Community Dental Health

Background: While observational studies have highlighted a potential link between diabetes and oral lichen planus (OLP), the causal relationship remains unclear, and it is uncertain which specific form of diabetes might promote OLP development. This Mendelian randomization (MR) study aims to estimate the causal effects of diabetes-related traits on OLP and identify potential mediating factors. Methods: Utilizing summary statistics from genome-wide association studies predominantly of European ancestry, we conducted univariable and multivariable MR to estimate overall and independent effects of four diabetes-related traits (type 1 diabetes [T1D], type 2 diabetes [T2D], fasting glucose, fasting insulin) on OLP. Two-step MR was employed to identify and assess the mediation proportion of 91 inflammatory factors. Results: Genetic susceptibility to T1D was found to increase the risk of OLP (inverse-variance weighted OR: 1.10, 95% CI: 1.04–1.16, p = 0.002), with consistent findings across all MR methods. The relationship between T1D and OLP remained robust after adjusting for T2D, fasting insulin, and fasting glucose. Furthermore, IL-10 was identified as a partial mediator, accounting for 23.3% of the causal effect of T1D on OLP. No potential pleiotropy for significant estimates was detected (p > 0.05). Univariable MR analyses showed no significant causal relationship between T2D, fasting glucose, fasting insulin, and OLP development. Conclusions: IL-10 may partially mediate the association between T1D and OLP. These findings provide genetic evidence suggesting a potential link between T1D and OLP through pathways beyond glycemic regulation, but should be interpreted with caution given the limitations of the study.

Observational studies have consistently reported associations between oral lichen planus (OLP) and psychological distress, yet whether these relationships are causal remains uncertain. We performed a two-sample Mendelian randomization (MR) analysis to investigate the potential causal effects of depressive traits and anxiety-stress-related disorders (ASRD) on OLP. Genetic instruments for depressive traits (n = 500,199) and ASRD (n = 31,885) were obtained from the largest available genome-wide association study (GWAS) meta-analyses of European ancestry. Summary-level data for OLP were derived from the FinnGen R8 release, including 1,073 cases and 341,426 controls. Causal estimates were primarily calculated using the inverse-variance weighted (IVW) method, complemented by weighted median, MR-Egger, MR-PRESSO, leave-one-out analyses, and PhenoScanner searches to evaluate robustness and horizontal pleiotropy. The IVW results suggested a significant causal effect of ASRD on OLP risk (odds ratio 1.20, 95% CI 1.02–1.42), whereas no evidence supported a causal association between depressive traits and OLP (0.155 ≤ p ≤ 0.694). Reverse MR analyses did not indicate that genetic liability to broad depression, major depressive disorder, or ASRD increased OLP risk (0.052 ≤ p ≤ 0.793). Sensitivity analyses yielded consistent findings, and exclusion of pleiotropic SNPs did not materially alter the results. These findings support a potential causal role of ASRD in OLP pathogenesis and suggest that psychological factors related to stress and anxiety may warrant consideration in the clinical management of OLP.

Aim: To identify report and discuss the tools assessing orthodontic treatment need (OTN), - complexity (OTC), -priority (OTP), and Oral Health-Related Quality of Life (OHRQoL in children and adolescents, defining their strengths and weaknesses and to pinpoint research gaps to inform orthodontic practitioners, policy makers, and future research endeavours. Methods: The databases of PubMed, Cochrane, Embase, and Web of Science were searched from inception to January 2025. Epidemiological studies, controlled trials, and comparative studies involving subjects ≤18 years old, using different tools to assess OTN, OTC, OTP, and OHRQoL were included. Three authors independently assessed study eligibility, extracted and analysed the data. Results: 15,898 articles were initially identified, from which 171 were finally included for analysis. For OTN, the Index of Orthodontic Treatment Need was the most frequently used, followed by the Dental Aesthetics Index. Both score occlusal traits and do not take into account other factors contributing to overall OTN. The Index of Complexity and Orthodontic Need was the third most used. Several OHRQoL questionnaires were retrieved, identifying Child Perception Questionnaire (CPQ) as most frequently used. Conclusions: A range of assessment tools were identified for OTN and OHRQoL. OTN indexes mainly rate dental malocclusion severity and don’t consider patient-specific factors, such as patient perception. A tool assessing OTC that takes into account treatment-specific factors, required skills of the orthodontist, treatment time, and costs is required. Additionally, no tool was found to assess OTN, which is crucial for allocation of public healthcare resources and insurance coverage for orthodontic treatment.

