Community Dentistry And Oral Epidemiology[JOURNAL]
Sun
200 papers
Change in Dental Visits Among Eligible Children Under the Impact of the Child Dental Benefits Schedule in Australia.
Nguyen L, Connelly LB, Birch S … +1 more , Nguyen HT
Community Dent Oral Epidemiol · 2025 Aug · PMID 40082383 · Full text
OBJECTIVES: In Australia, although there have been some improvements, child oral health continues to be a major public health issue. The Australian Government introduced the means-tested Child Dental Benefits Schedule (C...
OBJECTIVES: In Australia, although there have been some improvements, child oral health continues to be a major public health issue. The Australian Government introduced the means-tested Child Dental Benefits Schedule (CDBS) in 2014 to support access to dental services for children and adolescents aged 0-17 years from low-income families. There is a lack of evidence documenting whether the CDBS improved the dental attendance rate. This study aimed to evaluate the impact of the CDBS on dental visits among eligible children and adolescents in Australia. METHODS: The study analysed the data set from the birth cohort (B cohort) in the Longitudinal Study of Australian Children (LSAC). This is a nationally representative cohort survey collected biennially since 2004. The information on dental visits in the last 12 months was reported by the parents. A difference-in-differences analysis was used to examine 22,985 observations in the period 2008-2018. A propensity score matching (PSM) method was employed as a robustness check for the main findings. RESULTS: The proportion of children and adolescents eligible for CDBS in the six biennial surveys from 2008 to 2018 was 62.0%, 54.4%, 47%, 41.2%, 35.5%, and 28.9%, while the proportion of eligible individuals visiting dentists was 38.0%, 45.6%, 53.0%, 58.8%, 64.5%, and 71.1%, respectively. The analyses showed that the CDBS policy had a statistically significant and positive impact on dental visits among eligible children and adolescents. There was a 6.1-6.4 percentage point increase (p-value < 0.001) in dental visits across different specifications after the introduction of the CDBS policy. CONCLUSION: The removal of financial barriers was beneficial to improve dental visits; however, the target group still faces the other remaining barriers, especially those related to inequalities in the social determinants of health, impeding the uptake of free dental services.
Impact of the COVID-19 Pandemic on Antibiotic Prescribing by Dental Practitioners Across the United Kingdom's Four Countries: A Pharmacoepidemiological Study of Population-Level Dispensing Data, 2016-2023.
Bowman-Newmark J, Vahdati A, Karki A … +3 more , Young L, Cleary G, Thompson W
Community Dent Oral Epidemiol · 2025 Aug · PMID 40064619 · Full text
OBJECTIVES: To evaluate and compare the rates of antibiotic prescribing by dental practitioners across the constituent countries of the United Kingdom between March 2020 and August 2023 and to estimate the total 'excess'...
OBJECTIVES: To evaluate and compare the rates of antibiotic prescribing by dental practitioners across the constituent countries of the United Kingdom between March 2020 and August 2023 and to estimate the total 'excess' prescribing that occurred during this interval beyond the rates predicted based upon trends between March 2016 and February 2020. METHODS: Retrospective pharmacoepidemiological study of dental practitioners' antibiotic prescribing, by secondary analysis of population-level National Health Service dispensing data from England, Scotland, Wales and Health and Social Care dispensing data from Northern Ireland. RESULTS: Effective August 2023, the antibiotic items dispensed rate for each country remained in excess of that predicted based upon pre-pandemic trends. Between March 2020 and August 2023, those rates were 175.6, 227.2, 195.0 and 321.8 antibiotic items per 1000 population for England, Scotland, Wales and Northern Ireland, respectively. Those represented estimated total 'excesses' of 27.7% (95% confidence limit [CL], 14.8, 43.7), 43.3% (95% CL, 29.9, 60.0), 33.2% (95% CL, 20.4, 49.0) and 42.9% (95% CL, 27.6, 62.3). Pairwise comparisons showed statistically significant differences between England and Scotland, England and Northern Ireland, and Wales and Northern Ireland (p < 0.001), Scotland and Wales (p = 0.001), and Scotland and Northern Ireland (p = 0.009). There was no statistically significant difference between England and Wales. CONCLUSIONS: With shared prescribing guidelines and a single professional regulatory framework, it was unsurprising that similar antibiotic prescribing trends were found across the United Kingdom. Further research is required to investigate the reasons for the differences.
The Exclusivity of 'Vulnerable': Exploring How a Canadian Community Dental Clinic Defines and Describes Its Targeted Population.
Arntson C, Shields R, Yoon MN
Community Dent Oral Epidemiol · 2025 Aug · PMID 40022465 · Full text
OBJECTIVES: Addressing inequitable oral health access is a global priority. In Canada, community dental clinics (CDCs) play a crucial role in this endeavour, yet limited resources necessitate strategically targeting comm...
OBJECTIVES: Addressing inequitable oral health access is a global priority. In Canada, community dental clinics (CDCs) play a crucial role in this endeavour, yet limited resources necessitate strategically targeting communities for interventions. Various methods exist for defining communities and measuring outcomes, but how CDCs determine their target populations is under-researched. This study aimed to explore how decision-makers planning an inner-city CDC define the population they intend to serve. METHODS: Data was collected through key informant interviews, document analysis, and field observations. Purposive sampling was employed to select key informants and documents related to clinic planning and design. The researcher was immersed in the data throughout the study, which underwent inductive content analysis facilitated by NVivo software. RESULTS: Analysis included semi-structured key informant interviews (n = 11), textual data from public sources and key informants (n = 9), and field observations totalling 275 hours over 1 year (2020-2021). Key informants agreed that the clinic served a "vulnerable" population, but definitions of "vulnerable" varied. Initial coding revealed two distinct patient groups with differing portrayals. Based on five patient characteristics Sossauer et al. (2019) described, one group was portrayed positively, while the other was depicted negatively. CONCLUSIONS: This study underscores the necessity of establishing a shared understanding of "vulnerability" in interdisciplinary projects like the CDC examined here. Assumptions about community groups hold significant consequences, shaping resource allocation, programme implementation, and policy decisions. It is imperative to critically assess who is making these decisions, their conception of vulnerability, and the repercussions of these beliefs on affected communities.
