Community Dentistry And Oral Epidemiology[JOURNAL]
Sun
200 papers
Oral Health Outcomes and Their Sociodemographic and Service Utilisation Determinants in a Rural Population.
Echeverria MS, Borges RDC, Karam SA … +4 more , Haubert G, Cademartori MG, Agostini BA, Demarco FF
Community Dent Oral Epidemiol · 2026 Feb · PMID 40999560 · Publisher ↗
OBJECTIVES: The aim of the study was to evaluate the number of remaining teeth, use of dental prosthesis, and self-perception of oral health according to sociodemographic variables and use of dental services in a rural p...
OBJECTIVES: The aim of the study was to evaluate the number of remaining teeth, use of dental prosthesis, and self-perception of oral health according to sociodemographic variables and use of dental services in a rural population of the Municipality of Pelotas, RS, through a cross-sectional population-based study. METHODS: A cross-sectional study was conducted in the rural area of Pelotas, Brazil, aiming to assess the oral health status of adults aged 18 or older. Data collection occurred through a systematic sampling process in two stages, with sociodemographic factors and oral health outcomes analysed. The number of remaining teeth, use of dental prosthesis, self-perception of oral health and dental visit patterns were among the variables examined. Prevalence ratios were estimated using Poisson regression and odds ratios were estimated using ordinal logistic regression. RESULTS: Out of 1519 adults surveyed, the majority were male, aged 40-59, and had incomplete elementary education. Elderly women and people in the richest income quintile exhibited lower rates of remaining teeth and higher use of prosthesis, while people with higher education and use of dental services in the last year had more teeth. Worse self-perception of oral health was more prevalent in men, at age 40-59 and who had used dental services for curative reasons. CONCLUSIONS: The study highlights the need for targeted interventions to address oral health disparities in rural areas, emphasising the importance of preventive measures and equitable access to dental services. Strategies focusing on increasing access and reducing financial barriers can contribute to improving oral health outcomes among rural populations.
'How Good to Finally Have Options!' A Qualitative Reflexive Thematic Analysis Exploring Parents' Perceptions of Non-Invasive and Minimally Invasive Caries Management Strategies.
Stamere U, Stars I, Innes N … +4 more , Protasa N, Uribe SE, Mariño R, Maldupa I
Community Dent Oral Epidemiol · 2026 Feb · PMID 40976872 · Publisher ↗
OBJECTIVES: Caries prevalence remains high in Latvia, with limited adoption of minimally invasive dentistry (MID). While provider barriers are known, parental perspectives are underexplored. This study examined Latvian p...
OBJECTIVES: Caries prevalence remains high in Latvia, with limited adoption of minimally invasive dentistry (MID). While provider barriers are known, parental perspectives are underexplored. This study examined Latvian parents' views on MID to identify key barriers and facilitators to its acceptance. METHODS: An inductive qualitative approach was applied to explore parents' perceptions of non-invasive and minimally invasive caries management strategies. Data were collected using semi-structured interviews, conducted with parents (n = 19) whose children had experience of either minimally invasive or traditional caries management. All interviews were recorded, transcribed verbatim and analysed with reflexive thematic analysis. RESULTS: Four main themes were generated: (1) 'avoiding unnecesary discomfort and distress' described parents' views and experiences of non-invasive and minimally invasive caries management strategies as physically and psychologically less traumatic for their child and themselves; (2) 'prioritising treatment qualities', explored parents' expectations and priorities regarding the qualities offered by different dental treatment options; (3) 'the power of information', illustrated that parents' awareness of non-invasive and minimally invasive caries management strategies contributed to a better understanding of treatments and promoted choice, but required access to that information; and (4) 'choices of suitable options', described parents' reflections on having a variety of options for dental treatment, rather than a single option offered. CONCLUSIONS: Parents value effective communication, clear information and access to treatment options when considering minimally invasive caries management. Their views highlight the need for a shift towards patient-centred care models that prioritise comfort, informed decision-making and choice in paediatric dentistry.
Dental Shame: A Call for Understanding and Addressing the Role of Shame in Oral Health.
Folker L, Dolezal L, Jespersen AP … +4 more , Paisi M, Withers L, Worle C, Øzhayat EB
Community Dent Oral Epidemiol · 2026 Feb · PMID 40976871 · Full text
This commentary highlights dental shame as a pervasive but underexplored phenomenon with significant implications for oral health and systemic inequities. It proposes dental shame as a critical lens for understanding and...
This commentary highlights dental shame as a pervasive but underexplored phenomenon with significant implications for oral health and systemic inequities. It proposes dental shame as a critical lens for understanding and addressing the complex interplay between personal, social, economic, cultural and systemic factors contributing to oral health challenges. Drawing on interdisciplinary expertise, the authors collectively propose that dental shame is both a consequence and determinant of oral health issues, leading to a self-reinforcing dynamic of avoidance, withdrawal and exacerbated inequities. They identify five key aspects of oral health where dental shame warrants deeper investigation: clinical encounters, care and social services, daily oral health behaviours, systemic inequities and psychological trauma. On this basis, the authors call for more research on dental shame and advocate for shame-sensitive practices in dentistry and other health care and social settings. This approach includes fostering shame competence in practitioners, addressing systemic barriers and designing empathetic, inclusive care environments. Ultimately, the authors state that understanding and addressing dental shame can transform oral health promotion, reduce inequities and improve overall health outcomes.
