A Mixed Methods Systematic Review.
Kenny A, Dickson-Swift V, Carlin A … +4 more , Nelson D, Gussy M, Gayathri HDV, Baker S
Community Dent Oral Epidemiol · 2026 Jun · PMID 41708571 · Full text
OBJECTIVES: The aim of this mixed methods systematic review was to identify oral health interventions in rural areas of high-income countries and synthesise the evidence on how access is addressed. METHODS: Searches were...
OBJECTIVES: The aim of this mixed methods systematic review was to identify oral health interventions in rural areas of high-income countries and synthesise the evidence on how access is addressed. METHODS: Searches were conducted in Cochrane, CINAHL, Dentistry and Oral Sciences Source, PsycINFO and PubMed, with the last search in January-February 2025. All study types published in English since 2000 were included that reported oral health interventions aimed at addressing access to dental services. The Mixed Methods Appraisal Tool was used to assess study quality. The Penchansky and Thomas model of access, with Saurman's adaptation, guided the thematic synthesis. RESULTS: The final dataset was 73 articles. Most authors reported small-scale interventions delivered by dental and primary health providers. Fluoride varnish application, treatments and health promotion were most reported in clinics, community settings and schools. Lack of service availability and accessibility caused by geographic distance required alternative service models, including telehealth. Free or minimal cost interventions were needed in low-income settings. Stakeholder partnerships and understanding of local context were critical. Evaluations of community acceptability and awareness were rare. There was a dearth of studies addressing the six dimensions of access, with wide variation in study quality. CONCLUSIONS: There is an absence of robust, well evaluated studies, with lack of homogeneity preventing meta-analysis. Rural oral health interventions should be informed by comprehensive frameworks of access, be grounded in equity, involve communities in design, development and evaluation, should reduce silos between oral and general healthcare, and should prioritise prevention. Access to high quality oral health is a fundamental human rights and equity issue for rural people.
Intergenerational Dental Fear and Anxiety: Children's Pattern of Dental Service Use.
Schuch HS, Araujo CF, Demarco GT … +5 more , Cademartori MG, Goettems ML, Bertoldi AD, McNeil DW, Demarco FF
Community Dent Oral Epidemiol · 2026 Jun · PMID 41673775 · Full text
OBJECTIVES: Dental care-related fear and anxiety, involving emotional reactions to dental situations, can negatively impact children's quality of life, oral and systemic health. Recognising maternal characteristics as ke...
OBJECTIVES: Dental care-related fear and anxiety, involving emotional reactions to dental situations, can negatively impact children's quality of life, oral and systemic health. Recognising maternal characteristics as key determinants of child health, this study examined the intergenerational relationship between dental fear/anxiety and early childhood dental service utilisation. METHODS: Data were drawn from the baseline (birth), 12-month, and four-year follow-ups of the 2015 Pelotas Birth Cohort Study (Brazil). Outcomes included child dental fear/anxiety and dental service use (frequency and reasons) at age four. Exposures were maternal dental fear/anxiety at 12-month and maternal assessment of child dental fear/anxiety. Covariates, including maternal education and family income, were collected perinatally. All variables were obtained through questionnaires administered to mothers at each follow-up. Analyses used Poisson and multinomial logistic regression models. RESULTS: The sample included 3809 mother-child dyads; 79.7% of mothers and 64.2% of children had no reported dental fear/anxiety, yet 64.0% of children had never visited a dentist. Adjusted analyses showed that maternal dental fear/anxiety was associated with a 1.20 times higher prevalence of childhood dental fear/anxiety (PR = 1.20, 95% CI = 1.09; 1.32). Children with dental fear/anxiety had a 1.89 times higher prevalence of visits for curative reasons (PR = 1.89, 95% CI = 1.45; 2.48) and a 2.10 times higher prevalence of never visiting a dentist (PR = 2.10, 95% CI = 1.78; 2.48), adjusting for maternal dental fear/anxiety. CONCLUSION: Early and regular preventive visits may help mitigate dental fear/anxiety. This study highlights the intergenerational link between maternal and childhood dental fear and its impact on dental service utilisation.