Modelling Predictors of Homophily on Perceived Oral Health Status Among Social Network Ties in a Population of Public Housing Residents.
Casey SM, Velez M, McDonough R … +4 more , Bond JC, Garcia R, Gondal N, Heaton B
Community Dent Oral Epidemiol · 2025 Jun · PMID 40007459 · Full text
PURPOSE: Individual behaviours are often shared within social networks (homophily), suggesting network-level interventions hold promise for health promotion. Yet, little is known about oral health homophily. This study a...
PURPOSE: Individual behaviours are often shared within social networks (homophily), suggesting network-level interventions hold promise for health promotion. Yet, little is known about oral health homophily. This study aimed to identify individual- and network-based predictors of oral health homophily among individual's (ego) social networks of public housing residents. METHODS: Respondents self-reported demographics, oral health status and associated risk behaviours (n = 277). They named social contacts (alters), reported on relationship attributes, demographics and behavioural characteristics (n = 889). Hypothesised predictors of oral health homophily included relationship attributes (e.g., contact frequency), respondent-level and shared characteristics. Oral health homophily was modelled using multilevel (hierarchical) logistic regression evaluating model attributes (AIC) to determine gains in explanatory power. RESULTS: Relationship strength, including high frequency of shared meals and contact, was associated with higher odds of oral health homophily (OR [95% CI]: 1.92 [1.05, 3.52] and 1.62 [1.00, 2.63], respectively). The best performing model included daily shared meals and contact, respondent age, smoking and oral health status. CONCLUSIONS: Oral health homophily is predicted by relationship strength and 'excellent/very good/good' oral health. Respondents with poorer oral health and a smoking history were less homophilous in oral health. Multilevel interventions targeting oral health outcomes may benefit from accounting for social relationships.
Global Epidemiology and Socioeconomic Correlates of Salivary Gland Cancer From 2020 to 2040.
Mousavi SE, Ghasemi H, Najafi M … +1 more , Nejadghaderi SA
Community Dent Oral Epidemiol · 2025 Jun · PMID 39979564 · Publisher ↗
OBJECTIVES: To report the epidemiology and socioeconomic correlates of salivary gland cancers (SGCs) at global, regional and national levels by age, sex and country. METHODS: Data on the incidence and mortality of SGC fo...
OBJECTIVES: To report the epidemiology and socioeconomic correlates of salivary gland cancers (SGCs) at global, regional and national levels by age, sex and country. METHODS: Data on the incidence and mortality of SGC for the year 2020 were extracted from the Global Cancer Observatory. The relationships between incidence and mortality rates with the human development index (HDI) and the ratio of current healthcare expenditure to gross domestic product were investigated using bivariate correlation tests. Also, projections for new cancer cases or mortalities in a specific nation or region between 2025 and 2040 were estimated by multiplying age-specific incidence or mortality rates, with the anticipated population for the years 2025-2040. RESULTS: In 2020, the global crude incidence and mortality rates of SGC were 0.69 and 0.29, respectively. Among the World Health Organization regions, the Americas and Africa had the highest SGC age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR), respectively. By HDI classification, the very high HDI group had the highest SGC ASIR at 0.69, whereas the low HDI group had the highest SGC ASMR at 0.49. Among different age groups, those aged 70+ had the highest SGC incidence and mortality crude rates. Globally, males had higher SGC incidence and mortality crude rates than females. A strong negative correlation was found between HDI and SGC ASMR and the mortality-to-incidence ratio (p < 0.001). By 2040, the global incidence and mortality numbers of SGC are projected to increase by 50% and 60%, respectively. CONCLUSIONS: These findings provide crucial insight into the global distribution and disparities in SGC care quality. Furthermore, this report has the potential to aid in the planning of SGC control initiatives.
Why Aren't Antenatal Care Providers Adopting Oral Health Guidelines? A Qualitative Exploration.
Wilson A, Davies C, Bettiol S … +3 more , Bridgman H, Crocombe L, Hoang H
Community Dent Oral Epidemiol · 2025 Jun · PMID 39963895 · Full text
OBJECTIVE: The current Australian Pregnancy Care guidelines recommend that antenatal care providers discuss oral health, provide advice and refer women to dental professionals as needed. However, the delivery of oral hea...