A Systematic Review of the Facilitators and Challenges as Perceived by Dental Service Providers in the Provision of Oral Healthcare for Culturally and Linguistically Diverse Populations.
Balla SB, Angelakopoulos N, Tadakamadla J … +1 more , Tadakamadla SK
Community Dent Oral Epidemiol · 2026 Feb · PMID 40899138 · Full text
OBJECTIVES: Vulnerable groups, particularly those from Culturally and Linguistically Diverse (CALD) backgrounds, face heightened risks of poor oral health. There is a notable gap in systematically analysing the facilitat...
OBJECTIVES: Vulnerable groups, particularly those from Culturally and Linguistically Diverse (CALD) backgrounds, face heightened risks of poor oral health. There is a notable gap in systematically analysing the facilitators and challenges dental service providers face in meeting the needs of patients from CALD backgrounds. This study, therefore, sought to systematically review existing literature to address this gap and provide insights into the factors that influence dental service provision for CALD communities. METHODS: A comprehensive search of six electronic databases was conducted to identify facilitators and challenges in oral healthcare provision. Database searches covered January 1985 to May 2025 (last updated 31 May 2025). A meta-integration approach was employed to synthesise qualitative and quantitative findings. The quality of evidence was assessed using the Mixed Method Appraisal Tool (MMAT). Data organisation followed Ferlie and Shortell's healthcare model, with key themes identified via thematic analysis. RESULTS: Thirteen papers were included in this review, comprising three quantitative and 10 qualitative studies, sourced from diverse countries, including the United Kingdom, Australia, New Zealand, Japan, Sweden, Netherlands, Finland, Germany, the United States and Canada. Article quality varied from moderate to high. Although individual-level factors such as cultural beliefs and language barriers, impacted dental service provision and rigid organisational structures also served as a significant challenge. Structural/system-level challenges included policy implementation gaps, insufficient cross-cultural training for dental providers and affordability issues. CONCLUSION: The evidence from dental service providers in diverse settings suggests they encounter several challenges when providing dental care to CALD communities. In summary, delivering culturally sensitive oral healthcare is inherently complex. Policymakers must acknowledge that addressing the needs of CALD patients necessitates establishing supportive environments and strengthening institutional capabilities.
Framework for Equitable and Effective Oral Health Research in Africa.
El Tantawi M, Folayan MO, Bhayat A
Community Dent Oral Epidemiol · 2025 Dec · PMID 40899092 · Publisher ↗
BACKGROUND: The current heightened attention to oral health underscores the need to address populations who have been historically marginalised in mainstream policy and research endeavours. African countries lack suffici...
BACKGROUND: The current heightened attention to oral health underscores the need to address populations who have been historically marginalised in mainstream policy and research endeavours. African countries lack sufficient data on oral health problems and potential solutions to inform decision-making. AIM: This commentary addresses the shortcomings of oral health research in Africa and proposes a framework to foster fair and efficient research in this area. MATERIALS AND METHODS: We present an assessment of the current state of oral health research in Africa and outline key components of the framework. RESULTS: The framework includes: enhancing the capacities of African researchers, cultivating leadership, prioritising locally pertinent research, establishing equitable partnerships with international researchers, and translating research findings into actionable policies and practices. CONCLUSION: These pillars offer a roadmap for steering oral health research in Africa toward impactful outcomes that improve the oral health of African populations.
Strong Heart, Strong Smile: Tooth Loss and Incidence of CVD in American Indian Populations.
Mabbutt LM, Jensen P, Fretts A … +2 more , Best L, Cunha-Cruz J
Community Dent Oral Epidemiol · 2026 Feb · PMID 40887717 · Full text
OBJECTIVES: Tooth loss and cardiovascular disease (CVD) share risk factors and complex pathways in disease progression and co-morbidities. To date, little research on the relationship between tooth loss and CVD has been...
OBJECTIVES: Tooth loss and cardiovascular disease (CVD) share risk factors and complex pathways in disease progression and co-morbidities. To date, little research on the relationship between tooth loss and CVD has been conducted in American Indian populations. This study investigated the prevalence of edentulism among American Indian adults and its association with the incidence of CVD. METHODS: The ongoing longitudinal Strong Heart Study (SHS) is being conducted in rural American Indian communities in North Dakota, South Dakota and Oklahoma since 1989. This cohort study included SHS participants who had available tooth loss data during the 1997-1999 wave, which serves as the baseline for this analysis. Data analysis was performed in August 2023. Anthropometric, health and behaviour data were obtained from physical exams and interviews. Participants who reported no natural teeth were considered edentulous. CVD events were obtained from continuous mortality and morbidity surveillance through 2019. Crude and adjusted Cox proportional hazards regression models were fit to examine the association of edentulism with CVD events. RESULTS: Of 1982 participants, 29% (n = 584) were edentulous at baseline, and 41% (n = 822) developed CVD during up to 22 years follow-up. When adjusting for site, age, sex, education, smoking, diabetes, BMI and hypertension, the hazard ratio for developing CVD was 1.36 (95% CI: 1.15, 1.60) for the participants who were edentulous when compared to those reporting natural teeth present. CONCLUSIONS: The findings confirm the high burden of oral diseases and CVD among this sample of American Indians and suggest a significant positive association between edentulism and incidence of CVD that was partially explained by shared risk factors. The study highlights the need for interventions that address risk factors for non-communicable diseases to improve both oral health and cardiovascular health of American Indians.