Longitudinal Analysis of Fluoride Levels in Irish Water Supplies: A 52-Year Review.
Sharma V, O'Connell B, O'Flaherty E … +7 more , Rigby J, McLoughlin J, Cronin M, O'Sullivan M, Winning L, Cassetti O, Crowe M
Community Dent Oral Epidemiol · 2026 Jan · PMID 41606420 · Publisher ↗
BACKGROUND/AIM: The Health (Fluoridation of Water Supplies) Act of 1960 in Ireland mandates monthly fluoride sampling in Public Water Supplies (PWS). In 2007, authorities adjusted the mandated fluoride concentration from...
BACKGROUND/AIM: The Health (Fluoridation of Water Supplies) Act of 1960 in Ireland mandates monthly fluoride sampling in Public Water Supplies (PWS). In 2007, authorities adjusted the mandated fluoride concentration from 0.8-1.0 to 0.6-0.8 mg/L. Approximately 71% of the Irish population has access to fluoridated drinking water. This study aimed to analyse fluoride measurements in Irish water supplies for five decades (1964-2016) to assess compliance and effectiveness of the fluoridation programme. METHODS: Data were sourced from government records and Environmental Protection Agency (EPA) reports. Analysis focused on fluoride concentration measurements, compliance rates, and data completeness across public, private, and group water supplies. Descriptive statistics were used to evaluate trends and patterns in fluoride levels over time. RESULTS: By 2000, over 90% (n = 307) of PWS, each serving more than 1000 persons, were fluoridated. In the early monitoring period (1964-69), missing data were substantial at 66%, with satisfactory fluoride results (0.8-1.00 mg/L) at only 17% and marginal results (0.70-0.80 and > 1.00-1.10 mg/L) at 15%. Compliance improved steadily, reaching peak performance in 1994-99 with 57% satisfactory results. Following the 2007 adjustment in target concentrations, missing data decreased significantly to 18%, with satisfactory results (0.60-0.80 mg/L) increasing from 40% to 49% and marginal results (0.50-0.60 mg/L and > 0.80-0.90 mg/L) stabilising at 7%-13%. Analysis of private and group supplies revealed evolving trends: from 2000 to 2006, 21% of fluoride testing results were satisfactory and 75% marginal, while the 2007-2016 period showed 39% satisfactory and 48% unsatisfactory results, though only 1% exceeded 0.9 mg/L. CONCLUSION: The fluoride control in PWS has been largely effective, with consistent improvements in monitoring practices and compliance with target levels over the study period.
The Modified Oral Status Survey Tool: Development and Psychometrics for Accessible Oral Health Data Collection.
Byrne K, Daly B, McCallion P … +2 more , McCarron M, Phadraig CMG
Community Dent Oral Epidemiol · 2026 Jan · PMID 41496742 · Publisher ↗
OBJECTIVES: Understudied populations such as those with intellectual disabilities (ID) face significant disease burden and oral health disparities. Systematic exclusion from oral health research contributes to resultant...
OBJECTIVES: Understudied populations such as those with intellectual disabilities (ID) face significant disease burden and oral health disparities. Systematic exclusion from oral health research contributes to resultant health inequalities, limits understanding of the determinants and implications of disease, and hinders the ability to improve health through evidence-based policy and healthcare planning. This study reports the development of the Modified Oral Status Survey Tool (MOSST), an accessible, low burden oral health assessment tool designed for use with populations who require communication and cognitive supports. It explores the MOSST's key measurement attributes: conceptual coverage, content validity, reliability, feasibility, and cost. METHOD: The study followed an iterative tool development process. The MOSST was tested in two steps: (1) attribute testing of an interim version (MOSST v0.1) for inter and intra-rater reliability, burden, cost and feasibility; and (2) content validity testing of MOSST v1.0 using an expert and a Public and Patient Involvement (PPI) panel. Field testing involved data collection from Wave 5 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), with data from n = 469 participants undertaking a MOSST assessment. RESULTS: Data from n = 469 adults with ID were analysed. The MOSST demonstrated very strong/strong inter- and intra-rater reliability for tooth count (ICC = 0.999), denture wear, occlusal pairs, and oral pain (k = 0.808-1.00). Content validity was confirmed through expert and PPI panel reviews; item-level Content Validity Indices (iCVI) ranging from 0.85 to 1.00 were gained from the expert panel responses to measure agreement. This review process led to refinements, including replacing items representing occlusal function with functional tooth units and relocating the subjective oral pain item. This led to a final MOSSTv1.0 tool and associated training, protocol and resources. The MOSST was acceptable: 98% (n = 65) reporting data collection process acceptable; 100% (n = 66) painless and 100% (n = 66) not time-consuming. The cost per assessment was low (approx. €6.69) due to low equipment and staff costs. CONCLUSION: The MOSST is a seven-item tool recording indicators of oral function and disease. It was shown to be reliable, valid, and feasible for use by non-dental assessors among people with ID. It is low cost, low burden, quick and feasible and offers potential for use among understudied communities.