In health promotion, traditional evidence-based approaches have shown limitations in capturing the complexity of real-world interventions and in integrating the experiential knowledge of field actors. The CEKHP (Capitalize, collect, and circulate Experiential Knowledge in Health Promotion) method was developed in France as a response to this gap, offering a structured process for documenting and disseminating experiential knowledge. This method paper aims to describe the CEKHP methodology and demonstrate its added value for research and practice in health promotion, using a hospital-based pediatric oral health education program as a case study. The CEKHP method involves a five-step process (framing, data collection, analysis, validation, dissemination) facilitated by a trained third party in collaboration with project leaders. Data were collected through semi-structured interviews, then analyzed thematically based on a guiding capitalization question. The process produced a structured “capitalization sheet” co-validated by stakeholders. The method captured valuable contextual, procedural, and strategic elements of the program, highlighting barriers (e.g., perception of educational actions as secondary) and facilitators (e.g., institutional support, multidisciplinary collaboration). It enabled a reflexive analysis of the implementation and provided actionable insights for adaptation and transferability to other hospital settings. The CEKHP method bridges a critical gap in health promotion by formalizing the collection of tacit knowledge from practitioners. It contributes to a broader understanding of intervention applicability, supports reflective practice, and enhances the knowledge base beyond conventional evidence. As such, it is a promising tool to complement evidence-based strategies with practice-informed insights.

Background: Poor oral health severely affects quality of life, disproportionately impacting individuals with low socioeconomic status due to limited or partial dental coverage. In Barcelona, many people face barriers to dental care. In 2018, the Barcelona City Council launched a free dental service for economically disadvantaged populations to improve access to essential treatments. Objective: This study evaluates Barcelona’s Social Dentistry Service regarding its scope, patient profiles, satisfaction, and perceived impact from professional and patient perspectives. Methods: We conducted a non-experimental, mixed-methods evaluation involving patients and dental professionals. Data were obtained through interviews with both groups, an online questionnaire for professionals, and analysis of service records from 2018 to 2022. Results: From November 2018 to December 2022, the service provided 39,557 visits to 4499 individuals (4344 adults; 155 children). Professionals strongly endorsed the service, stressing its necessity and positive impact. Patients reported high satisfaction, citing accessibility, effective treatments, and professional quality as strengths, while also expressing concerns about gaps in coverage and future availability. Both groups reported benefits beyond oral health, including improved physical and mental well-being, social relationships, and self-care. Patients highlighted pain relief, increased self-esteem, quality of life, and motivation for social participation. Conclusion: The Social Dentistry Service markedly improves patients’ oral health, psychological well-being, and social integration. Universal dental coverage policies are needed; meanwhile, similar interventions should be sustained and expanded in areas lacking coverage.

Objective: There is evidence to show that young children with educational additional support needs (ASN) have poorer oral health and less access to primary care dental services than their peers however, less is known about the oral health and dental service access of young people with ASN as they embark on secondary education. This study investigates the rates of tooth extraction under general anaesthesia and primary care dental attendance in young people with educational ASN attending secondary school in Scotland. Methods: A multi-cohort study of 214,142 young people followed up from age 12 to 16 years in Scotland using data linkage of three routine databases: Pupil Census; Scottish Morbidity Records; and Management Information and Dental Accounting System. Rates of tooth extraction under general anaesthetic in hospital and access to primary care dental services were compared among young people with ASN to those with no recorded ASN. Results: Tooth extraction under general anaesthesia was higher among young people with autism (Adjusted Risk Ratio (aRR) = 2.48; 95% Confidence Interval (CI) = 1.85 to 3.25) and with intellectual disabilities (aRR = 1.76; 95% CI = 1.43 to 2.16) compared to those with no ASN. Regular attendance at primary dental care was less likely for young people with any ASN, particularly among those with intellectual disabilities and social-related ASN. Conclusions: Young people with ASN experience greater inequalities in oral health and dental care, which would also include preventive interventions, than their peers without ASN. Early intervention through national oral health improvement programmes such as Childsmile may help reduce these inequalities.

