Community Dentistry And Oral Epidemiology[JOURNAL]
Sun
200 papers
Costs of Providing Culturally Safe Dental Care for Indigenous People of Australia: A Follow-Up Intervention Study.
Guzzo GL, Kularatna S, Nath S … +4 more , Kapellas K, Weyrich LS, Hedges J, Jamieson LM
Community Dent Oral Epidemiol · 2026 Jun · PMID 41398715 · Publisher ↗
OBJECTIVES: To establish the monetary costs of supporting the Indigenous community in Australia to receive culturally safe dental care. METHODS: Financial data was analysed from a follow-up dental intervention study invo...
OBJECTIVES: To establish the monetary costs of supporting the Indigenous community in Australia to receive culturally safe dental care. METHODS: Financial data was analysed from a follow-up dental intervention study involving 173 Indigenous Australians-164 adults and nine children-who received fully funded dental treatment through private dental clinics. Participants were seen at baseline and 12-month follow-up for an oral health assessment, conducted at a location of their preference. Following the initial assessment, participants were referred to a private dental practice near their residence or of their choosing, with preference given to a practice that employed an Indigenous dentist. The study team provided additional support as required, such as transportation vouchers to attend appointments, assistance with bookings, providing reminders, and checking in regarding treatment experiences. RESULTS: Most participants were employed and primarily resided in metropolitan and inner regional locations of South Australia. The total expenditure for private dental treatment was nearly $300 000 AUD, with a median per capita cost of $1332 AUD (IQR: $727-$2311). The largest proportion of funding (42.3%) was spent on restorative treatments, both overall and within each age group. Participants who reported they would have considerable difficulty paying a $100 dental bill had a higher median cost of treatment ($1384, IQR: $1073-$2691) than those who reported they would have less difficulty ($961, IQR: $633-$2001). Following dental treatment, participants reported that both their general and oral health improved. CONCLUSIONS: The dental expenditure and volume of care required by participants in this study demonstrate that unmet dental needs persist in the Indigenous community, which can be addressed by reducing cultural, structural, and financial barriers.
Do Socioeconomic Inequalities, Residential Setting and Social Networks Predict Different Patterns of Dental Services Utilisation?
Araújo Júnior CADS, Vettore MV, de Queiroz Herkrath APC … +2 more , Cordeiro D, Herkrath FJ
Community Dent Oral Epidemiol · 2026 Jun · PMID 41361955 · Publisher ↗
OBJECTIVE: To estimate the probability of dental services utilisation according to demographics, socioeconomic characteristics, and social networks of Brazilians aged 15 years and above. METHODS: The study used data from...
OBJECTIVE: To estimate the probability of dental services utilisation according to demographics, socioeconomic characteristics, and social networks of Brazilians aged 15 years and above. METHODS: The study used data from the 2019 Brazilian National Health Survey, a household-based representative nationwide survey. Individual interviews collected information on time interval since the last dental appointment, residential setting, sex, race/skin colour, years of school completed with approval, family income and social networks. Predicted probabilities and 95% confidence intervals (CIs) of time since last dental visit were estimated using a multinomial logistic regression model. Estimates were obtained using the post-estimation commands of Stata MP, version 17.0, considering the complex sampling design and sampling weights. RESULTS: Prevalence of last dental visit in the last 12 months was 48.4% (47.8%-49.0%). The projected scenarios showed a significant effect of sex, socioeconomic characteristics and social networks on dental services utilisation. The worst scenario was observed for male individuals living in rural areas, with lower schooling, lower income and lower social networks. In this group, the prevalence of dental visit in the previous 12 months was 14.7% (13.1%-16.2%) and 23.1% (19.3%-26.9%) reported never having had a dental visit. Individuals with low social networks exhibited lower dental services utilisation than those with high social networks, across both better and worse socioeconomic status scenarios. CONCLUSION: Individuals aged 15 years and above with poor socioeconomic status, living in rural areas, and those with low social networks had lower use of dental services.
Preventing Dental Caries in Indonesia: A Scoping Review of Policies and National Initiatives.
Susanti I, Detsomboonrat P, Amalia R … +1 more , Urwannachotima N
Community Dent Oral Epidemiol · 2026 Jun · PMID 41361948 · Publisher ↗
BACKGROUND: Dental caries remains a significant public health issue in Indonesia, with high prevalence across age groups and ongoing disparities in access to preventive care. While national initiatives such as the 'Carie...
BACKGROUND: Dental caries remains a significant public health issue in Indonesia, with high prevalence across age groups and ongoing disparities in access to preventive care. While national initiatives such as the 'Caries-Free Indonesia by 2030' goal signal increasing political attention, the effectiveness and equity of current oral health strategies remain uncertain. OBJECTIVE: This scoping review aims to assess the policy direction and documented effectiveness of Indonesia's national-level caries prevention programmes through a review of government policy documents and relevant literature. METHODS: This scoping review followed the PRISMA-ScR guidelines. A systematic search was conducted through PubMed, Scopus, Cochrane Library and Google Scholar, and supplemented by government policy documents. Studies were included if they focused on oral health policy or national caries prevention programmes in Indonesia and were published in English or Indonesian. Exclusion criteria included reviews, commentaries, clinical treatment-focused studies and articles without full text or policy relevance. In total, 32 articles were included in this study. RESULTS: Indonesia's oral health policy framework has evolved toward greater integration and equity, reflected in expanded target populations and alignment with WHO's life-course approach. However, implementation remains fragmented due to inconsistent implementation, workforce shortages, inadequate funding and weak evaluation. The School Dental Health Program (UKGS) demonstrates inconsistent outcomes across provinces and lacks a robust data system for monitoring. Community-based initiatives, such as Posyandu and integrated antenatal care (iANC), show promise but are limited in scale and evaluation. Preventive efforts are underfunded under the UHC scheme, while curative services dominate. Additionally, the absence of a sugar-sweetened beverage (SSB) tax and poor integration of oral health into national surveillance systems hinders upstream and system-wide interventions. CONCLUSION: Despite policy advancements, Indonesia's oral health policies and national-level programmes face some barriers that limit programme effectiveness. Strengthening data systems, rebalancing health financing toward prevention, implementing fiscal measures and formalising multi-sectoral coordination are essential to support sustainable oral health improvements.