OBJECTIVE: The current Australian Pregnancy Care guidelines recommend that antenatal care providers discuss oral health, provide advice and refer women to dental professionals as needed. However, the delivery of oral health recommendations in antenatal settings appears substandard. This study aimed to identify the barriers and enablers influencing antenatal care providers' adoption of the oral health guidelines. METHODS: A qualitative study was conducted using semi-structured interviews with a purposive sample of antenatal care providers in Tasmania, Australia. Data analysis followed a thematic coding method using the Capability, Opportunity, Motivation - Behaviour (COM-B) model and Theoretical Domains Framework to identify implementation barriers and enablers and to inform recommendations. RESULTS: Twenty-five antenatal care providers participated (midwives n = 14, general practitioners n = 10 and obstetrician-gynaecologist n = 1). Thirty-two explanatory themes were identified and mapped directly to six COM-B constructs and 11 Theoretical Domains Framework domains. Eight main themes were identified as both impeding and enabling when viewed in different contexts: (1) perceived patient knowledge and awareness; (2) professional oral health knowledge, training and skills; (3) awareness of the guidelines on oral health; (4) patient education and professional resources; (5) interprofessional collaboration and support; (6) streamlined referral processes and access to dental services; (7) perceived outcomes of oral health interventions; and (8) perceived professional responsibility related to oral health. CONCLUSIONS: Key strategies include improvements to the promotion and dissemination of relevant guidelines, professional education and training, and development and adoption of oral health-centred models of care to support interprofessional collaboration. Future research should focus on developing brief and sustainable interventions that address antenatal care providers' practice behaviours.
Adverse Childhood Experiences and the Co-occurrence of Poor Oral Health and Multimorbidity: Findings From the Canadian Longitudinal Study on Aging.
Hensel ALJ, Nicholson K, Anderson KK … +1 more , Gomaa NA
Community Dent Oral Epidemiol · 2025 Jun · PMID 39963890 · Full text
OBJECTIVES: To investigate the extent of the association of adverse childhood experiences (ACEs) with co-occurring poor self-reported oral health (SROH) and multimorbidity in middle-aged and older adults, and whether the...
OBJECTIVES: To investigate the extent of the association of adverse childhood experiences (ACEs) with co-occurring poor self-reported oral health (SROH) and multimorbidity in middle-aged and older adults, and whether these associations differ by age and sex. METHODS: This cross-sectional study used data from 27 765 adults aged 45-85 years from the first follow-up wave (2015-2018) of the Canadian Longitudinal Study on Aging (CLSA). Four categories were generated to assess co-occurring SROH and multimorbidity: (i) good SROH, no multimorbidity; (ii) poor SROH, no multimorbidity; (iii) good SROH, multimorbidity and (iv) poor SROH and multimorbidity. Age-and sex-stratified multinomial logistic regressions were used to examine associations of ACEs (e.g. childhood maltreatment, neglect, parental death, serious illness or separation) with co-occurring poor SROH and multimorbidity, adjusted for the confounders race/ethnicity, income, level of education, smoking status and alcohol consumption. RESULTS: Over a third of participants reported having multimorbidity (35.3%), 10.4% reported poor SROH, and almost 30% of participants had experienced at least one ACE. There was a gradient in the association between higher ACEs and each of the health outcome categories, with the greater odds being for the co-occurrence of poor SROH and multimorbidity (OR = 1.37, 95% CI: 1.30, 1.44). The associations between ACEs and adverse health outcomes in later life were significant across age groups and sexes, with middle-aged females demonstrating the strongest associations. CONCLUSIONS: ACEs are linked to an increased non-communicable chronic disease burden and poor oral health among middle-aged and older Canadians, highlighting the importance of prevention in early life and the focus on psychosocial factors over the life course for healthy aging.
Using Propensity Score Subclassification to Estimate the Population-Average Causal Effect of Temporomandibular Dysfunction Experience on Oral Health-Related Quality of Life Among Australian Adults.
Hanna K, Hariyani N, Mejia G … +2 more , Jamieson L, Brennan DS
Community Dent Oral Epidemiol · 2025 Jun · PMID 39959951 · Full text
BACKGROUND: Temporomandibular dysfunction (TMD) experience might impair oral health-related quality of life (OHRQoL). Causal inference using population-based cross-sectional data is challenging given the potential for bi...
BACKGROUND: Temporomandibular dysfunction (TMD) experience might impair oral health-related quality of life (OHRQoL). Causal inference using population-based cross-sectional data is challenging given the potential for bias. Propensity Score Subclassification (PS-Subclassification) provides a tool to mitigate confounding bias. The aim of this study was to estimate the Population-Average Treatment Effect (PATE) of having TMD experience among Australian adults on OHRQoL using PS-Subclassification and statistically estimated Minimally Important Differences (MID-S). METHOD: Australia's National Survey of Adult Oral Health (NSAOH) 2004-06 data were used which included a Computer Assisted Telephone Interview, mailed questionnaire and oral epidemiological examination. Data included demographics, socioeconomics, caries experience (DMFT index), periodontitis, TMD experience using the TMD Diagnostic Criteria Question, the Oral Health Impact Profile (OHIP-14) and perceived stress. Analysis steps included: (1) generating propensity scores (PS) for TMD experience probability using causal model-derived confounders while incorporating survey design elements; (2) PS-Subclassification and weighting; (3) assessing common support and group balance and (4) estimating the PATE for TMD experience on OHIP-14 overall and domains scores using complex samples GLM. RESULTS: Of the 4063 NSAOH participants, 397 with TMD and 3656 without TMD were included in PS-Subclassification (all data were used) and shared common support for their PS and established adequate covariate balance (SMD < 0.2). Experiencing TMD had higher OHIP-14 total scores (B = 3.498, 95% CI: 2.218-4.778) with a small MID-S (Cohen's F = 0.03). TMD experience impaired all OHIP-14 domains (p < 0.05) with physical pain and psychological domains among the highest impaired OHIP-14 domains with a small MID-S. CONCLUSION: TMD experience impaired the overall OHRQoL measured by the OHIP-14 among Australian adults with a small MID-S. Physical pain and psychological domains were among the highest impaired OHRQoL domains with a small MID-S. Clinicians and policymakers might consider these findings to support TMD screening and patient-centred management.