This study aims to examine the associations of ethnicity and socioeconomic factors with obvious dental caries and assess longitudinal changes between 5 and 11-years of age. A retrospective longitudinal design was employed, linking individual-level health and education records for children aged 5 and 11-years living in Scotland between 2004 and 2018 (n = 155,737). At age five, Polish and Gypsy/Traveller children had around four times higher odds for developing obvious caries compared to White Scottish peers (OR = 4.37, 95% CI: 3.87–4.94) and (OR = 3.47, 95% CI: 2.52–4.79) respectively. By age 11, African, Chinese, Indian, and White British children showed lower odds of developing obvious caries, while Gypsy/Traveller (OR = 2.70, 95% CI: 1.98–3.70), and Polish (OR = 1.34, 95% CI: 1.18–1.52) children remained at elevated risk compared to White Scottish children. Longitudinal analysis revealed limited overall ethnic differences in new obvious caries development, though African (OR = 0.51, 95% CI: 0.39–0.67) and Chinese (OR = 0.58, 95% CI: 0.38–0.90) children were less likely to develop new obvious caries compared to White Scottish children. Several minority groups, including Polish, Gypsy/Traveller, Pakistani, and Arab children, demonstrated improvements in caries status between ages five and 11 compared to White Scottish children. Obvious caries presence at age five is strongly associated with caries at age 11 (OR = 3.24, 95% CI: 3.16–3.33). Ethnic disparities in obvious dental caries were evident at age 5 and independent of socioeconomic status. By age 11, these inequalities diminished for most groups, with socioeconomic factors emerging as the primary drivers of oral health inequalities, except among Gypsy/Traveller and Polish children.

This cross-sectional study analyzed the relationship between oral health-related factors and sarcopenia in 3729 middle-aged and older adults. Oral health-related factors were assessed using three indicators: toothbrushing habit, chewing ability, and the number of natural teeth. Participants were classified as having an inadequate toothbrushing habit if they brushed their teeth fewer than twice per day; poor chewing ability if they reported that chewing was “uncomfortable” or “very uncomfortable”; and inadequate natural teeth if they had fewer than 20. Sarcopenia was diagnosed on the basis of appendicular skeletal muscle mass index (males <7.0 kg/m² and females <5.7 kg/m²) and handgrip strength (males <28 kg and females <18 kg) according to the Asian Working Group for Sarcopenia. The results showed that participants with inadequate toothbrushing habit, poor chewing ability, and inadequate natural teeth had 1.38-, 1.39-, and 1.36-times higher odds of sarcopenia, respectively. These findings suggest that oral health-related factors are associated with sarcopenia in middle-aged and older adults.

Objective: Evidence linking tooth loss to dementia is limited by cross-sectional designs and short follow-ups. This study examined the association between tooth loss and long-term dementia incidence in a nationwide cohort in the Republic of Korea, from a dental public health perspective. Basic research design: Observational cohort study. Participants: Data from 112,070 adults aged ≥40 years in the National Health Insurance Service–Health Screening Cohort who completed general and oral health examinations in 2005–2006 and were followed for up to 15 years. Main outcome measures: Tooth loss was categorized as 0, 1–7, 8–14, or ≥15 missing teeth. Incident all-cause dementia, Alzheimer’s disease, and vascular dementia were identified using diagnostic codes. Cox models estimated adjusted hazard ratios (aHRs) with sensitivity analyses requiring ≥2 diagnoses and subgroup analyses by sex and age. Results: Over a mean 13.5-year follow-up, 7616 participants (6.8%) developed dementia, with higher cumulative incidence observed across increasing levels of tooth loss. Higher aHRs were observed with increasing levels of tooth loss; participants with ≥15 missing teeth had the highest estimates (1 diagnosis: aHR 3.23, 95% CI 2.85–3.64; ≥2 diagnoses: aHR 2.01, 95% CI 1.77–2.28). Associations were similar for Alzheimer’s disease and weaker for vascular dementia. Conclusion: Tooth loss was associated with higher long-term dementia risk, supporting its role as a potential population-level oral health indicator relevant to dental public health surveillance and prevention strategies.

Smoking cessation has been a public health focus for many years due to the impact of tobacco-use on the health system, society and wider economy. Evidence based information on supporting patients with smoking cessation is already available to dental teams but there appears to be limited information on the effects of tobacco on oral health for smoking cessation teams. Smoking affects the mouth, including increasing the risk of oral cancer, with prevention and early detection of oral diseases, a key priority in supporting health. There are opportunities for smoking cessation advisers to pass on oral health messages to their clients to help them maintain a good level of oral hygiene and encourage them to visit the dentist for regular checks. We developed and delivered a training session for smoking cessation advisors in a Southeast local authority. The session presented the effects of tobacco-use on the mouth, oral health promotion messaging for teams to incorporate into their sessions with clients, the importance of oral hygiene and available resources for soft tissue self-checks. The role of the dental team in oral health care was described and the importance of regular dental visits highlighted. This paper reflects the development, delivery and learning from this training initiative, particularly around future opportunities and challenges. Public Health Competencies being illustrated: oral health promotion, strategic leadership and collaborative working for health and oral health improvement.