Aboriginal and Torres Strait Islander Dental Program Evaluations: A Mixed-Methods Systematic Review.
Pham A, Hedges J, Flanagan E … +3 more , Mastrosavas T, Jamieson L, Nath S
Community Dent Oral Epidemiol · 2025 Dec · PMID 40873005 · Full text
OBJECTIVE: Over the last 20 years, the disparity in oral health between Aboriginal and Torres Strait Islander Australians and other Australians has continued to grow. This suggests that further programmes and programme i...
OBJECTIVE: Over the last 20 years, the disparity in oral health between Aboriginal and Torres Strait Islander Australians and other Australians has continued to grow. This suggests that further programmes and programme improvements are needed to reach equitable oral health outcomes for Aboriginal and Torres Strait Islander Peoples. This mixed methods systematic review aims to assess Aboriginal and Torres Strait Islander Dental Programme Evaluations by measuring outcomes and cultural safety via the Lowitja Institute Evaluation Framework to Improve Aboriginal and Torres Strait Islander Health. METHODS: Databases searched were PubMed, Embase, Dentistry & Oral Sciences Source, Public Health Database and Scopus. All years were included. The date of the last search was the 1 May 2025. Published articles researching dental health programmes with Aboriginal and Torres Strait Islander participants in Australia were identified. Quantitative, qualitative and mixed methods studies were included. The Joanna Briggs Institute approach to Mixed-Methods Systematic Reviews was followed, except for a deviation in critical appraisal, which utilised the Quality Assessment for Diverse Studies (QuADs) instead. This review protocol was registered in PROSPERO (CRD42025637868) a priori. RESULTS: There were 54 studies included. New South Wales, South Australia, Queensland, Northern Territory and Western Australia were the states with the most data. The research designs included qualitative, quantitative and mixed-methods approaches. Most studies were of relatively high quality, as assessed by the QuADS criteria. Evaluations of dental programs for Aboriginal and Torres Strait Islander communities largely adhered to the Lowitja Framework, particularly in shared responsibility, partnerships and active engagement with Aboriginal and Torres Strait Islander peoples and their communities. Program effectiveness was primarily assessed through reductions in dental decay and participant feedback. Findings may be limited because the Lowitja Framework was developed via evaluation tenders, and the studies included were sourced from research articles. CONCLUSIONS: Strong partnerships between programs, evaluation teams and Aboriginal and Torres Strait Islander communities are critical for cultural safety. Effective study designs should be used, and culturally relevant and holistic outcome measures should be chosen. Lessons learnt from this systematic review can be used to improve the effectiveness of Aboriginal and Torres Strait Islander dental programme evaluations.
Association of Prolonged Breastfeeding With Early Childhood Caries Using Propensity Score Matching in the French Longitudinal Study of Children (ELFE Cohort).
Brown U, Azogui-Levy S, Nabet C … +6 more , Dufourg MN, Charles MA, Kerguen J, Kaminski M, Marchand-Martin L, Germa A
Community Dent Oral Epidemiol · 2025 Dec · PMID 40873003 · Full text
OBJECTIVES: The aim of this study was to investigate the link between prolonged breastfeeding (≥ 12 months) and early childhood caries (ECC) using propensity score matching (PSM) to account for observed confounders, redu...
OBJECTIVES: The aim of this study was to investigate the link between prolonged breastfeeding (≥ 12 months) and early childhood caries (ECC) using propensity score matching (PSM) to account for observed confounders, reduce bias, and provide a more reliable estimate of this relationship. METHODS: This study utilised data from the French Longitudinal Study of Children (ELFE Cohort), comprising 11 718 participants. PSM was employed to pair children who were breastfed for 12 months or longer with those breastfed for less than 12 months or not at all, controlling for shared risk factors such as socioeconomic status and dietary habits. Logistic regression models were conducted to examine the association between ECC, reported by the parents at 3.5 years, and prolonged breastfeeding. RESULTS: Infants (7.6%) who were breastfed for 12 months or more exhibited twice the odds of developing ECC at 3.5 years compared to those breastfed for less than 12 months or not at all (OR = 2.20, 95% CI: 1.39, 3.47). CONCLUSION: Children breastfed for 12 or more months are at increased risk of developing ECC. Further research is needed to investigate specific breastfeeding practices that may contribute to this increased risk, with the aim of promoting prolonged breastfeeding while ensuring optimal oral health.
Mediating Role of Health Insurance on Socioeconomic Inequalities in Dental Utilisation Patterns Among Indonesian Adults.
Khairinisa S, Matsuyama Y, Kiuchi S … +2 more , Maharani DA, Aida J
Community Dent Oral Epidemiol · 2025 Dec · PMID 40851263 · Full text
OBJECTIVES: From the perspective of Universal Health Coverage (UHC) to reduce health inequalities, health insurance plays a crucial role. This study examined the mediating effect of health insurance on the economic and e...