Developing a Prototype Home-Based Toothbrushing Support Tool for Families in Scotland: A Mixed-Methods Study With Modified Delphi Survey and Semi-Structured Interviews.
Fletcher E, Sherriff A, Duijster D … +2 more , de Jong-Lenters M, Ross A
Community Dent Oral Epidemiol · 2025 Jun · PMID 39936245 · Full text
BACKGROUND: Scotland's National Oral Health Programme for Children, Childsmile, provides targeted home toothbrushing support for families of young children (0-3 years) in the home setting. The study describes the adaptat...
BACKGROUND: Scotland's National Oral Health Programme for Children, Childsmile, provides targeted home toothbrushing support for families of young children (0-3 years) in the home setting. The study describes the adaptation of an existing dental practice-based intervention from the Netherlands using pictorial cards (Uitblinkers) for use in the programme. The aims were to modify Uitblinkers for the setting and context in Scotland by: (1) identifying the barriers that parents/carers in need of extra support face in implementing supervised toothbrushing; (2) explore consensus about behaviour change techniques that are appropriate and valid to address these; and (3) making recommendations for the design of a co-produced home-support tool and identifying facilitators for implementation in practice. METHODS: A modified Delphi study was carried out consisting of two survey rounds with a purposively recruited expert panel (n = 21) to develop consensus on home toothbrushing barriers (aim 1), behaviour change techniques (aim 2) and considerations for implementation (aim 3). Proposition statements for the Delphi were derived from literature, discussions with project advisors and from Uitblinkers, an existing behaviour change intervention for parents developed by the Academic Centre for Dentistry Amsterdam (ACTA) and delivered in dental practice. Then 12 in-depth, semi-structured interviews were conducted with Dental Health Support Workers in Scotland (delivering the home support toothbrushing intervention) to gather the views on the proposed toothbrushing barriers, behaviour change techniques and considerations for implementation (aim 1 to 3). Delphi results are presented descriptively in terms of percentage agreement and priority ratings. Interview transcripts were analysed using Template Analysis. RESULTS: From the Delphi study, a final set of 11 overlapping child, parent and environmental/social toothbrushing barriers was agreed upon (aim 1), to be addressed through a tool based on applied Motivational Interviewing, and a combination of Operant Conditioning, Stimulus Control and Goal-Setting techniques (aim 2). Experts supported the tool as realistic for delivery in the home setting, provided staff were trained. A physical 'paper' tool was preferred to a proposed electronic version (aim 3). Themes from interviews were: (1) the barriers present an exhaustive set and are valid from staff experience with families; (2) Motivational interviewing is appropriate and fits with usual practice; (3) the included behaviour change techniques are workable; (4) the tool is generally feasible within the operation of Childsmile home visits; (5) the tool is not less applicable for children with additional support needs. CONCLUSIONS: A card-based conversational intervention to provide targeted home toothbrushing support for families of young children (0-3 years) in the home setting in Scotland, drawing from a template from the Netherlands, has been deemed worthy of further testing based on expert consensus and staff views on barriers faced, appropriate behaviour change techniques to address these and the design of a physical tool.
Sociodemographic Inequalities in Oral Health-Related Quality of Life in Older Adults: 15 Years Follow-Up of the 1932 and 1942 Birth Cohorts in Sweden.
Åstrøm AN, Mastrovito B, Sannevik J … +3 more , Lie SA, Johansson A, Johansson AK
Community Dent Oral Epidemiol · 2025 Apr · PMID 39907310 · Publisher ↗
OBJECTIVES: Focusing on two birth cohorts of older adults, this study aimed to (1) describe the development of oral health-related quality of life (OHRQoL) across time from 2007 to 2022 and (2) assess sociodemographic in...
OBJECTIVES: Focusing on two birth cohorts of older adults, this study aimed to (1) describe the development of oral health-related quality of life (OHRQoL) across time from 2007 to 2022 and (2) assess sociodemographic inequalities in OHRQoL and whether these inequalities remain stable, widen or narrow during the follow-up period. METHODS: In 1992 and 2007 the 1942 and 1932 birth cohorts living in the Swedish counties of Örebro and Östergotland participated with 6346 (response 71.4%) and 3735 individuals (response 71.9%), respectively. Of the 6346 1942 birth cohort participants, 2479 (38.5% of baseline) completed postal follow-ups in 1997, 2002, 2007, 2012, 2017 and 2022. Of the 3735 1932 birth cohort participants, 751 (20% of baseline) participated also in 2012, 2017 and 2022. Oral impacts of daily performance (OIDP) and socio-demographic characteristics were assessed at each survey year. A cohort table depicted the prevalence rates of OIDP (OIDP > 0) across time, disentangling age, period and cohort effects. Logistic mixed models with interaction terms of each socio-demographic covariate and time were used to test differences in socio-demographic inequalities of oral impacts over time. RESULTS: Between 2007 and 2022, OIDP > 0 varied from 22.7% to 28.7% in the 1932 birth cohort (age 75-90) and from 25.3% to 26.6% in the 1942 cohort (age 65-80). Mixed models revealed that cluster specific odds ratios (ORs) for OIDP > 0 varied from 0.2 to 2.5 with respect to avoidance of dental care due to cost and health perceptions in the 1942 cohort. Corresponding OR estimates in the 1932 cohort were 0.2 and 2.1. In both cohorts, inequality estimates according to country of birth and education were smaller in 2022 than in 2007. In the 1932 cohort, inequality according to sex was larger in 2022 than in 2007. CONCLUSION: Higher prevalence of oral impacts with increasing age and overtime were observed for both cohorts. Narrowing and widening of oral health socio-demographic disparities occurred. Further examination of the interaction of socio-demographic factors with age or time may allow for targeted policy strategies aimed to alleviate oral health disparities in older ages.