Immigrants in high-income countries experience disproportionately high rates of oral diseases compared to the general population. Existing research largely focuses on biomedical models, individual behaviours or cultural factors providing limited insights into how everyday practices shape oral health outcomes. This study explored how oral health social practices were performed, sustained and/or modified within Indian immigrant families with young children in Australia. A qualitative study was conducted using semi-structured interviews with 17 participants (12 mothers, 5 service providers), using focused ethnography and a social practice theory lens (based on Shove et al.), beginning with inductive coding followed by deductive coding to identify practices and their elements. Social practices such as teeth cleaning/brushing, mouth rinsing, flossing, tongue cleaning and mouth wiping, along with feeding/eating and health advice seeking, along with their elements (meanings, materials and competences) were identified as shaped by intergenerational knowledge of hygiene and care, children wanting to fit in, acculturation and protecting cultural identity. By exploring social practices, and their elements this research offers a new way to engage families into focusing on their everyday routines to understand what supports or undermines performances of oral health related practices rather than solely focusing on persuading individuals to follow recommended behaviours.

This systematic review and meta-analysis aimed to synthesise the evidence on the association between sense of coherence (SOC) and the utilisation of dental services among children and adolescents. Children and adolescents aged 0–18 years and/or their parents were included. The outcome was utilisation of dental services (regular attendance and preventive-oriented use), in relation to individual or parental SOC (assessed using the SOC-13 instrument). This systematic review (PROSPERO No CRD42024626799) was conducted in accordance with the PRISMA guidelines. A comprehensive search of electronic databases (PubMed, Web of Science, EMBASE, LILACS, Scopus, and APA PsycINFO), and grey literature was conducted on January 14, 2025, and updated on September 30, 2025. No language restrictions were applied. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Meta-analyses using random-effects were performed. Eleven studies (one cohort study and ten cross-sectional studies) were included. Of these, 10 were eligible for meta-analysis. The pooled results showed a significant association between higher parents’ SOC and more regular use and preventive-oriented utilisation of dental services among children and adolescents. No statistically significant association was observed between adolescents’ SOC and dental service utilisation. Considerable heterogeneity was identified across studies. In conclusion, higher parental SOC was associated with more regular dental attendance and preventive dental care patterns during childhood and adolescence. These results underscore the relevance of psychosocial determinants within the family context and support public health strategies that incorporate family-centred and salutogenic approaches to promote preventive oral health behaviours.

This study aimed to investigate whether the association between alcohol consumption and two oral health outcomes—tooth loss, measured as non-functional dentition (NFD), and poor self-rated oral health (SROH)—varies according to socioeconomic position (SEP). Data were drawn from the 2019 Brazilian National Health Survey. SEP was operationalised using educational attainment, and average alcohol consumption was categorised in 20 g/day increments. Sex-stratified multivariable Poisson regression models were used to assess whether the association between alcohol consumption and oral health outcomes varied in magnitude and direction across SEP levels. The sample comprised 21,330 men and 13,650 women. Among men, those with low educational attainment consuming >0 to ≤20 g/day (PR: 1.80; 95% CI: 1.13, 2.89) and >40 g/day (PR: 1.90; 95% CI: 1.10, 3.26) had a higher prevalence of NFD and poor SROH, respectively, compared with their highly educated counterparts reporting the same levels of consumption. Among women, those with low educational attainment consuming >0 to ≤20 g/day (PR: 1.59; 95% CI: 1.18, 2.13) had a higher prevalence of poor SROH than their highly educated counterparts. In conclusion, the association between alcohol consumption and oral health outcomes differs across SEP, both in magnitude and direction. Even low-to-moderate alcohol intake was associated with a higher prevalence of NFD and poor SROH, with stronger associations observed among individuals with lower educational attainment. These findings should be interpreted in light of the inherent limitations of the cross-sectional design.