Lunchbox Preparation as a Social Practice and Its Impact on Children's Oral Health in Culturally Diverse Contexts.
Jamkar R, Ward PR, Fisher C … +2 more , Calache H, Slack-Smith L
Community Dent Oral Epidemiol · 2026 Jun · PMID 41486499 · Publisher ↗
OBJECTIVE: Poor oral health (dental decay) is a globally recognised concern, especially among refugee and immigrant children. Poor oral health is linked with children's unhealthy dietary intake and eating patterns. The o...
OBJECTIVE: Poor oral health (dental decay) is a globally recognised concern, especially among refugee and immigrant children. Poor oral health is linked with children's unhealthy dietary intake and eating patterns. The objective of this study was to explore lunchbox preparation as a social practice and its interconnection with other social practices to understand its effect on children's dietary consumption and in turn on oral health. METHODS: Focused ethnography was utilised to enable an in-depth understanding of lunchbox preparation as a social practice and its elements: materials (physical objects), meanings (purpose) and competences (knowledge). Semi-structured interviews with 35 mothers from culturally and linguistically diverse backgrounds and five service providers, along with observations, were used for data collection. Data were analysed inductively and deductively through a social practice theory lens. RESULTS: Lunchbox preparation was identified as a social practice shaped by interconnected practices of meal planning, food shopping and cooking. Meanings behind the contents of lunchboxes included children's preferences, emotional dynamics, ideals of responsible parenting not limited to nutrition. Competences in preparing convenient, easy and desirable meals were also noted. Inclusion of ready-to-eat discretionary foods (materials) was also reported. CONCLUSION: Through a social practice lens, it was demonstrated how everyday decisions around the contents of lunchboxes are often driven by convenience, emotional needs and not by individual choices. This may contribute to increased consumption of retentive and sugary foods thus shaping dietary routines and eating patterns that have implications for children's oral health. The findings also highlight the need to view these food-related practices as socially embedded rather than purely individual or nutrition-driven.
With the Rise of Right-Wing Governments, Why a One-Time "50% Health Tax" Will Be a Hard Sell and How It Could Be Implemented.
Abbas H, El Tantawi M, Hoshi-Harada M … +4 more , Takeuchi K, Osaka K, Guarnizo-Herreño CC, Peres MA
Community Dent Oral Epidemiol · 2025 Dec · PMID 41472325 · Publisher ↗
Recent calls from the World Health Organization (WHO) to globally impose a one-time tax, labelled as "Health tax", on tobacco, alcohol and sugar sweetened beverages (SSBs) aim to achieve a 50% retail price increase to re...