Socio-Economic Differences in the Oral Health of Irish Adolescents: The Potential Role of Behavioural, Material and Psychosocial Factors.
Sharma V, O'Sullivan M, Winning L … +4 more , Cassetti O, O'Sullivan A, Honari B, Crowe M
Community Dent Oral Epidemiol · 2026 Jun · PMID 41355175 · Full text
BACKGROUND/OBJECTIVES: Socio-economic inequalities in oral health are a universal phenomenon. This study investigated socio-economic differences in Irish adolescents' oral health and the potential role of behaviour (oral...
BACKGROUND/OBJECTIVES: Socio-economic inequalities in oral health are a universal phenomenon. This study investigated socio-economic differences in Irish adolescents' oral health and the potential role of behaviour (oral health behaviours), material (structural, material and economic constraints) and psychosocial factors (parental stress and family structure) in these differences. METHODS: Data analysed were from the first three waves of the Growing Up in Ireland child cohort survey on self- (self-rated oral health (SROH)) and parent-reported oral health outcomes (dental fillings) at age 17/18 years; socio-economic status (SES) measures, behavioural, material and psychosocial factors at 13 years; and potential confounders at 9 years of age. Logistic regression was used to study associations between oral health outcomes and SES indicators and for mediation analysis. RESULTS: Socio-economic disadvantage was associated with poorer oral health outcomes, with gender-specific patterns. Young males from the lowest educational and income groups had higher odds of suboptimal (fair/poor) self-rated oral health (odds ratio (OR): 2.31 (1.29; 4.13) and OR: 1.72 (1.16; 2.56)), and those in the lowest income quintile and with full medical cards had higher odds of dental fillings (ORs: 1.58-1.82 and ORs: 1.44-1.65) compared with higher socio-economic groups. Young females showed significant associations between selected socio-economic indicators (education, income, occupation and medical status) (ORs: 1.39-3.34) and dental fillings, with education demonstrating the strongest association (ORs: 1.91-3.34). For males, material, behavioural, and psychosocial factors mediated the SES-SROH relationship (97%-100%, 22%-69% and 5%-56% respectively), whereas for dental fillings, mediation was observed for material (11%-55%) and psychosocial (10%-37%) factors, with minimal mediation by behavioural factors (0%-2%). Among females, material factors were the primary mediators of the SES-dental fillings relationship (11%-55%), with smaller contributions from behavioural (0%-21%) and psychosocial (0%-26%) factors. CONCLUSION: Social disparities in oral health are common among Irish adolescents with gender-specific patterns. Material factors were the primary pathway explaining these inequalities, though the strength and nature of these relationships vary by oral health outcome and gender.
Fluoride Varnish for Caries Prevention in Preschoolers: An Overview of Reviews.
Couto FM, Sousa FSO, Dhyppolito IM … +3 more , Barja-Fidalgo F, Dos Santos APP, Nadanovsky P
Community Dent Oral Epidemiol · 2026 Apr · PMID 41267395 · Full text
OBJECTIVES: This study aimed to overview the available evidence from systematic reviews (SRs) on the effects of fluoride varnish (FV) for caries prevention in preschoolers. METHODS: Systematic reviews, with or without me...
OBJECTIVES: This study aimed to overview the available evidence from systematic reviews (SRs) on the effects of fluoride varnish (FV) for caries prevention in preschoolers. METHODS: Systematic reviews, with or without meta-analyses, of randomised controlled trials (RCTs) and quasi-randomised trials evaluating the use of FV in preschoolers to prevent dentin caries compared to placebo, standard care, or no intervention were included. The search was last updated in July 2025 across eight electronic databases. Two researchers independently assessed eligibility and extracted data, resolving disagreements by discussion or with a third researcher if needed. The methodological quality, risk of bias, and certainty of evidence of the SRs were assessed using AMSTAR-2, ROBIS, and GRADE, respectively. The results were synthesised descriptively. RESULTS: Fourteen SRs published between 2001 and 2023 were included. Six SRs reported insufficient evidence to conclude on the effectiveness of FV; six concluded that FV is effective; and two suggested that FV provides a probably irrelevant clinical benefit. One SR had a high methodological quality, two had low, and 11 were rated as critically low. The risk of bias was considered low in three SRs and high in 11. The certainty of evidence ranged from moderate to very low, with the risk of bias being the criterion that most contributed to downgrading it. CONCLUSIONS: Most systematic reviews on the effectiveness of fluoride varnish in preventing caries in preschoolers are of critically low quality and high risk of bias, with conflicting findings. Systematic reviews that included more recent studies with lower risk of bias indicated that fluoride varnish provides relatively limited or no additional benefit to children who use fluoride toothpaste. Therefore, the routine application of fluoride varnish in preschoolers should be reconsidered.