The Association Between Periodontal Status, Oral Health-Related Quality of Life and Self-Rated Oral Health in Socially Underprivileged Adolescents.
Ripardo ACG, Queiroz AC, Herkrath APCQ … +5 more , Herkrath FJ, Rebelo Vieira JM, Pereira JV, Rebelo MAB, Vettore MV
Community Dent Oral Epidemiol · 2025 Jun · PMID 39895116 · Full text
OBJECTIVES: To assess the associations between periodontal conditions, dental caries, sex, psychosocial factors, socioeconomic status, oral health-related quality of life (OHRQoL), and self-rated oral health among adoles...
OBJECTIVES: To assess the associations between periodontal conditions, dental caries, sex, psychosocial factors, socioeconomic status, oral health-related quality of life (OHRQoL), and self-rated oral health among adolescents living in socially deprived neighbourhoods. METHODS: A school-based survey was conducted in a random sample of 406 12-year-old adolescents in 11 neighbourhoods in the East region of Manaus, Brazil. Gingival status, dental calculus (Community Periodontal Index), and dental caries (DMFT index) were registered through clinical examinations. Adolescents self-completed questionnaires to assess psychosocial factors (self-esteem, sense of coherence, and oral health beliefs), socioeconomic status (family income, parent's schooling, number of goods, and house crowding), oral health-related quality of life (OHRQoL) (CPQ), and self-rated oral health. Direct and indirect relationships between variables were tested using structural equation modelling guided by the Wilson and Cleary model. RESULTS: Greater gingival bleeding was directly associated with worse self-rated oral health. Poor OHRQoL was directly linked to the number of teeth with dental calculus, more teeth with dental caries experience, and worse psychosocial factors. Worse socioeconomic status and dental calculus were associated with gingival bleeding. Dental calculus and socioeconomic status were indirectly associated with self-rated oral health via gingival status. OHRQoL mediated the association of dental caries experience and psychosocial factors with self-rated oral health. CONCLUSIONS: Gingival bleeding and dental calculus may negatively affect self-reported oral health in adolescents. Socioeconomic status and psychosocial factors were also relevant determinants for oral health in this age group.
Supervised Toothbrushing Programmes: Understanding Barriers and Facilitators to Implementation.
Gray-Burrows KA, El-Yousfi S, Hudson K … +6 more , Watt S, Lloyd E, El Shuwihdi H, Broomhead T, Day PF, Marshman Z
Community Dent Oral Epidemiol · 2025 Jun · PMID 39878080 · Full text
OBJECTIVES: Supervised toothbrushing programmes (STPs), whereby children brush their teeth at nursery or school with a fluoride toothpaste under staff supervision, are a clinically and cost-effective intervention to redu...
OBJECTIVES: Supervised toothbrushing programmes (STPs), whereby children brush their teeth at nursery or school with a fluoride toothpaste under staff supervision, are a clinically and cost-effective intervention to reduce dental caries. However, uptake is varied, and the reasons unknown. The aim was to use an implementation science approach to explore the perspectives of key stakeholders on the barriers and facilitators at each level of implementation of STPs. METHODS: This qualitative study involved individual interviews and focus groups with a purposive sample of stakeholders involved at all levels of implementation of STPs: (1) policymakers; (2) providers of STPs; (3) nursery/school staff; (4) parents/carers; and (5) children (aged 2-6 years old) across England. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS: A total of 159 stakeholders were interviewed (40 individual interviews and 17 focus groups) across all levels of implementation. Barriers and facilitators to STP implementation were identified across 35 of the 39 CFIR constructs. Four themes were identified that determined STP implementation: (1) acceptability of STPs; (2) external 'make or break' conditions; (3) the importance of engagement across the system; and (4) desire for centralised support. CONCLUSIONS: This is the first study to qualitatively explore the barriers and facilitators to STP at all levels of implementation underpinned by an implementation science framework. The findings have strong implications for policymakers who wish to implement STPs, highlighting the need for careful consideration of the adaptability of the programmes, the role of formal and informal engagement systems, and the need for centralised support. This work has facilitated the co-design and piloting of a supervised toothbrushing implementation toolkit, which provides a central hub of resources and good practice to optimise implementation of STPs at scale.
A Theoretically Informed Process Evaluation in Parallel to a Feasibility Study of a Complex Oral Health Intervention Using NICE Guidelines in a Care Home Setting.
Brocklehurst P, Langley J, Wassall R … +15 more , Daniyal S, Syed SS, Harvey M, Goulden N, Sherriff A, Heilmann A, Hoare Z, Smith C, Watt R, O'Neill C, Kee F, Cairns P, Lievesley N, McKenna G, Tsakos G
Community Dent Oral Epidemiol · 2025 Apr · PMID 39815448 · Full text
BACKGROUND: A theoretically informed process evaluation was undertaken in parallel to a study examining the feasibility of an oral health intervention based on an existing guideline for care homes. The objectives were to...