OBJECTIVES: From the perspective of Universal Health Coverage (UHC) to reduce health inequalities, health insurance plays a crucial role. This study examined the mediating effect of health insurance on the economic and educational inequalities in dental utilisation patterns among Indonesian adults. METHODS: This cross-sectional study analysed self-reported data from participants (n = 26 351) of the Indonesian Family Life Survey-5 (IFLS-5) conducted during the transition of Indonesia's health financing system in 2014-2015. Economic and educational inequalities in dental utilisation were measured and examined using the relative concentration index (RCI). A multinomial logistic regression, adjusted for confounders (sex, age, ethnicity, religion, marital status, household size and residency based on province and rural-urban), examined the association of economic status (quintiles of adjusted monthly household expenditure) and educational status (unschooled to higher education) with dental utilisation patterns (never/irregular/regular). The extent to which the association was explained by health insurance ownership (public and private insurance) was assessed using the Karlson-Holm-Breen mediation method. RESULTS: Among participants, 12.9% of individuals utilise dental visits irregularly and 1.4% regularly, with the utilisation concentrated among those with higher economic status (RCI: 0.30, standard error [SE]: 0.01) and educational status (RCI: 0.34, SE: 0.01). Compared to those with the lowest economic quintile, the highest economic quintile showed higher odds of irregular utilisation (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.89-2.48) and regular utilisation (OR: 4.28; 95% CI: 2.50-7.34). People with higher education were more likely to utilise dental care, with higher odds ratios of irregular utilisation (OR: 6.80; 95% CI: 5.04-9.18) and regular utilisation (OR: 7.34; 95% CI: 2.24-24.04) compared to unschooled individuals. Private insurance partly mediated the association with regular dental utilisation: stronger indirect effects were observed at the highest economic level (proportion mediated [PM]: 10.6%) and highest educational level (PM: 9.2%). In contrast, the mediation effects of public insurance were less remarkable. CONCLUSION: Education and economic status play a significant role in determining dental utilisation patterns, with limited mediating effects for public insurance on these associations. To ensure equitable access to quality dental utilisation across socioeconomic groups, it is crucial to strengthen public insurance programmes that effectively address the needs of disadvantaged populations.
Assessing Total Fluoride Intake in Children: Reliability of Commonly Used Methods.
Zohoori FV, Buzalaf MAR, Maguire A … +8 more , Sanderson R, Giacaman RA, Martignon S, Beltran EO, Eskandari F, Kronic J, Gambetta-Tessini K, Levy FM
Community Dent Oral Epidemiol · 2025 Dec · PMID 40842184 · Full text
OBJECTIVES: Fluoride exposure in children is commonly estimated using questionnaires or urinary biomarkers. However, no study has yet compared these methods for classifying participants into five intake categories rangin...
OBJECTIVES: Fluoride exposure in children is commonly estimated using questionnaires or urinary biomarkers. However, no study has yet compared these methods for classifying participants into five intake categories ranging from low to high. This study aimed to estimate the extent of agreement and classification consistency between questionnaire- and urinary-based methods for assessing total daily fluoride intake (TDFI) in children aged 4-7 years. METHODS: A total of 104 healthy children across three countries (UK, Brazil, Chile) receiving one of three fluoridation modalities (non-fluoridated-water, fluoridated-water, or fluoridated-milk) provided a 24-h urine sample and completed validated dietary and oral hygiene questionnaires. TDFI was estimated from dietary sources and toothpaste ingestion, adjusted for body weight. Urinary fluoride concentration was measured and 24 h-UFE determined by multiplying urine volume by fluoride concentration. TDFI was predicted from 24 h-UFE using the WHO's recommended method. Method agreement was assessed using paired t-tests and Bland-Altman analysis to evaluate continuous fluoride intake estimates. Cohen's kappa was used to assess agreement between categorical intake classifications, while descriptive statistics reported the percentage of children in each intake group. RESULTS: The questionnaire method estimated a higher mean TDFI (0.072 mg/kgbw/day) than the urine-based method (0.058 mg/kgbw/day, p = 0.01). Bland-Altman analysis showed good agreement for lower mean TDFI values (< 0.10 mg/kgbw/day) but increasing variability at higher fluoride intake levels. The questionnaire classified a larger proportion of children as high exposure (≥ 0.1 mg/kgbw/day) than the urine method (19.2% vs. 11.5%), with the greatest discrepancy observed in the fluoridated milk group (46.2% vs. 7.7%). Despite these classifications, Cohen's kappa revealed minimal agreement between methods (κ = 0.034, p = 0.508), suggesting that classification concordance was likely due to chance. CONCLUSION: This first study comparing questionnaire and urinary methods for assessing TDFI in children found significant discrepancies and minimal agreement, especially in higher exposure groups, highlighting the risk of misclassification and the need for research into combined assessment approaches.
Oral and Oropharyngeal Cancer Mortality in Brazil: Estimates and Projections up to 2042.
Chisini LA, Salvi LC, Costa FDS … +2 more , de Carvalho RV, Vasconcelos ACU
Community Dent Oral Epidemiol · 2025 Dec · PMID 40830923 · Full text
OBJECTIVES: To assess the effect of age-period-birth cohort on mortality rates related to lip/oral and oropharyngeal cancer (LOOPC) in Brazil from 1980 to 2019 and to estimate the future mortality rate for 2042. MATERIAL...