Cost-Effectiveness of Applying Fluoride Varnish to Preschoolers in a Brazilian Scenario: An Economic Modelling Study.
Dhyppolito IM, Castro R, Dos Santos APP … +1 more , Nadanovsky P
Community Dent Oral Epidemiol · 2026 Apr · PMID 41267389 · Full text
BACKGROUND: International economic evaluations have not found convincing evidence that the application of fluoride varnish (FV) in preschool children is a cost-effective anti-caries measure, and there is a lack of econom...
BACKGROUND: International economic evaluations have not found convincing evidence that the application of fluoride varnish (FV) in preschool children is a cost-effective anti-caries measure, and there is a lack of economic evaluations of FV in the Brazilian context. AIM: This study evaluated the cost-effectiveness (CE) of standard care plus FV for Brazilian preschoolers in the general population, comparing it to standard care in terms of prevention of cavitated caries lesions and disability-adjusted life years (DALY) outcomes. METHODS: Markov models were used, with a 4-year time horizon and 6-month cycles. Transition probabilities were obtained from a national epidemiological survey and randomised controlled trials (RCTs). The effectiveness of FV was derived from a systematic review of RCTs. Costs (in Brazilian reais) were sourced from the 2022 National Agency for Supplemental Health dental procedures list. A discount rate of 5% was applied. CE analyses, Markov simulations (MS), and sensitivity analyses (SA) were conducted. Deterministic sensitivity analysis (DSA) used a 95% confidence interval for each variable. For probabilistic sensitivity analysis (PSA), beta distribution curves were used for probabilities, gamma for costs, and lognormal for effectiveness. RESULTS: Standard care plus FV showed an increase in effectiveness (0.01894 and 0.00018 for avoided caries and DALY, respectively) compared to standard care, with an additional cost of R$131.27 per child in the 4-year period. The ICER (incremental cost-effectiveness ratio) was calculated at R$6929.09 per cavitated caries lesion prevented and R$727604.84 per DALY avoided. MS revealed little difference in the percentage of individuals in each health state at the end of the simulations. FV prevented cavities in 4 out of every 100 children over a 4-year period, at an average annual cost of R$33 per child (assuming each child who developed cavitated caries lesions had only one). DSA indicated that FV effectiveness was the parameter with the highest potential to influence the ICER. PSA suggested high CE thresholds, from which FV would be considered cost-effective: R$7000 for caries and R$730000 for DALY. CONCLUSION: The total cost of care was lower in the group that invested less in prevention (without FV) compared to the group that invested more (with FV). While it is often said that "more prevention is always better," economic evaluations remind us that not all preventive strategies provide good value for money.
Discrimination and (In)dignity in the Oral Health Care Setting and Oral Health Outcomes: A Latent Class Analysis.
Raskin SE, Heaton LJ, O'Malley JJ … +2 more , Sonnek AC, Tranby EP
Community Dent Oral Epidemiol · 2026 Apr · PMID 41254341 · Full text
OBJECTIVES: This study conducted a latent class analysis (LCA) on a large, nationally representative dataset of United States adults to determine whether there are distinct archetypes of oral health-related outcomes asso...
OBJECTIVES: This study conducted a latent class analysis (LCA) on a large, nationally representative dataset of United States adults to determine whether there are distinct archetypes of oral health-related outcomes associated with discrimination and microaggression experiences in the oral health setting. METHODS: Respondents (18+ years) to the 2022 and 2023 rounds of the State of Oral Health Equity in America survey completed the 7-item Everyday Discrimination Scale-Oral Health (EDSOC) to assess discriminatory experiences, and the 4-item Dignity in Oral Care Scale (DOCS) to assess microaggression experiences. LCA model inputs were variables related to oral health, social determinants of health, socio-demographic factors and EDSOC and DOCS scores. Models were compared using multiple goodness-of-fit estimates. RESULTS: The best-fitting model (N = 10 922; 50.9% female) produced 6 archetypes, generally representing shifts in demographic characteristics and discrimination and microaggression experiences in oral health settings. For example, while the "American Dream of Success" archetype consisted of mostly white adults aged 30 and above with regular access to dental care and fewer discriminatory and microaggression experiences, the "Vulnerable Adulthood" archetype consisted of younger (44 and below), more racially diverse adults with less access to dental care and more experiences with discrimination and microaggressions. CONCLUSIONS: Results emphasise disproportionate discrimination and microaggression experiences in the oral health care system by younger and more diverse groups of adults compared to older, more non-Hispanic white adults. These findings emphasise the importance of oral health professionals providing culturally sensitive care that considers the intersectionality of all patients' backgrounds and experiences.
Estimating Caries Risk in Unsealed-Permanent Molars Among Young Adults With Data From Repeated National Surveys and a Markov Model.
Griffin SO, Lin M, Naavaal S … +2 more , Wei L, Scherrer CR
Community Dent Oral Epidemiol · 2026 Jun · PMID 41243735 · Full text
OBJECTIVE: Demonstrate and evaluate methodology to estimate annual probability a sound-unsealed molar develops caries (AP) among US adults, aged 21 and 25 years. METHODS: A synthetic birth cohort was created with Nationa...