BACKGROUND: A theoretically informed process evaluation was undertaken in parallel to a study examining the feasibility of an oral health intervention based on an existing guideline for care homes. The objectives were to explore the factors that influenced the implementation of the intervention in order to understand the potential pathway to impact. The research team initially utilised Pfadenhauer et al.'s framework, which focuses on a number of different implementation factors: intervention characteristics, context, theory, process, strategy, agents, outcomes and setting. METHODS: Nine semi-structured interviews were undertaken with care home managers and staff, predominantly within the intervention arm of the study. Interview schedules were originally based on Pfadenhauer et al.'s framework. These were coded and analysed using thematic analysis. Given the range of themes that emerged, the research team ran a reflexive workshop to determine whether Pfadenhauer et al.'s framework was able to capture and frame the authentic voice of those interviewed. RESULTS: The research team found that a systems lens approach better fitted the data from the interviews, capturing the idiosyncrasy of the different settings and the importance of values and beliefs of the key stakeholders. It was clear that unlike the structure proposed by Pfaednhauer et al., many of the factors were interdependent and hierarchical in nature, that is, paradigm and goals within the care home had a direct impact on the system structure, which fed into how the care home was maintained, which led onto how the different actors (care home managers and staff) behaved. The process also highlighted key factors for intervention delivery: time poverty, competing needs, staff turnover, differences between shift patterns and between permanent and agency staff. Cognitive capacity of the residents and staff attitudes were also key. CONCLUSIONS: Adding a reflexive workshop enabled the research to critically review the Pfadenhauer et al.'s framework and change to a systems lens approach, which better explained the interdependent and hierarchical nature of the findings. It also highlighted a number of key factors that could influence the pathway to impact for the intervention. TRIAL REGISTRATION: ISRCTN10276613.
Your Teeth, You Are in Control: A Process Evaluation of the Implementation of a Cognitive Behavioural Therapy Intervention for Reducing Child Dental Anxiety.
Kettle J, Porritt J, Baker SR … +3 more , Rodd H, Cross E, Marshman Z
Community Dent Oral Epidemiol · 2025 Apr · PMID 39791199 · Full text
AIM: To explore the views of patients, caregivers, and dental professionals on the factors that influence implementation, processes, and effectiveness of a guided self-help cognitive behavioural therapy (CBT) interventio...
AIM: To explore the views of patients, caregivers, and dental professionals on the factors that influence implementation, processes, and effectiveness of a guided self-help cognitive behavioural therapy (CBT) intervention, 'Your teeth, you are in control' (YTYAIC), in the CALM trial. METHODS: Semi-structured interviews were conducted as part of this qualitative component of the process evaluation, and data were analysed using a framework approach based on the Consolidated Framework for Implementation Research (CFIR) and the Five Areas Model of CBT. RESULTS: Thirty-seven participants were recruited. Potential mechanisms of action were identified using the Five Areas Model of CBT. Participants felt the intervention may exert change through targeting unhelpful thoughts and feelings (e.g., building trust and perceptions of control) and behaviours (e.g., encouraging effective communication and coping strategies) and facilitating a more positive situational context (e.g., developing more supportive relationships). Enablers (e.g., adaptability, design and delivery) and barriers (e.g., time/resource constraints, cost) to implementation were identified using the CFIR. CONCLUSIONS: This study revealed multiple potential mechanisms of action which could reduce dental anxiety and examined how implementation and contextual factors may influence this change process. The results of the research revealed that the intervention could be implemented in primary dental care and identified the potential barriers which should be addressed to aid successful implementation of the intervention in real world contexts. TRIAL REGISTRATION: This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).
Lifetime Use of Dental Services and Dental Caries in Adolescents in 2004 Pelotas Birth Cohort.
Fôlha CN, Cascaes AM, Correa MB … +5 more , Cademartori MG, Matijasevich A, Santos IS, Barros AJD, Camargo MBJ
Community Dent Oral Epidemiol · 2025 Apr · PMID 39739758 · Publisher ↗
OBJECTIVE: To examine the association between the lifetime utilisation of dental services and dental caries experience in mixed dentition among adolescents participating in the 2004 Pelotas Birth Cohort, Southern Brazil....
OBJECTIVE: To examine the association between the lifetime utilisation of dental services and dental caries experience in mixed dentition among adolescents participating in the 2004 Pelotas Birth Cohort, Southern Brazil. METHODS: This longitudinal study analysed a sample of 996 adolescents aged 12-13 years. Dental caries experience and untreated dental caries were the outcomes, assessed by the mean of decayed, missed and filled in deciduous (dmfs index) and in permanent (DMFS index) teeth, based on World Health Organization criteria. The main exposure was lifetime use of dental services, defined as: always have gone to the dentist for preventive reason; have gone to the dentist at times for preventive reason, at times for problem-oriented reason; always have gone to the dentist for problem-oriented reason (reference category). Family income mobility during the first 4 years of the child's life, maternal schooling, adolescent sex and skin colour were the confounders. Crude and adjusted analyses were conducted using negative binomial regression, estimating mean ratios (MR), and 95% confidence intervals (95% CI). RESULTS: In the adjusted analysis, adolescents who consistently utilised dental services for preventive reasons exhibited a mean 49% lower dental caries indexes (MR = 0.51; 95% CI 0.35-0.76) and 56% lower mean of untreated dental caries (MR = 0.44; 95% CI 0.26-0.74) compared to their counterparts who consistently sought dental care for problem-oriented reasons. The utilisation of dental services occasionally for preventive reasons and occasionally for problem-oriented reasons was also associated with lower caries indexes. CONCLUSION: The lifetime utilisation of dental services, whether always or occasionally for preventive reasons, was found to be a protective factor for dental caries in adolescence. These findings reinforce the importance of raising awareness among the public regarding the preventive use of dental services. Additionally, there is a need to organise dental services to facilitate the provision of preventive dental care since early childhood.
School-Based Fluoride Mouth-Rinse Programs and Dental Caries Treatment Expenditure: An Ecological Study of the NDB Open Data Japan.