Adults with diabetes mellitus are at an increased risk of poor oral health; however, how individual- and community-level factors jointly contribute to oral health disparities in this population remains unknown. This study aimed to examine multilevel determinants of self-rated oral health among adults with diabetes in South Korea. A cross-sectional analysis was conducted using data from 21,996 adults aged ≥19 years with physician-diagnosed diabetes who participated in the 2021 Korea Community Health Survey. Self-rated oral health was dichotomized as good or poor. Individual- and community-level variables representing health behaviors, clinical care, social and economic factors, and physical environment were selected, guided by the County Health Rankings model. Multilevel logistic regression models accounted for clustering within administrative districts. At the individual level, poorer self-rated oral health was significantly associated with sociodemographic disadvantages (older age, male sex, not married, lower education, and economic inactivity), poorer general health status, adverse health behaviors (lifetime smoking and inadequate toothbrushing), and unmet dental care needs (all p < 0.05). At the community level, greater accessibility to public transportation was associated with better self-rated oral health (OR = 0.997, 95% CI: 0.993–1.000), whereas a higher prevalence of moderate-intensity physical activity was associated with poorer oral health (OR = 1.006, 95% CI: 1.000–1.011). Self-rated oral health among adults with diabetes is influenced by individual-level socioeconomic and behavioral factors alongside selected community-level contextual conditions. Multilevel strategies integrating oral health into chronic disease management are required, while addressing structural barriers to dental care.

In recent years, global conflicts have caused a significant rise in displaced individuals, increasing the number of asylum seekers and refugees. Iceland is no exception. Objective: To assess the dental hygiene practices, oral health status, and dental caries experience (dmft/DMFT) among children and adolescents, 0–18 years, seeking international protection in Iceland. The secondary purpose is to identify areas for improvement of preventive measures and dental care services among this demographic. Basic research design and participants: Review of dental examination charts of 189 children, 0–18 years, who attended the Faculty of Odontology, University of Iceland, between January 1, 2023, and April 1, 2024. Results: Half (52.9%) the children had either never attended a previous dental appointment (39.7%) or not in the previous 2 years (13.2%). Dental pain was the main reason for previous visits (29.4%), with 43.1% reporting having experienced dental pain before. Most children (87.3%) brushed their teeth since the eruption of the first tooth, and 82.4% used fluoride toothpaste. Dental caries affected 61.4% of the children, and 20.6% had dental infections at the time of examination. The mean dmft for six-year-olds was 4.33, while for twelve-year-olds, mean DMFT was 2.55. The prevalence of gingivitis was 37.8%, dental erosion 12.3%, dental fluorosis 8.8%, and molar incisor hypomineralisation 12.3%. Conclusions: The dental health of children seeking international protection in Iceland is poor compared to their peers in other Nordic countries and beyond. The findings highlight the need for a comprehensive and integrated approach to dental healthcare for these children.

Aims: Studies have investigated the interrelationship between periodontitis (PD) and rheumatoid arthritis (RA). However, obesity, a risk factor common between both conditions requires further investigation. Therefore, the objective of this study was to pool evidence on whether concurrent RA and PD (RAPD) are associated with high Body Mass Index (BMI) compared to non-RAPD individuals. Methods: Systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with the protocol registered with the International Prospective Register of Systematic Reviews. Embase, Medline, Web of Science and the Cochrane Library were accessed for relevant literature. The Newcastle-Ottawa scale was used to assess risk of bias among each study. Meta-analysis was performed using Revman statistical software. The effect size was measured using mean difference with 95% confidence intervals and a p-value of 0.05. Results: The search identified 770 articles. Following screening of title with abstracts and full text assessment, nine studies, involving 86,137 participants were included. Seven studies reported low to moderate risk of bias. In meta-analysis BMI was higher in people with RAPD than non-RAPD (MD = 0.56; Z = 2.06; p = 0.04). Conclusion: The correlation between high BMI and RAPD underscores a potential interplay between periodontal health and inflammatory diseases like obesity and RA. Thus, observational studies are warranted.

Shift work is common in the manufacturing industry and is associated with an increased risk of chronic disease due to irregular lifestyles. However, the dental health status of shift workers has rarely been assessed or reported. Therefore, this study examined the relationship between shift work and periodontal disease using data from dental and medical examinations conducted among individuals employed in the manufacturing industry. This cross-sectional study analyzed data from workers aged 40–64 years at a Japanese manufacturing facility who underwent dental examinations in 2023 and medical examinations in 2022. The examined variables included periodontal pocket depth (PPD), work schedules, general health status, and oral hygiene behavior. To examine the association between shift work and periodontal disease, we performed logistic regression and propensity score analyses separately for men and women using PPD ≥4 mm as the dependent variable. The study included 1866 daytime workers (1159 men and 707 women) and 468 shift workers (434 men and 34 women). Among men, shift workers had a significantly higher rate of PPD ≥4 mm than daytime workers in both analyses. However, no significant relationship between shift work and PPD ≥4 mm rates was observed among women in either analysis. These findings suggest a significantly higher likelihood of periodontal disease among male shift workers in the Japanese manufacturing industry.