OBJECTIVE: Demonstrate and evaluate methodology to estimate annual probability a sound-unsealed molar develops caries (AP) among US adults, aged 21 and 25 years. METHODS: A synthetic birth cohort was created with National Health and Nutrition Examination Survey data from 2001 to 2004 and 2011 to 2014. The synthetic birth cohort was born between 1982 and 1989 and was aged 15 to 19 years in 2001-2004 and 25 to 29 in 2011-2014. Caries increment (difference in per-person decayed, missing and filled molars (DMF) between adolescence and young adulthood) obtained from the synthetic birth cohort was used to estimate AP not adjusted for the presence of sealants. Adjusted estimates were obtained by inputting information on sound-sealed, sound-unsealed and DMF molars among adolescents and DMF among young adults from the synthetic cohort and sealant retention from the literature into a Markov model. AP was estimated by solving for the AP that yielded the DMF for the synthetic cohort in young adults. To evaluate Markov-model performance, longitudinal data from five caries effectiveness trials were used to estimate true AP and adjusted AP. One-way sensitivity analyses of model parameters were also conducted. RESULTS: The adjusted AP (0.038) was notably higher than the unadjusted AP (0.031). The average and median percentage deviation of adjusted APs relative to their true values were, respectively, 10.1% and 7.1%. The most influential model parameters were DMF in adulthood and annual retention. CONCLUSION: This methodology provides reasonable estimates of AP that can be used in cost-effective analyses of providing sealants to young adults.
Patterns and Predictors of Toothbrushing Frequency in Irish Adolescents: The Role of Autism and Intellectual Disability.
Parry JA, Newton JT, Ryan C
Community Dent Oral Epidemiol · 2026 Apr · PMID 41243697 · Full text
OBJECTIVE: To visualise and explore patterns of daily toothbrushing frequency in Irish adolescents and contribute to the understanding of predictors of toothbrushing habits in autistic adolescents and adolescents with in...
OBJECTIVE: To visualise and explore patterns of daily toothbrushing frequency in Irish adolescents and contribute to the understanding of predictors of toothbrushing habits in autistic adolescents and adolescents with intellectual disability. METHODS: Data from the Growing Up in Ireland national longitudinal child study were explored to visualise patterns of toothbrushing in children between 9 and 17/18 years. Data for 17/18-year-olds were examined using descriptive and logistic regression analysis to gain insight into predictors of twice-a-day toothbrushing within the full adolescent dataset and a subgroup of autistic adolescents and adolescents with intellectual disability. RESULTS: Gender, eating breakfast every day and experience of orthodontics positively predicted twice-a-day toothbrushing for young people in general. Oral health rating below excellent, infrequent dental checkups, obesity and drinking soft drinks (not diet) daily negatively predicted twice-a-day toothbrushing. For autistic adolescents and adolescents with intellectual disability, results suggested that the lowest self-rating of oral health, drinking soft drinks (not diet) daily and being autistic with intellectual disability may be factors that influence less than twice-a-day toothbrushing. CONCLUSION: Regular contact with the dental team and healthy lifestyle habits may positively influence twice-a-day toothbrushing. Frequency of toothbrushing and actionable targets to support oral health, where high support and more complex oral health challenges exist, require further research.
Exploring the Education and Perceptions of Dental Professionals Toward Poverty and Oral Health Disparities: A Scoping Review.
Allen L, Doughty J, Beattie S … +2 more , Hardman C, Albadri S
Community Dent Oral Epidemiol · 2026 Feb · PMID 41219670 · Full text
OBJECTIVE: The objective of the present study was to map the available research, investigating how dental professionals perceive those who experience poverty, and what educational interventions are available in this area...
OBJECTIVE: The objective of the present study was to map the available research, investigating how dental professionals perceive those who experience poverty, and what educational interventions are available in this area, with the aim of providing a narrative summary and identifying key research gaps within the literature. METHOD: Following Joanna Briggs scoping review methodology, databases searched included PubMed, Scopus, CINAHL, Dentistry and Oral Sciences, Health Research Premium and Web of Science databases. A manual search was also performed on Google Scholar to identify grey literature. Search strategies included medical subject headings and key terms including poverty, financial hardship, social deprivation, oral health, oral diseases, dental caries, communication, learning and dental education. RESULTS: A total of 1046 articles were assessed for eligibility, of which 34 studies met the predefined inclusion criteria. The studies included in this review highlight conflicting understandings about what it means to be living in poverty. Outreach activities shared lived experiences, and immersive opportunities were reported to improve dental professionals' attitudes and willingness to provide dental care for people living in poverty. CONCLUSION: To the study teams' knowledge, this is the first review to examine specifically how poverty and oral health are understood by the dental profession. This review highlights the need for further research as to the long-term effectiveness and cost-effectiveness of educational interventions to increase understanding.
Refining Scale Measurement: Reassessing Oral Impacts on Daily Performances Properties With Item Response Theory.
Celeste RK, Perazzo MF, Tsakos G … +1 more , Reichenheim M
Community Dent Oral Epidemiol · 2026 Feb · PMID 41199142 · Full text
OBJECTIVES: Many oral health-related quality of life instruments have been developed but few have undergone a comprehensive psychometric assessment. One commonly used measure is the Oral Impact on Daily Performance (OIDP...