OBJECTIVES: To assess the effect of age-period-birth cohort on mortality rates related to lip/oral and oropharyngeal cancer (LOOPC) in Brazil from 1980 to 2019 and to estimate the future mortality rate for 2042. MATERIALS AND METHODS: Mortality rate per 100 000 inhabitants, and age-standardised mortality rate (ASR) per 100 000 inhabitants were estimated. The Prais-Winsten regression model was used to estimate the trends and the annual percent change (APC%). The age-period-cohort effects were calculated using the Poisson regression model. Lee-Carter model was employed to perform projections. RESULTS: A total of 134 941 deaths were observed. Prais-Winsten regression model revealed a slight upward trend in lip and oral cancer mortality among men (p = 0.04) and women (p = 0.02), as well as in oropharyngeal cancer among men (p = 0.02). Significant age-period-cohort was observed for LOOPC in both sexes (p < 0.01). The risk ratio declined in recent cohorts for men (Both Cancers) but increased for women (Lip/Oral Cancer). Period analysis showed a risk increase for lip/oral cancer in recent periods in both sexes and a decrease for men and women for oropharyngeal cancer. In 2042, mortality projections decrease in lip/oral cancer for men aged between 40 and 60 years and oropharyngeal cancer in men between 35 and 60 years. For women, no significant changes are projected. The model projections mortality rate reveal varied outcomes across the diverse regions of Brazil. CONCLUSION: A significant age-period cohort was observed over the 40 years assessed. Projections for 2042 indicated a significant decrease in LOOPC mortality rates for men and no change for women.
Exploring Oral Health in Children From Culturally and Linguistically Diverse Backgrounds Using Social Practice Theory Lens: A Scoping Review.
Jamkar R, Ward PR, Calache H … +4 more , Fisher C, Dickson-Swift V, Girard IM, Slack-Smith L
Community Dent Oral Epidemiol · 2025 Dec · PMID 40824210 · Full text
OBJECTIVES: There is evidence that children from culturally and linguistically diverse (CALD) backgrounds in high-income countries experience a higher burden of oral diseases compared to children from non-CALD background...
OBJECTIVES: There is evidence that children from culturally and linguistically diverse (CALD) backgrounds in high-income countries experience a higher burden of oral diseases compared to children from non-CALD backgrounds. Oral disease remains a significant health problem in high-income countries, and the success of current traditional approaches to manage oral diseases has been limited. Thus, it is time to examine other approaches that look beyond the individual and focus on the wide-ranging influences, including context. One such approach is the use of social practice theory (SPT) which examines the 'practice' (an everyday activity), how it happens, and what is required to engage with it. This review aimed to map out oral health-related practices across international literature through the three elements of the SPT framework (materials, meanings and competences) in children from CALD backgrounds in high-income countries. METHODS: This scoping review followed Joanna Briggs Institute's Population, Concept and Context framework. MEDLINE database was initially searched via a librarian guided search strategy to retrieve relevant studies. The words from titles and abstracts from relevant studies and index terms were later used to develop a full search strategy, which was then used to search Scopus, EMBASE, MEDLINE, PsychINFO, CINAHL, Public Health Database and Dentistry and Oral Sciences Source. The reference lists from all retrieved studies were screened for any additional relevant studies. Peer-reviewed qualitative and quantitative, mixed-methods and systematic review studies published in English were included. Screening of eligible studies and data extraction was performed in Covidence. Data extracted from each study was analysed and interpreted using Shove's SPT framework. RESULTS: Thirty-seven studies were included in the review. A number of key oral health-related social practices such as feeding children, sleeping, using a comforter, teeth cleaning and health and care oriented mobility were identified in children from CALD backgrounds along with their three elements: materials, meanings and competences. CONCLUSION: Using a SPT lens allowed a new way of exploring family, cultural and community factors and moving away from the restrictive focus on individual behaviour. Focusing future research on these dynamics of practices can provide insights into the impact of barriers and facilitators on their implementation of interventions and identify opportunities for leveraging positive change.
Barriers to and Facilitators for the Use of Research Evidence in Oral Health Policies and Guidelines: An International Qualitative Study.
Verdugo-Paiva F, Wallach M, Ortuño D … +2 more , Glick M, Carrasco-Labra A
Community Dent Oral Epidemiol · 2026 Feb · PMID 40785053 · Full text
OBJECTIVES: To explore perceived barriers to and facilitators for using research evidence to inform guidelines and policies in oral health (OH) reported by guideline developers and policymakers. METHODS: An abductive rea...