Tadokoro D, Honda K, Kusama T … +3 more , Takeuchi K, Osaka K, Aida J
Community Dent Oral Epidemiol · 2025 Apr · PMID 39722120 · Publisher ↗
OBJECTIVES: The prevalence of dental caries is high in Japan, leading to a huge burden of overall expenditure on dental caries treatment for the population. School-based fluoride mouth-rinse (S-FMR) has been implemented...
OBJECTIVES: The prevalence of dental caries is high in Japan, leading to a huge burden of overall expenditure on dental caries treatment for the population. School-based fluoride mouth-rinse (S-FMR) has been implemented as a public health intervention. However, its cost-effectiveness remains unclear, where universal health insurance covers a broad range of dental treatments at relatively low cost. The aim of the study was to determine whether S-FMR is associated with lower dental caries treatment expenditure in Japan, where the universal health insurance system widely covers dental treatments. In addition, the cost-benefit of S-FMR was estimated. METHODS: This ecological study examined the association between S-FMR coverage and dental caries treatment expenditure in all 47 prefectures of Japan. Data were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data (NDB Open Data Japan), national survey data on the prevalence of S-FMR, and other census data for each prefecture. The outcome variable was the average annual treatment expenditure of for children aged 5-14 per child. The explanatory variable was the S-FMR coverage of children per prefecture, divided into quartiles: (Q1) 0.0%-0.48%, (Q2) 0.54%-6.9%, (Q3) 7.2%-25.0% and (Q4) 26.9%-80.4%. Linear regression analysis was performed with adjustment for the number of dental clinics per 100 000 individuals, per capita prefectural income, and percentage of the population aged between 5 and 14 years. RESULTS: The dental caries treatment expenditure was lower in prefectures with higher S-FMR coverage: (Q1) 2378 JPY, (Q2) 2215 JPY, (Q3) 2217 JPY and (Q4) 2065 JPY. Linear regression analysis showed that, compared to the prefectures with the lowest S-FMR coverage, the prefectures with the highest coverage exhibited significantly lower per person dental caries treatment expenditure by 186.0 (95% CI = 96.6, 275.4) JPY. When annual cost of S-FMR per person was lower, 200 JPY, S-FMR would save 0.9 billion JPY if all prefectures change from Q1 to Q4 (approximately 8.2 million USD). CONCLUSIONS: Although public healthcare insurance in Japan covers most dental treatments at a relatively low cost, the current findings suggest that S-FMR could still be a cost-effective public health intervention.
Restricting Periodontal Treatment Frequency: Impact on Tooth Loss in Danish Adults.
Raittio E, Lopez R, Baelum V
Community Dent Oral Epidemiol · 2025 Apr · PMID 39715711 · Full text
OBJECTIVE: The study aimed to estimate the effect of a periodontal treatment policy that would restrict the receipt of periodontal therapy to no more than once every second year, on the 10-year risk of tooth extraction a...
OBJECTIVE: The study aimed to estimate the effect of a periodontal treatment policy that would restrict the receipt of periodontal therapy to no more than once every second year, on the 10-year risk of tooth extraction among Danish adults. METHODS: Data from linked nationwide Danish registers consisted of a random sample of 20 000 50-year-olds who were followed from the beginning of 1990 to the end of 2021. The longitudinal modified treatment policies' causal inference framework was used. In each of two slightly different counterfactual scenarios, the receipt of supragingival or subgingival periodontal therapy was restricted to no more than once every second year. The cumulative incidence of tooth extraction from 2012 to 2021 was compared between the counterfactual scenarios and the observed periodontal visiting pattern, while informative censoring, and time-varying and time-invariant confounding were accounted for using the social, economic and dental service utilisation history. RESULTS: During the 10-year follow-up period, 5021 (25.1%) individuals received at least one tooth extraction. In the two counterfactual scenarios, the number of years receiving supragingival or subgingival periodontal therapy was 30%-50% lower than in the observed data. The 10-year cumulative incidence of tooth loss was practically the same in the two counterfactual scenarios as under the observed periodontal visiting patterns. CONCLUSION: The findings indicate that a considerable decrease in the number and frequency of periodontal care visits would not have significant impact on the incidence of tooth loss in Denmark.
Psychosocial Determinants of Poor Dental Attendance Among Young Mexican-Identifying Adults in California.
Devi A, Martinez LS, Kritz-Silverstein D … +4 more , Calzo JP, Strong DR, Hoeft KS, Finlayson TL
Community Dent Oral Epidemiol · 2025 Apr · PMID 39676271 · Full text
OBJECTIVE: Engagement in preventive dental care is a complex health behaviour and is determined by multiple factors. The study aimed to understand the association of psychosocial determinants with poor dental attendance....
OBJECTIVE: Engagement in preventive dental care is a complex health behaviour and is determined by multiple factors. The study aimed to understand the association of psychosocial determinants with poor dental attendance. METHODS: Survey data from 333 Mexican-identifying adults in California aged 21-40-year were analysed. Poor dental attendance was a composite of time since last dental visit and reason for visit. Responses of 'more than 1 year ago' for last dental visit, or 'something was wrong, bothering or hurting/emergency dental problem' as the reason for last dental visit were categorised as poor dental attendance. Psychosocial determinants including dental anxiety assessed using the Modified Dental Anxiety Scale, participant reported quality of provider interactions, and perceived social support were assessed. Logistic regression analyses examined associations after accounting for covariates. RESULTS: Over half (58%) had poor dental attendance. Among those with poor dental attendance, 22% had high dental anxiety, 41% perceived low quality of dental explanation, and 48% reported provider occasionally/never checked patient understanding. Participants with high anxiety had twice the odds of poor dental attendance (OR = 2.07, 95% CI = 1.01-4.22) than those with low dental anxiety. Additionally, those reporting that providers did not explain oral health status or treatments well had two times higher odds of poor dental attendance than those reporting adequate explanation (OR = 2.06, 95% CI = 1.11-3.83). Checking patient understanding or perceived social support was not significantly associated with dental attendance. CONCLUSION: Dental anxiety and poor provider interactions affect use of dental services. Interventions targeting dental staff should prioritise enhancing communication skills and checking patient understanding to improve their dental attendance.