OBJECTIVES: Many oral health-related quality of life instruments have been developed but few have undergone a comprehensive psychometric assessment. One commonly used measure is the Oral Impact on Daily Performance (OIDP). This study revised the configural and metric properties as well as the performance of items based on Item Response Theory (IRT) of a dichotomous-item version of OIDP in Brazil. METHODS: The nine-item dichotomous version of the OIDP was analysed using data from a nationally representative sample from the Oral Health Survey (SBBrasil 2010). It consisted of 30 064 individuals aged 12 to 75 and was split into two partitions comprising n = 20 040 and n = 10 024, respectively. Confirmatory factor analyses (CFA) were conducted on the larger partition and cross-validated on the smaller to assess configural and metric properties. The item performance was evaluated using a 2-parameter item response theory (IRT) model. Sampling weights were used in all analyses. RESULTS: The unidimensional model presented two violations of conditional independence, one between items i5 (practising sports) and i4 (going out) and another between items i6 (trouble in speaking) and i7 (shame of speaking or smiling). A CFA of the most parsimonious model (removing i5, i6 and i7) yielded a RMSEA = 0.02, WRMR = 1.42, CFI = 0.99 and TLI = 0.99. The IRT analyses showed that three pairs of items had very similar levels of difficulty and discrimination suggesting redundancy. CONCLUSIONS: A shorter dichotomous version of the OIDP scale has acceptable configural and metric properties. Being more concise and thus efficient, it may be better suited for large-scale population surveys than the version currently in use.
Fluoride and Neurodevelopmental Hazard Modelling: An Assessment of Concentration-Response Analysis.
Kumar JV, Moss ME, Liu H … +3 more , Fisher-Owens S, Rugg-Gunn A, Kuring J
Community Dent Oral Epidemiol · 2026 Feb · PMID 41174838 · Full text
OBJECTIVES: A National Academies Consensus Study report concluded that the evidence did not support an assessment that fluoride is a neurodevelopmental hazard. However, some researchers have undertaken benchmark dose mod...
OBJECTIVES: A National Academies Consensus Study report concluded that the evidence did not support an assessment that fluoride is a neurodevelopmental hazard. However, some researchers have undertaken benchmark dose modelling to determine a safe fluoride concentration level in water. Therefore, the suitability of the data for modelling fluoride concentration in urine and water and cognition response using standard criteria was assessed. METHODS: Data quality was evaluated using a standard tool. A random-effects meta-analysis of standardised mean difference (SMD) and regression coefficients was conducted to assess effect sizes and heterogeneity. The Environmental Protection Agency (EPA) benchmark dose modelling was utilised to determine the association between fluoride concentrations and cognition scores. RESULTS: All four maternal urinary fluoride (MUF) studies did not meet the standards for acceptable quality, as identified by the EPA data quality criteria, which are necessary for combining data from different studies for dose-response analysis. The pooled estimate was not statistically significant (β = -1.06, 95% CI: -3.63, 1.50; p = 0.42; I = 62%). A meta-analysis of five studies conducted in fluoridated areas showed a pooled SMD effect size of 0.04 (95% CI: -0.06, 0.14; p = 0.42; I = 0%), favoring higher fluoride. The benchmark dose models did not reveal a functional relationship between MUF or water fluoride concentration and cognitive outcomes (Goodness-of-fit p < 0.1). CONCLUSIONS: The data quality assessment revealed serious flaws that render the maternal urinary studies unacceptable for hazard assessment and benchmark dose modelling. Therefore, more appropriate studies in endemic fluorosis areas are needed to accurately determine whether fluoride is associated with adverse cognitive outcomes in populations with meaningful exposure.
The Role of Health Literacy in Adults' Dental Service Utilisation: A Scoping Review.
Lu X, Nanjappa S, Wijesiri TID … +2 more , Mossey P, Yuan S
Community Dent Oral Epidemiol · 2026 Apr · PMID 41168673 · Full text
OBJECTIVES: Health literacy refers to an individual's ability to understand health information, navigate healthcare systems, make informed decisions and adopt health-promoting behaviours. The scoping review examined the...
OBJECTIVES: Health literacy refers to an individual's ability to understand health information, navigate healthcare systems, make informed decisions and adopt health-promoting behaviours. The scoping review examined the available literature to explore adults' health literacy levels, health literacy measurements, and the role of health literacy in adults' dental service utilisation. METHODS: The scoping review used Arksey and O'Malley's framework, refined by Joanna Briggs Institute methodology. The inclusion criteria were peer-reviewed studies, published in English with adult participants in a dental setting. Four databases (MEDLINE via PubMed, Scopus, CINAHL and ASSIA) were searched for relevant studies from January 2000 to January 2025. RESULTS: Nineteen studies met the inclusion criteria, with 12 out of 19 conducted in the US. Health literacy was assessed by 11 different measures. Although most studies reported relatively inadequate health literacy levels, inconsistent findings persist due to a lack of consensus on measurement. Dental service utilisation, primarily assessed by dental visits, dental information seeking, and dentist-patient communication, demonstrated inconsistent associations with health literacy. CONCLUSIONS: While some studies suggested a positive association between health literacy and dental service utilisation, the mechanisms through which health literacy influenced dental service utilisation remained unclear and required further investigation.
Oral Health and Social Isolation After 6 Years: Mediation of Oral Functions.