Recent calls from the World Health Organization (WHO) to globally impose a one-time tax, labelled as "Health tax", on tobacco, alcohol and sugar sweetened beverages (SSBs) aim to achieve a 50% retail price increase to reduce consumption and improve health outcomes. However, with the rise of right-wing governments globally, this substantial intervention might be a hard sell. Right-wing governments usually lean towards tax reductions to stimulate economic growth, job creation and encourage investments. In addition, they support free-market capitalism, deregulation and minimum government interventions. Furthermore, some of such governments share a sentiment of distrust in science and cut health and research spending. Moreover, regardless of political orientations, path dependence (the institutional resistance to change) is another hurdle. In addition, the expected restrictions on the availability and affordability of these products in case of implementing such tax may lead to public rebuttal. All these structural, political and commercial determinants of health raise concerns about the applicability of such intervention and its sustainability if implemented. This commentary argues that the implementation of this substantial one-time tax would be a hard sell and could backlash among most of the right-wing policy makers due to their inherent tax aversion stance and other factors. It suggests that advocacy using a more negotiable approach could be a way forward. For example, "a gradual phased implementation" could offer a viable alternative following two successful case studies from the Philippines and Egypt under their right-wing governments. The Philippines implemented the "Sin Tax Reform" an annual excise tax increase on (tobacco, alcohol, and SSBs) from 2012 onwards, while Egypt imposed annual tax increases on tobacco products since 2010 onwards. These phased approaches seemed to have gained more favourable consideration from right-wing policy makers and contributed to smoking reduction in the Philippines but not in Egypt. In addition, some alternatives such as marketing restrictions on these products among other interventions could be considered. Context specific variations as well as the variations in readiness to adopt such fiscal policies for the health cause among the right-wing political spectrum are acknowledged.
Upstream Interventions to Promote Oral Health and Reduce Oral Health Inequalities: A Scoping Review.
Stennett M, Dawson E, Hijryana M … +4 more , Cannon P, Daly B, Macpherson L, Watt RG
Community Dent Oral Epidemiol · 2026 Apr · PMID 41461972 · Full text
OBJECTIVES: This scoping review aimed to map global evidence on upstream interventions which promote oral health and reduce socioeconomic inequalities in oral health. METHODS: A review was undertaken in accordance with t...
OBJECTIVES: This scoping review aimed to map global evidence on upstream interventions which promote oral health and reduce socioeconomic inequalities in oral health. METHODS: A review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. A multistranded comprehensive search strategy was employed to identify relevant studies. Article texts were retrieved and assessed for eligibility against the inclusion criteria. Key findings were extracted and summarised. RESULTS: A total of 99 articles (74 empirical studies and 25 systematic, scoping and umbrella reviews) were included in the scoping review. The review findings revealed a limited number of upstream interventions specifically focused on promoting oral health and reducing oral health inequalities. Legislative and regulatory measures (e.g., advertising controls), fiscal measures (e.g., sugar-sweetened beverage taxation) and specific oral health interventions (e.g., water fluoridation) have shown a positive impact on promoting oral health. In addition, fiscal measures, food subsidies targeted at low-income groups and improvements to housing/work environments have proven effective in reducing socioeconomic inequalities in general health outcomes. CONCLUSIONS: Despite a very detailed and thorough search of the global literature, this scoping review identified a limited number of upstream interventions that specifically focused on improving oral health, and an even smaller number of upstream interventions that tackled oral health inequalities. However, the review did identify three levels of upstream intervention including: policies tackling the broader socio-political determinants of health; policies combating non-communicable diseases (NCDs) linked to oral health; and some specific interventions (e.g., water fluoridation) focusing on oral health. The upstream approach to prevention remains highly relevant to public health policy and provides a guiding principle for future strategic action to promote oral health and tackle oral health inequalities.
Parental Perceptions of Dental Care Utilisation and Their Association With Treatment Completion, Follow-Up and Children's Quality of Life: A Cross-Sectional Study.
Bahdila D
Community Dent Oral Epidemiol · 2026 Apr · PMID 41449664 · Publisher ↗
OBJECTIVES: Although previous studies explored parents' perceptions of accessing dental care, few examined their link to treatment completion, follow-up and children's quality of life. This study aimed to (1) examine the...