Process Evaluation of a Secondary School-Based Digital Behaviour Change Intervention to Improve Toothbrushing: The BRIGHT Randomised Controlled Trial.
El-Yousfi S, Innes N, Kellar I … +9 more , Fairhurst C, Ainsworth H, Chestnutt I, Day P, Dey D, Pavitt S, Robertson M, Whiteside K, Marshman Z
Community Dent Oral Epidemiol · 2025 Apr · PMID 39586828 · Full text
OBJECTIVES: The aim was to conduct a process evaluation of a multicomponent behaviour change intervention to reduce dental caries in secondary school children in the UK. The intervention was evaluated in the BRIGHT rando...
OBJECTIVES: The aim was to conduct a process evaluation of a multicomponent behaviour change intervention to reduce dental caries in secondary school children in the UK. The intervention was evaluated in the BRIGHT randomised controlled trial which investigated clinical and cost-effectiveness. The trial involved 4680 participants from 42 schools with a follow-up period of 2.5 years. Schools with an above-average proportion of free school meal (FSM) eligibility, an indicator of low household income, were recruited. The intervention, an oral health classroom-based session (CBS) delivered by school staff and twice-daily text messages aimed to improve toothbrushing frequency with fluoride toothpaste. METHODS: Key components of process evaluations were examined: Implementation (fidelity, dose delivered, adaptations and reach), mechanisms of impact (acceptability and dose received) and influential contextual factors. Data collection ran alongside that of the outcome evaluation. Mixed-methods data collection comprised pupil self-reported questionnaires, staff feedback questionnaires, CBS and text message delivery logs and semi-structured interviews/focus groups with school staff and pupils. Quantitative data were summarised descriptively, while framework analysis was applied to the qualitative data. RESULTS: The intervention was generally implemented as intended, albeit with some schools not confirming CBS delivery and a technical problem resulting in text messages being stopped prematurely. Some adaptations to the CBS were made by school staff. In terms of reach, 21.9% (n = 1025) of participants were FSM-eligible. At baseline, 77.6% (n = 3631) of randomised participants reported brushing at least twice daily with no difference over time in the social cognitive determinants of toothbrushing behaviour. The intervention was generally found to be acceptable with varying levels of participant responsiveness reported. The actual dose received was unclear; some schools did not provide a CBS attendance register, and some participants reported blocking or muting the text messages. CONCLUSIONS: This evaluation raises the question of whether the intervention dose and quality of delivery were sufficient to support the required behaviour change mechanisms. Moreover, a high proportion of participants brushed twice daily at baseline; this also calls into question the intervention's ability to bring about significant change. The trial findings did not favour the implementation of the two-component intervention (CBS and text messages) within a school setting. However, with oral health as part of the general health school curriculum, the BRIGHT CBS could be adopted within the UK curriculum as it was co-developed with young people and was found acceptable to pupils and teachers. TRIAL REGISTRATION: ISRCTN number: 12139369.
Long-Term Oral Health Effects of Traumatic Events Among World Trade Center Health Registry Enrolees, 2003-2020.
Akinkugbe AA, Midya V, Crane MA … +3 more , Garcia DT, Clark US, Wright RJ
Community Dent Oral Epidemiol · 2025 Apr · PMID 39582260 · Full text
OBJECTIVES: Posttraumatic stress disorder (PTSD) is a disabling mental health condition arising from experiencing serious traumatic events. This study investigated if PTSD secondary to the World Trade Center terrorist at...
OBJECTIVES: Posttraumatic stress disorder (PTSD) is a disabling mental health condition arising from experiencing serious traumatic events. This study investigated if PTSD secondary to the World Trade Center terrorist attack on 11 September 2001 (9/11) is associated with self-reported doctor's diagnosis of periodontitis and count of missing teeth. METHODS: Data from the World Trade Center Health Registry, 2003-2020 (n = 20 826) were used to prospectively examine the rate of periodontitis and cross-sectionally the odds of missing teeth among enrolees with/without PTSD post-9/11 using a modified Poisson regression and generalised logit model, respectively, adjusted for covariates. RESULTS: Approximately 17% reported a doctor's diagnosis of PTSD post-9/11 and 7.4% a doctor's diagnosis of periodontitis. There were 355 new cases of periodontitis (incidence rate = 7.6 per 1000 person-years) among those with PTSD and a rate of 4.3 per 1000 person-years among those without PTSD. The covariate-adjusted rate ratio for periodontitis comparing those with and without PTSD = 1.52 (95% CI: 1.33, 1.74). The adjusted odds ratio (OR) (95% CI) comparing those with and without PTSD were, respectively, OR = 1.15 (95% CI: 1.05, 1.25) and OR = 1.41 (95% CI: 1.09, 1.83) for missing 1-5 teeth and all teeth missing, respectively, as compared to no missing teeth. CONCLUSIONS: PTSD post-9/11 appears to be associated with poorer oral health outcomes, underscoring the far-reaching consequences of traumatic events on oral health.
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