Abbas H, Takeuchi K, Kusama T … +2 more , Kiuchi S, Osaka K
Community Dent Oral Epidemiol · 2026 Apr · PMID 41139664 · Full text
OBJECTIVES: Tooth loss was longitudinally associated with social isolation. The absence of dental prosthesis use was an additional risk factor. However, the mediating pathways for this association are unknown. The aim of...
OBJECTIVES: Tooth loss was longitudinally associated with social isolation. The absence of dental prosthesis use was an additional risk factor. However, the mediating pathways for this association are unknown. The aim of this cohort study was to estimate the mediating effect of three oral functions: speaking, smiling and chewing observed at baseline on the association between oral health at baseline and social isolation after 6 years of follow-up. METHODS: The 2010-2016 panel data from 6103 functionally independent participants aged ≥ 65 years who were not socially isolated at baseline was used from the Japan Gerontological Evaluation Study (JAGES). Causal mediation analysis using parametric logistic regression models was used to calculate the natural direct effect (NDE), the natural indirect effect (NIE), and the total effect. Social isolation was derived from a 5-point index and dichotomised (0/3 = not isolated, 4/5 = isolated). The confounders observed at baseline were age, sex, educational attainment, income, activities of daily living, living area, and having depressive symptoms assessed using the geriatric depression scale (GDS-15). RESULTS: The mean age of the participants was 72.4 years (SD = ±5.1), and 44.7% were males. Social isolation was observed at follow-up among 3.6% of participants (n = 220). The cumulative incidence rate of socially isolated participants among those with ≥ 20 teeth was 2.9% increasing gradually to 3.2%, 3.5%, 3.7% and 7.2% among those with 10-19 teeth and used dental prosthesis, 10-19 teeth and did not use the dental prosthesis, 0-9 teeth and used dental prosthesis, and 0-9 teeth and did not use the dental prosthesis respectively. Compared with those with ≥ 20 teeth, having difficulty in speaking [NIE odds ratio (OR) = 1.02, 95% confidence interval (CI) = 0.93-1.11], problems in smiling (NIE OR = 1.02, 95% CI = 0.93-1.10) and difficulty in chewing (NIE OR = 1.04, 95% CI = 0.94-1.14) might have mediated the association for those with 10-19 teeth and used dental prosthesis as well as for those with 10-19 teeth without dental prosthesis (NIE OR = 1.02, 95% CI = 0.94-1.10), (NIE OR = 1.02, 95% CI = 0.93-1.11) and (NIE OR = 1.02, 95% CI = 0.93-1.11) respectively. While they might not have mediated the association for those with 0-9 teeth with and without dental prosthesis use. CONCLUSION: With low precision and uncertain estimates, limited oral function might have mediated the association between tooth loss (10-19 with and without dental prosthesis use groups) and social isolation over 6 years. It was uncertain whether a mediation effect of oral functions was observed for those with 0-9 teeth with and without dental prosthesis use.
Tracking the Debate: Geo-Temporal Sentiment Analysis of Community Water Fluoridation on 'X' (Formerly Twitter) With Five-Year Forecast.
Torwane N, Lalloo R, Ha D … +1 more , Do L
Community Dent Oral Epidemiol · 2026 Apr · PMID 41131739 · Publisher ↗
OBJECTIVES: This study examined country-level geo-temporal sentiment trends in community water fluoridation (CWF) discussions on 'X' from 2014 to 2023 and generated a five-year forecast to anticipate future shifts. METHO...
OBJECTIVES: This study examined country-level geo-temporal sentiment trends in community water fluoridation (CWF) discussions on 'X' from 2014 to 2023 and generated a five-year forecast to anticipate future shifts. METHODS: Sentiment analysis was conducted using the VADER 'SentimentIntensityAnalyzer', with polarity thresholds defined as negative (< -0.05), neutral (-0.05 to +0.05) and positive (> +0.05). Data were collected via the 'X' API and examined for sentiment distribution, country-level geo-temporal patterns based on user location information, and engagement metrics (likes, retweets, replies). Ethical approval was obtained, and only publicly available data were analysed in compliance with the platform's terms of service. Limitations include restriction to English-language tweets and the non-representativeness and demographic biases of 'X' users compared with national populations. RESULTS: Of 72 309 original tweets analysed, 37.4% were negative, 34.4% positive and 28.2% neutral. Countries with low tweet volumes (e.g., Venezuela, Cyprus, Croatia, Pakistan, Vietnam) showed predominantly positive sentiment. In contrast, high-volume countries (the US, Canada, Australia, Brazil and the United Kingdom) displayed mixed sentiment without a clear majority. Predictive modelling indicated a modest shift toward less positive sentiment polarity over the next 5 years, with average polarity projected to decrease from 0.43 in 2024 to 0.38 in 2028. Supplementary analysis of more recent tweets (Jan 2024-Aug 2025) provided further insight into emerging patterns, broadly consistent with the projected trends. CONCLUSIONS: CWF discourse on 'X' is polarised and varies across countries and time. The expected decline in positivity underscores the need for tailored country-specific public health communication strategies to strengthen engagement and counter misinformation.
Sense of Coherence as a Modifier of Income Inequalities in Self-Rated Oral and General Health: A Cross-Sectional Study.