OBJECTIVES: Although previous studies explored parents' perceptions of accessing dental care, few examined their link to treatment completion, follow-up and children's quality of life. This study aimed to (1) examine the association between parents' perceptions and utilisation outcomes (access, treatment completion and follow-up) alongside children's quality of life; and (2) identify barriers reported by parents for failing to complete treatment or adhere to follow-up. METHODS: A cross-sectional study was conducted among primary schoolchildren in Jeddah, Saudi Arabia, using stratified cluster sampling. Caregivers completed surveys on access and barriers, whereas children completed the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) and underwent clinical examinations. Multilevel logistic regression models analysed predictors of care utilisation and CARIES-QC scores. RESULTS: 785 schoolchildren and their parents from 11 schools were included. Perceived difficulty accessing care increased the odds of treatment incompletion (AOR: 5.84, 95% CI: 2.98-11.44), lack of follow-up (AOR: 2.11, 95% CI: 1.15-3.87) and poorer CARIES-QC scores (β = 1.70, 95% CI: 0.56-2.85). The most common reported barriers for incomplete treatment or not following up were financial barriers (25.6%, n = 72 and 45.9%, n = 56) and dismissive attitudes toward primary teeth (17.4%, n = 49 and 22.1%, n = 27), respectively. CONCLUSION: Perceived difficulty in accessing dental care was significantly associated with incomplete treatment, missed follow-ups and poorer caries-specific quality of life. Financial constraints and misconceptions about primary teeth were key reported barriers, emphasising the need to address both parents' perceptions and reported barriers to improve oral health outcomes.
Model-Based Cost-Effectiveness of Direct Restorations: Amalgam Dominates.
Bailey O, Stone SJ, Taylor G … +2 more , Ternent L, Vernazza CR
Community Dent Oral Epidemiol · 2025 Dec · PMID 41423779 · Publisher ↗
OBJECTIVES: A phase-down of dental amalgam use has been mandated and the feasibility of its phase-out in England by 2030 is being explored. Amalgam use in English National Health Service (NHS) care still predominates for...
OBJECTIVES: A phase-down of dental amalgam use has been mandated and the feasibility of its phase-out in England by 2030 is being explored. Amalgam use in English National Health Service (NHS) care still predominates for posterior restorations, though access to this care is increasingly limited. The objective of this study was to quantify the relative long-term costs and consequences of amalgam versus composite direct posterior restorations in adult permanent teeth in the English NHS setting. METHODS: A microsimulation model of restoration failure and reintervention was constructed and parameterised in TreeAge Pro, based on a review of the literature. It extrapolated costs and outcomes of directly restoring cariously-cavitated lower premolar teeth in 10 000 18-year-old English NHS patients with amalgam and composite restorations over a lifetime-horizon. Discounting of 3.5% was applied to costs and outcomes. An extended medical-sector perspective with societal considerations was taken. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Amalgam robustly dominated conventional and bulk-fill composite restorations, being less costly over a lifetime from patient (£70) and funder perspectives (£34), with the restoration and tooth surviving significantly longer (4-years; 12-years non-discounted). Amalgam also incurred reduced numbers of visits (1), treatment time (43-min), and laboratory costs (£8) for fixed and removable prosthodontics over a lifetime. Time until a direct restoration was no longer possible was significantly higher for amalgam than composite (6-years; 17-years non-discounted). CONCLUSIONS: The model showed good internal and external validity, accurately predicting tooth survival following restoration in relation to long-term NHS claims data. Without considerable educational change to upskill clinicians and health service change, an amalgam phase-out in England will likely have significant lifelong impacts on restoration and tooth survival and costs for all stakeholders, whilst reducing societal productivity and exacerbating already existing issues of limited access to care and socio-economic inequalities.
Oral Health-Head and Neck Cancers: Addressing Confounding Through Negative Control and Quantitative Bias Analyses.
Elango PK, Nicolau B, Farsi N … +3 more , Grant AV, Rousseau MC, Madathil S
Community Dent Oral Epidemiol · 2026 Jun · PMID 41404699 · Full text
OBJECTIVES: While there are plausible biological explanations for the association between oral health and head and neck cancers (HNC), existing studies have yielded conflicting results. A key concern is that these associ...