OBJECTIVES: To explore perceived barriers to and facilitators for using research evidence to inform guidelines and policies in oral health (OH) reported by guideline developers and policymakers. METHODS: An abductive reasoning approach utilising in-depth semi-structured interviews was used. Interviewed individuals had a high-level understanding of the processes involved in developing OH evidence-informed guidelines and policy documents, including methodological steps and workflow. Purposive sampling was used to select participants with experience generating national or regional documents from different continents. Interviews were recorded and transcribed verbatim. After validation, data were analysed thematically using NVivo software. Transcriptions were coded and collated into themes and subthemes, with coding saturation achieved after coding all transcripts and confirming that no new codes emerged. RESULTS: Participants worked in seven organisations across Europe, North America, and South America, including professional associations, scientific societies, governmental, and global organisations. Participants' perceptions were classified into seven main themes: research evidence (availability of evidence synthesis, direct and local evidence, certainty of the evidence and emerging research evidence), guidelines and policy documents (accessibility to guidelines, documents terminology, question scope and methodological rigour), organisational and system-level (costs, availability and accessibility to needed expertise, workload, health system characteristics, circumstances and events, and pressures), contact and collaboration (relationship with non-governmental organisations, research centers, governmental institutions and users), guidelines and policies users (evidence-informed decision-making (EIDM) expertise, attitudes toward EIDM, inclusion of patients' perspectives), guideline developers and policymakers (attitudes toward EIDM, autonomy, responsibility and expectations, and self-Interested behaviour), and others (OH in the context of overall health and use of technology). Several reported barriers were specific to the OH field, including dental professionals' resistance to changing practice (acquiring new dental materials), absence of patient advocacy organisations in OH, an overemphasis on personalised treatment planning, overvaluation of surrogated outcomes, challenges with dental device regulations, limitations in incorporating economic evaluation for decision-making at a population level, disconnect between evidence-based care and coverage, low priority given to OH by authorities and the public, and lack of communication between dental and non-dental professionals. CONCLUSIONS: Understanding particular challenges hindering the integration of research evidence into guideline and policy document development processes is critical to improving their quality. Similarly, awareness of facilitators can aid in formulating strategies to enhance this process and counter barriers. TRIAL REGISTRATION: Open Science Framework (DOI: 10.17605/OSF.IO/W4KG7).
Self-Determination in Action: A Scoping Review on Oral Health Training for Indigenous Health Workers Globally.
Cachagee M, Poirier B, Doak F … +4 more , Sethi S, Hedges J, Larkin M, Jamieson L
Community Dent Oral Epidemiol · 2025 Dec · PMID 40785040 · Full text
UNLABELLED: Globally, the systemic marginalisation of Indigenous Peoples has led to significant health disparities rooted in the legacy of colonisation and ongoing settler colonialism. OBJECTIVE: This scoping review aime...
UNLABELLED: Globally, the systemic marginalisation of Indigenous Peoples has led to significant health disparities rooted in the legacy of colonisation and ongoing settler colonialism. OBJECTIVE: This scoping review aimed to collate oral health promotion training programmes tailored for Indigenous Health Workers (IHW), who play a pivotal role in improving health outcomes by bridging mainstream healthcare with Indigenous Communities, globally. METHODS: A systematic, two-step search was conducted across five databases-PubMed, Scopus, Web of Science, EMBASE and ProQuest Central-without geographic restrictions. Two independent reviewers screened studies, and additional sources were identified from reference lists. A supplementary search of grey literature was performed in Google Scholar and relevant websites. RESULTS: Of the 374 eligible articles, 11 programmes fulfilled the inclusion criteria. These programmes covered 10 topic areas, including: oral anatomy, early childhood oral health, and the influence of diet and chronic disease on oral health. Effective programmes were collaboratively developed with Indigenous Communities, aligning closely with Community needs and promoting self-determination. The findings emphasise the importance of involving IHW in oral health initiatives to tackle ongoing oral disease disparities and advance oral health equity for Indigenous populations. CONCLUSION: By prioritising Indigenous leadership and cultural knowledge, these programs exemplify avenues for strengthening equitable, culturally centred healthcare for Indigenous Communities globally. There remains a critical need for sustainable investment in IHW oral health training, enabling Indigenous-led initiatives to meaningfully address oral health disparities.
Remote Caries Assessment With CariesCare International: Accuracy of Smartphone and Professional Camera Images.
Abreu-Placeres N, Yunes Fragoso P, Rodriguez A … +9 more , Martignon S, Ekstrand KR, Beltrán EO, Cortes A, Douglas GVA, Newton JT, Pitts NB, Deery C, Garrido LE
Community Dent Oral Epidemiol · 2025 Dec · PMID 40770821 · Publisher ↗
OBJECTIVE: To evaluate the accuracy of remote caries lesion assessment using the CariesCare International (CCI) system applied to images captured with smartphones and professional cameras. METHODS: A cross-sectional stud...
OBJECTIVE: To evaluate the accuracy of remote caries lesion assessment using the CariesCare International (CCI) system applied to images captured with smartphones and professional cameras. METHODS: A cross-sectional study was conducted with 30 children aged 5-10 years, who underwent clinical dental examinations and intraoral photography using both a digital single-lens reflex (DSLR) camera and a smartphone. Trained examiners, blinded to the imaging devices, assessed the photographs and in-person examinations, with the latter serving as the gold standard. Statistical analyses included weighted kappa ( ) to evaluate inter-examiner reproducibility, along with sensitivity (Se), specificity (Sp), and area under the receiver operating characteristic curve (AUC) to determine detection accuracy. RESULTS: Inter-examiner reproducibility was excellent across all methods ( > 0.94). The professional camera demonstrated superior accuracy (Se = 0.87, Sp = 0.98; AUC = 0.92), with strong performance even for initial lesions (AUC = 0.88). Smartphone images showed good overall accuracy (Se = 0.73, Sp = 0.92, AUC = 0.83), performing particularly well for moderate and extensive lesions (AUC ≥ 0.87) and acceptably for initial lesions (AUC = 0.77). Both imaging methods achieved high specificity, reflecting accurate identification of sound surfaces. CONCLUSIONS: These findings support the use of both professional and smartphone photography as effective tools for remote caries lesion assessment using the CariesCare International (CCI) system. Smartphone-based assessments represent a cost-effective and accessible alternative, especially in settings with limited resources. Integrating standardised systems like CCI into remote diagnostic workflows enhances diagnostic accuracy and can broaden access to dental care, helping reduce global oral health disparities.