Zakershahrak M, Chrisopoulos S, Luzzi L … +2 more , Jamieson L, Brennan D
Community Dent Oral Epidemiol · 2026 Jun · PMID 41121588 · Publisher ↗
OBJECTIVE: To investigate whether a stronger Sense of Coherence (SOC) modifies the association between low household income and poor self-rated dental and general health measures (SRDH and SRGH, respectively). METHODS: C...
OBJECTIVE: To investigate whether a stronger Sense of Coherence (SOC) modifies the association between low household income and poor self-rated dental and general health measures (SRDH and SRGH, respectively). METHODS: Cross-sectional analyses were performed using data from the Dental Care and Oral Health Study (DCOHS, 2015-2016) in South Australia (n = 3664). In multivariate Poisson regression models, the main effects, interactions and effect modifications of SOC in the association between income and SRDH and SRGH were estimated using prevalence ratios (PRs) for poor self-rated health. RESULTS: In the low-income group, among those with stronger SOC, the prevalence of poor SRDH (16.0%) and SRGH (8.1%) was lower than that of those with weaker SOC (25.0% and 18.9%). Lower coherence (weak SOC) was associated with poor SRGH (PR = 4.8, 95% CI [1.8-13.1]). The interaction between lower coherence and low- and middle-income strata was not associated with the prevalence of poor SRDH and SRGH. CONCLUSIONS: Although interactions between SOC and income were not statistically significant, findings suggest a potential modifying role of strong SOC on the association between low income and poor health. These results should be interpreted with caution, as they are exploratory.
Trends of Dispensed Opioids Prescribed by Australian Dentists: 2013-2022.
Teoh L, Taylor M, Kelty E … +7 more , Sanfilippo FM, Lim M, McCullough M, Etherton-Beer C, Park A, Preen D, Page A
Community Dent Oral Epidemiol · 2026 Feb · PMID 41058076 · Full text
BACKGROUND: In Australia, the prescribing of opioid medicines by dentists has increased in recent years, despite opioids not being first-line treatment for dental pain. The aim of this longitudinal study was to examine t...
BACKGROUND: In Australia, the prescribing of opioid medicines by dentists has increased in recent years, despite opioids not being first-line treatment for dental pain. The aim of this longitudinal study was to examine the dispensing of opioids prescribed by dentists in Australia during 2013-2022. METHOD: A nationally representative 10% sample of patients identified from the Australian Pharmaceutical Benefits Scheme dispensing data from 2013 to 2022 was used. Three outcomes were assessed: (1) incidence of dispensing of all dental prescriptions; (2) incidence of dispensing of opioids prescribed by dentists; (3) average number of tablets/capsules of dental opioid supply. Outcomes pertaining to opioid use were examined overall, and by year, age and sex. RESULTS: From 2013 to 2022, 998 774 dental prescriptions (of any kind) were dispensed to 470 118 patients. The mean annual incidence rate for dispensing any dental medication was 48.4 (95% CI: 48.3-48.5)/1000 person-years. Opioids accounted for 183 303 prescriptions (18.4%), with a mean annual incidence rate of 11.0 (95% CI: 11.0-11.1)/1000 person-years. The majority of patients (99.1%) were dispensed ≤ 4 opioid prescriptions across the 10-year period, with 0.9% of patients (n = 1312) receiving between 5 and 149 dispensed opioids. Over the study period, the average annual incidence of dispensed dental opioids increased by 4.4% (95% CI: 1.0-8.2). A reduction in the mean quantity of opioid pills dispensed was observed over time. Dental opioids were dispensed to 2727 children and adolescents. CONCLUSION: The incidence of dispensing of dental opioids in Australia increased by an average of 4.4% per year over a decade. While there was a reduction in opioid quantities dispensed, dispensing of opioids for children occurred, and a small number of patients were dispensed excessive quantities of dental opioids. Evidence-based tailored opioid stewardship interventions need to include dentists, and dentists should be provided access to drug monitoring programmes to enable more informed prescribing decisions.
Mapping Dental Care for Children and Adolescents With Rare Diseases: A Brazilian Multicentre Study.
Prado HV, de Souza RMS, Fonseca GGFG … +19 more , Carvalho KRJ, Silva AVMV, Mascarenhas IFT, Bergo BR, Soares HLB, de Jesus BM, Sobral LRFE, Reis KD, Marques KLDS, de Oliveira FS, Martelli DRB, de Arruda JAA, Fournier BPJ, Travassos DV, Macari S, Lanza CRM, Borges-Oliveira AC, Martelli-Júnior H, Silva TA
Community Dent Oral Epidemiol · 2026 Apr · PMID 41041936 · Full text
OBJECTIVES: To describe the landscape of dental care provided by specialised centres for children and adolescents with rare diseases (RDs) in the state of Minas Gerais, southeastern Brazil. METHODS: A retrospective cross...
OBJECTIVES: To describe the landscape of dental care provided by specialised centres for children and adolescents with rare diseases (RDs) in the state of Minas Gerais, southeastern Brazil. METHODS: A retrospective cross-sectional study was conducted involving individuals aged 0-18 years with a confirmed diagnosis of a RD who received care at five specialised dental centres. Data on the diagnosis, age at first dental appointment, frequency of annual visits and travel distance from home to treatment centre were analysed using descriptive and inferential statistics. RESULTS: A total of 1057 individuals with 244 different RDs were identified. Most were boys (54.9%). The average age at the first dental appointment was 8.52 years. Haematological diseases were the most prevalent (38.9%). The average travel distance for treatment was 99.1 km, with individuals from the Jequitinhonha region traveling the farthest (526.3 km). The average number of annual dental visits was 2.4. Patients with craniofacial syndromes accessed care earlier (average: 3.6 years) and had more frequent follow-up appointments (average: 4.8 visits/year). Significant regional disparities were found in age at first appointment (p < 0.001), travel distance (p < 0.001) and frequency of visits (p = 0.002). CONCLUSIONS: Children and adolescents with RDs had delayed initiation of dental care, low follow-up rates and substantial travel burdens. The concentration of specialised centres in the state capital underscores the need for policy reforms to improve equitable access, particularly for patients in remote areas.