OBJECTIVES: While there are plausible biological explanations for the association between oral health and head and neck cancers (HNC), existing studies have yielded conflicting results. A key concern is that these associations are influenced by mediators, unmeasured risk factors, and biases. To address this, a negative control exposure was used to evaluate whether the associations between oral health and HNC risk could be attributed to unmeasured confounding. Additionally, quantitative bias analysis (QBA) was performed to estimate the extent of non-differential misclassification of exposure. METHODS: The HeNCe study, a hospital-based case-control study, recruited incident HNC cases (n = 389) frequency matched to controls (n = 429) by sex and age (within 5 years) from four major referral hospitals in Montreal, Canada. In-person interviews collected information on life course exposures. Unconditional logistic regression estimated the odds ratios (OR) and 95% confidence intervals (CI) for the associations between oral health indicators and HNC, controlling for confounders identified using directed acyclic graphs (DAG). Sexually transmitted diseases (STD) were used as a negative control exposure to test for unmeasured confounding in the associations. QBA, using predetermined bias parameters from previous studies, estimated the magnitude and direction of exposure misclassification bias. RESULTS: Complete denture use and having more than nine missing teeth were associated with an increased HNC risk [OR = 1.33, 95% CI (0.93-1.90) & OR = 1.31, 95% CI (0.93-1.83)], respectively. Similar results were obtained when stratified by HNC subsite. Negative control analysis yielded a null finding, indicating no significant bias due to unmeasured confounders. Bias-corrected estimates of the association between oral health indicators and HNC risk moved further from the null. CONCLUSION: Negative control exposure analysis indicated that unmeasured confounding did not affect the association between oral health and HNC risk. QBA yielded corrected estimates of increased magnitude, suggesting that the crude associations may have been underestimated.
Sociodemographic Predictors of Child-Parent Agreement on Oral Health.
Lee SY, Wang Y, Huang Y … +5 more , Shen J, Zhou L, Manesh B, Maida CA, Liu H
Community Dent Oral Epidemiol · 2026 Apr · PMID 41399055 · Publisher ↗
BACKGROUND: Oral health is vital for children's overall well-being. Parents play a critical role in shaping children's oral health through preventive care behaviors and treatment adherence. Although prior studies have fo...
BACKGROUND: Oral health is vital for children's overall well-being. Parents play a critical role in shaping children's oral health through preventive care behaviors and treatment adherence. Although prior studies have focused on parents as reliable proxies for reporting their children's oral health, notable discrepancies between parental reports and children's perspectives reveal gaps in knowledge, attitudes, and practices. These differences are often shaped by parental sociodemographic factors, including age, gender, education, income, and ethnicity. This study aimed to evaluate child-parent agreement on self-reported oral health measures across four key domains: professional care, hygiene practices, periodontal health, and aesthetic concerns, and inform interventions to enhance communication and pediatric oral health. METHODS: This cross-sectional study included 306 child-parent dyads from 12 Los Angeles County schools. Surveys were adapted using the NIH PROMIS (Patient-Reported Outcome Measurement Information System) framework, and included seven shared questions to assess alignment in perceptions and behaviors. Bivariate and multivariate logistic regression models were conducted to analyze the associations between child-parent agreement and parental age, gender, income, education, and ethnicity. Machine learning models (Random Forest, XGBoost) were applied to evaluate the predictive performance of these variables. RESULTS: Child-parent agreement on oral health behaviours and perceptions was significantly associated with sociodemographic factors. In multivariate analysis, non-Hispanic parents showed higher agreement with their children regarding cavity history (p = 0.003). Parents from households with an annual income over $80 000 showed higher agreement on cavity presence (p = 0.022), brushing before sleep (p = 0.007), and gum bleeding while brushing (p = 0.048), but lower agreement on flossing (p = 0.009). Female parents exhibited greater agreement with children on brushing behaviour (p = 0.046) and gum bleeding while brushing (p = 0.001). Parents with completed college education had significantly lower agreement regarding gum bleeding while flossing (p = 0.002), whereas high school graduates showed lower agreement across several behaviours. Machine learning models (Random Forest and XGBoost) demonstrated similar predictive performance in modelling agreement (accuracy range: 0.417-0.738; CI: 0.29-0.83), with DENTIST and TEETH2 yielding the highest predictive accuracies. CONCLUSIONS: Parent sociodemographic factors are significantly associated with child-parent agreement on self-reported child oral health. Tailored interventions, culturally sensitive strategies, and improved survey tools are essential for enhancing the accuracy of outcome reporting.
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