Developmental Defects of Enamel and Associated Factors in 2-Year-Old Children: A Birth Cohort Study.
Pinheiro E, Abanto J, Costa ES … +4 more , Antunes JLF, Cardoso MA, Bönecker M, MINA‐Brazil Study Group
Community Dent Oral Epidemiol · 2026 Feb · PMID 40762384 · Publisher ↗
OBJECTIVES: To assess the maternal and child factors associated with developmental defects of the enamel (DDE) in a cohort of 2-year-old children. METHODS: This study analysed data from the MINA-Brazil birth cohort study...
OBJECTIVES: To assess the maternal and child factors associated with developmental defects of the enamel (DDE) in a cohort of 2-year-old children. METHODS: This study analysed data from the MINA-Brazil birth cohort study. A total of 800 mother-child pairs were surveyed. Oral clinical examinations were conducted using the modified DDE Index. Associated factors in the pre-, peri- and post-natal periods were collected by standardised procedures. Crude and adjusted Poisson regression models with robust variance, following a hierarchical framework selection of covariates, were used to determine the relationships between maternal and child factors and DDE. RESULTS: The prevalence of DDE was 29.5% (95% CI 26.3%-32.7%), and children's mean age was 23.8 ± 1.3 months. Maternal age below 21 years at the time of delivery (PR 1.51, 95% CI 1.16-1.98), pregnant women as the head of the family (PR 1.36, 95% CI 1.03-1.80), multiparity (PR 1.41, 95% CI 1.09-1.82), large for gestational age newborns (PR 1.47, 95% CI 1.13-1.91), otitis media in the first few months of life (PR 2.43, 95% CI 1.43-4.13) and stunting at 1 year (PR 2.21, 95% CI 1.38-3.54) were all associated with DDE. CONCLUSIONS: Several maternal sociodemographic and obstetric factors, as well as perinatal morbidity and nutritional factors, may be determinants of DDE in infants. This emphasises the importance of child development and sociodemographic factors for oral health. Future studies should consider both longitudinal and transdisciplinary approaches.
Early Life Violent Victimisation and Dental Care Use From Adolescence Through Adulthood.
Testa A, Mijares L, Jackson DB … +4 more , Semenza D, Stansfield R, Silver I, Mungia R
Community Dent Oral Epidemiol · 2025 Dec · PMID 40760732 · Full text
OBJECTIVES: This study examined the relationship between early-life violent victimisation and dental care utilisation patterns from adolescence to middle adulthood (ages 11-43). METHODS: Data were from Waves I through V...
OBJECTIVES: This study examined the relationship between early-life violent victimisation and dental care utilisation patterns from adolescence to middle adulthood (ages 11-43). METHODS: Data were from Waves I through V of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Group-based trajectory modelling (GBTM) was used to examine patterns of dental care use across five waves, spanning ages 11-43. Multinomial logistic regression was used to assess the relationship between violent victimisation experiences in adolescence and dental care use trajectory group membership, adjusting for demographic, socioeconomic and health-related covariates. RESULTS: Four dental care trajectories were identified: High Dental Care Use (22.8%), Intermittent Decreasing Dental Care Use (38.6%), Intermittent Increasing Dental Care Use (21.8%) and Low Dental Care Use (16.9%). Higher violent victimisation in adolescence was associated with an increased relative risk of belonging to the Intermittent Dental Care Use (RRR = 1.09, 95% CI = 1.02-1.41) and Low Dental Care Use (RRR = 1.21, 95% CI = 1.01-1.46) compared to the High Dental Care Use group. CONCLUSIONS: Early-life violent victimisation serves as a risk factor for less regular dental care use over the life course. Addressing the cumulative effects of violent victimisation through trauma-informed care and targeted interventions may improve dental care access and mitigate disparities over the life course.
A Link Work Intervention to Facilitate Dental Visiting in People With Severe Mental Illness: A Two-Arm, Multi-Site, Assessor Blind, Randomised Feasibility Trial With Dental Record Linkage.
Palmier-Claus J, Morris A, French P … +23 more , Griffiths R, Aggarwal VR, Berry K, Gkioni E, Harris R, Laverty L, Lobban F, Procter S, Kerry E, Newens C, Mupinga P, Golby R, Valemis K, Oakes L, Fazekas F, Perry A, Shiers D, Lodge C, Hilton C, Dawber A, Elliott E, Lunat F, Burnside G
Community Dent Oral Epidemiol · 2025 Oct · PMID 40755121 · Full text
OBJECTIVES: People with severe mental illness experience poor oral health, compared to the general population. They experience inequity in accessing dental services. This randomised controlled trial evaluated the accepta...