Perceived Barriers and Potential Strategies for People Who Use Drugs in Accessing Oral Healthcare: A Qualitative Study of Service Providers.
Kangutkar T, Gussy M, Knevel R … +1 more , Calache H
Community Dent Oral Epidemiol · 2026 Feb · PMID 41025695 · Full text
OBJECTIVE: Access to appropriate oral healthcare is vital for overall health and well-being. However, people who use drugs (PWUD) often face significant barriers in accessing oral healthcare services. This qualitative st...
OBJECTIVE: Access to appropriate oral healthcare is vital for overall health and well-being. However, people who use drugs (PWUD) often face significant barriers in accessing oral healthcare services. This qualitative study focused on exploring the perspectives of public oral health service providers and harm reduction workers to understand the barriers that they perceived were experienced by PWUD in accessing oral healthcare and identified potential strategies to address these barriers. METHOD: Thirty-five participants (20 public oral health service providers and 15 harm reduction workers) were recruited from both metropolitan and regional areas of Victoria, Australia, through purposive sampling and a snowballing technique. Individual online semi-structured interviews were conducted, and data were analysed using a hybrid approach to thematic analysis. RESULTS: Service providers felt that continuous drug use impacted PWUD's ability to perceive dental pain, which delayed identification of oral health symptoms at the individual level. Major life crises meant that PWUD had limited awareness about the oral health consequences of their drug use, which further hindered their access to care. Service providers described how negative experiences and perceived judgements by PWUD about the visual effects of drugs created barriers to accessing dental care. Triggers of memories of traumatic abuse associated with the dental environments were also identified as a distressing factor for PWUD. Perceived service-level barriers included the lack of explicit recognition of PWUD as eligible for priority access in public dental clinics, financial impediments and coercive tactics from some oral health service providers. Service providers with experience of working in rural areas shared how the lack of anonymity and the risk of being identified as a drug user was an additional challenge for PWUD in accessing oral health services in rural areas. The participants proposed several potential strategies including drop-in oral health sessions at harm reduction facilities involving case managers to address appointment issues and training oral health service providers in trauma-informed care. They emphasised the need for interprofessional collaboration between oral health and harm reduction sectors. One key recommendation proposed by the participants was to establish oral health integrated harm reduction programmes that require careful consideration of feasibility, acceptability, resource allocation and potential implications on service quality. CONCLUSION: This study highlighted previously unrecognised perceived barriers by service providers working with PWUD that could impact the implementation of any interventions that aim to improve access to dental services by PWUD. By addressing the individual and service level barriers comprehensively, healthcare systems can better address the oral health needs of PWUD and reduce disparities in access to care.
Assessing the Impact of Periodontal Therapy on Tooth Loss: A Register-Based Longitudinal Study in Denmark.
Raittio E, Baelum V
Community Dent Oral Epidemiol · 2025 Dec · PMID 41013953 · Full text
OBJECTIVES: While regular periodontal care is advocated to reduce tooth loss considerably among periodontitis patients, evidence from observational studies is often limited to small single-center studies. This study aims...
OBJECTIVES: While regular periodontal care is advocated to reduce tooth loss considerably among periodontitis patients, evidence from observational studies is often limited to small single-center studies. This study aims to quantify the effect of periodontal care on tooth extractions among 40-year-old new periodontitis patients over 20 years. METHODS: A nationwide register-based cohort study was conducted, encompassing 40-year-old individuals with incident periodontitis in 2001, tracked through Danish registers until the end of 2021. Receiving any periodontal care was determined annually, and the number of tooth extractions served as the annually varying outcome. G-estimation of structural nested mean models adjusted for time-varying confounding and loss to follow-up was employed to estimate the average treatment effect of periodontal therapy on subsequent tooth extractions. RESULTS: The study included 1251 40-year-olds with incident periodontitis in 2001. The average follow-up from 2002 onwards was 19.1 years and amounted to 23,878 person-years. On average, participants received periodontal care in 12.1 years (SD 6.3) and lost an average of 2.3 teeth (SD 3.5). G-estimation showed that receiving periodontal therapy in a given year compared to not receiving any periodontal therapy reduced the number of teeth extracted in the following year by 0.04 (95% CI: 0.02; 0.06). Receiving periodontal therapy for 5 years in a row compared to not receiving any periodontal therapy was associated with an average of 0.08 (95% CI: 0.04; 0.13) fewer extracted teeth, while on average 0.62 teeth were lost in a 5-year period (0.12 per year). CONCLUSIONS: Periodontal therapy resulted in a modest reduction in tooth extractions among 40-year-olds with incident periodontitis over 20 years. The effectiveness of periodontal therapy against tooth loss seems to be considerably smaller than indicated by earlier clinical studies.
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