OBJECTIVES: People with severe mental illness experience poor oral health, compared to the general population. They experience inequity in accessing dental services. This randomised controlled trial evaluated the acceptability and feasibility of a link work intervention to support people with severe mental illness to access a routine dental appointment. METHODS: This was a feasibility randomised controlled trial across three sites with 1:1 allocation to Treatment as usual (TAU) or TAU plus a link work intervention (ISRCTN13650779). Participants were adults accessing mental health services who had not attended a routine dental appointment in the past 3 years. The intervention comprised up to six sessions with a link worker. Participants completed self-report assessments and an optional dental examination at baseline and after nine months. Dental visiting data were obtained through self-report and the NHS Business Services Authority (BSA). RESULTS: One hundred and sixty-one participants were referred into the trial, resulting in 79 out of the target 84 randomisations (94.0%) over 7 months. There were high levels of engagement with the intervention. Dental visiting data were available for 84.8% of participants (95% CI: 75.3%, 91.1%). Uptake of the optional dental examination within the research assessment battery was low (follow-up: 12.7%; 95% CI: 7.0%, 21.8%). There were no serious adverse events attributable to the intervention or trial procedures. There were substantially higher rates of dental attendance after nine months in the link work intervention arm, compared to TAU, in both the self-report (91.7% vs. 26.7%) and NHS BSA (55.3% vs. 12.1%) data. There was also a signal of improved self-reported oral health-related quality of life favouring the link work intervention arm. CONCLUSIONS: The trial procedures and link work intervention were found to be feasible, acceptable and safe. The intervention showed promise in terms of clinical outcomes. The effectiveness of the intervention requires evaluation in a larger trial. TRIAL REGISTRATION: NCT05545228.
Disparities in Dental Visits Among Participants of the Virginia Living Well Registry.
Williams AR, Wilson-Genderson M, Naavaal S … +2 more , Sheppard V, Thomson MD
Community Dent Oral Epidemiol · 2025 Oct · PMID 40739701 · Publisher ↗
OBJECTIVES: Good oral health is integral to maintaining overall health. Yet little is known about the breadth of factors that affect dental visits. The objective of this study was to test for associations between reporte...
OBJECTIVES: Good oral health is integral to maintaining overall health. Yet little is known about the breadth of factors that affect dental visits. The objective of this study was to test for associations between reported dental visits and factors that may be related to dental visits: predisposing (demographics, educational attainment, marital status, employment and smoking status); enabling (income, insurance status, rurality, primary care and dental healthcare provider shortage areas (D-HPSA)) and need (overall health status and emotional wellbeing). METHODS: Survey data were collected 2018-2020 for the Virginia Living Well (VALW) Registry, a convenience sample (n = 528) of largely rural (79.2%) panel of adult Virginians. Cross-sectional analyses included multilevel logistic regression models with the outcome of dental visits in the past 12 months that controlled for nesting of participants within geography. RESULTS: Overall, 65% reported dental visits in the last 12 months. Models showed smoking (OR 0.51; 95% CI 0.29, 0.87), Medicaid coverage (OR 0.29; 95% CI 0.14-0.58), living in an area with a higher DHPSA score (OR 0.54; 95% CI 0.31-0.2) and lower overall health (OR 0.64; 95% CI 0.50-0.82) were associated with lower odds of having seen a dentist in the past 12 months. CONCLUSIONS: Health factors and healthcare provider shortages appeared to be associated with reported dental visits for Virginian participants of the VALW registry. Participants with Medicaid coverage and those living in a high D-HPSA coverage had lower reports of dental visits. More work is needed to improve equity in access to oral healthcare providers and coverage for dental care to align with recommended care guidelines.
Periodontitis and Social Conditions: The Role of Social Mobility and Employment Status in an Adult Population in Norway - The Tromsø Study.
Holde GE, Steinvik LM, Jönsson B … +3 more , Bondø I, Myking E, Stein L
Community Dent Oral Epidemiol · 2025 Oct · PMID 40734199 · Publisher ↗
OBJECTIVES: Social condition mobility refers to an individual's ability to move up or down the social ladder during their lifetime. The aim of this study was to explore the relationship between social conditions and peri...
OBJECTIVES: Social condition mobility refers to an individual's ability to move up or down the social ladder during their lifetime. The aim of this study was to explore the relationship between social conditions and periodontitis in an adult Norwegian population, specifically the role of social mobility and employment status. METHODS: The study was cross-sectional, based on data collected from a subset (n = 3717) of 21 083 participants in a population health study (The Tromsø Study: Tromsø7) aged 40-99 years. Data were collected through questionnaires and clinical examinations. Periodontitis was assessed by periodontal probing depth and radiographic bone loss, according to the 2017 case definition of periodontitis. Current social conditions were measured by participants' own income, education and employment status. Early life social conditions were measured by perceived financial situation as a child and their parents' education. Social condition mobility for educational and economic status was categorised as stable high, upward mobility, downward mobility and stable low. RESULTS: The prevalence of Stage III-IV periodontitis was lowest among those with persistently high educational and economic status (12% and 16%, respectively) and among leaders/academics (11%), and highest among those with persistently low educational and economic status (25% and 28%, respectively) and unemployed participants (25%). After adjusting for age, sex, smoking and BMI, educational and economic status were no longer significantly associated with periodontitis. Being unemployed increased the odds of having Stage III-IV periodontitis by 2.2 times (p = 0.012), independently of other risk factors for periodontitis. CONCLUSIONS: While stable high educational and economic status appears protective against severe periodontitis, unemployment emerged as a significant independent risk factor. These findings highlight the importance of addressing unemployment and related social determinants in efforts to reduce the burden of periodontitis. Programmes aimed at improving oral health literacy and access to dental care in these populations, along with a common risk factor approach addressing smoking cessation and other lifestyle factors contributing to periodontitis, could help reduce disparities.
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