Community Dental Health

Objective: To explore attitudes, behaviours, and perceptions of e-cigarettes among students at the University of Dundee, Scotland, UK. Basic research design: A mixed-methods study approach combining an online questionnaire and focus groups. Clinical setting: University of Dundee campus environment. Participants: University of Dundee students aged 18 and older. Seventy-five participants completed the questionnaire, with five participants in-person focus groups. Interventions: No interventions applied; observational study only. Main outcome measures: E-cigarette awareness, usage patterns, visibility, perceptions of safety compared to traditional cigarettes, influence of flavours and packaging, attitudes towards public space usage, and environmental concerns. Results: Among participants, 99% were aware of e-cigarettes, with 37% reporting use. Demographics showed 40% aged 21–25, with 73% women and 24% men. Among focus group participants, 20% were current e-cigarette users, 20% had tried e-cigarettes, and 60% were non-smokers. E-cigarettes were highly visible to 75% of respondents, and 94% believed flavours and packaging influenced appeal. Most participants (76%) perceived e-cigarettes as safer than traditional cigarettes. Qualitative themes revealed addiction concerns, social influences, and uncertainty about long-term health effects. Conclusions: This study revealed complex attitudes towards e-cigarettes among university students, highlighting both their perceived benefits as smoking cessation aids and concerns about non-smoker appeal. Findings emphasise the need for comprehensive education, targeted policies, and research into long-term health and environmental impacts. Future studies should examine longitudinal effects, education intervention effectiveness, and environmental consequences of e-cigarette use.

Objectives: This systematic review aimed to investigate the association between depression and oral health outcomes, including periodontitis, gingivitis, dental caries, partial tooth loss, and edentulism (complete tooth loss). Methods: A comprehensive search was conducted across seven major databases and two gray literature sources, including only studies with probabilistic samples, clinical assessment of oral outcomes, validated measuring of depression, and analyses statistically controlled for confounders. Two reviewers independently performed study selection, data extraction, risk of bias assessment (Newcastle-Ottawa scale), and evaluation of evidence certainty. Results: From 5865 unique records identified, 53 studies were included (44 cross-sectional and 9 cohort studies), with low risk of bias in 45 studies. Depression was significantly associated with the outcomes of periodontitis (OR = 1.30, 95%CI 1.07–1.57, I² = 56%), dental caries (PR = 1.32, 95%CI 1.12–1.52, I² = 0%), and edentulism (OR = 1.26, 95%CI 1.16–1.37, I² = 35%). Individuals with edentulism were more likely to have the outcome of depression compared to controls (OR = 1.37, 95%CI 1.15–1.64, I² = 69%). Meta-analyses demonstrated very low to low certainty of evidence. Conclusions: This systematic review and meta-analysis found significant associations between depression and oral health outcomes, such as periodontitis, dental caries and edentulism. These findings reinforce the interconnection between oral health and psychological factors.

Background: People experiencing homelessness (PEH) have significantly poorer oral health compared to the general population, with barriers to dental care exacerbating health inequalities. Community-based dental interventions delivered by dental students offers a potential solution for improving oral health among PEH. Objectives: This scoping review aims to map existing literature on community-based dental interventions provided by dental students to PEH and to explore the reported outcomes of these from the perspectives of PEH. Methods: A scoping review was conducted using the PRISMA-ScR checklist. The comprehensive search was conducted across multiple databases and reference lists were hand searched. The Population, Concept, Context (PCC) framework using Joanna Briggs Institute (JBI) methodology was followed to guide the search strategy and eligibility criteria. Studies were screened against the eligibility criteria by two reviewers. Results: Six studies met the inclusion criteria, originating from the UK, Australia, the USA, and Canada. Interventions included oral health education and clinical treatments. Thematic analysis identified two overarching themes: ‘experience of the intervention’ and ‘impact of the intervention.’ High levels of satisfaction were reported, with participants noting improved oral health knowledge and intentions to improve oral health behaviours. Conclusions: Community-based dental interventions were well-received by PEH and led to improved oral health knowledge, oral health behaviour change and psychosocial wellbeing. The interventions fostered dignity and trust through respectful care, while also enriching dental education by promoting empathy and social accountability. Despite promising short-term outcomes, further inclusive and longitudinal research is needed to assess long-term impact and global relevance.

Objective:This study aims to investigate the causal inference underlying this association through the application of Mendelian randomization (MR) analysis. Basic research design: A Two-Sample Mendelian Randomization Study. Clinical setting: NA. Participants: This study uses summary data from genome-wide association studies (GWAS) of seven antibodies targeting Helicobacter pylori (H. pylori) and periodontal diseases, employing a two-sample MR design. It analyzed 97,830 cases and 272,252 controls for gingivitis, 4784 cases for chronic periodontitis, and 367 cases for acute periodontitis. Interventions: NA. Main outcome measures: This study aimed to overcome the limitations of observational studies and provide insights into whether H. pylori plays a causal role in the development of periodontal disease (PD). Results:The genetic prediction results indicate a statistically significant association between H. pylori UREA antibody levels and the risk of acute periodontitis (OR = 0.7, 95% CI: 0.50–0.98, p = 0.035). In the Weighted Median method, comparable results were obtained (OR = 0.61, 95% CI: 0.39 - 0.95, p = 0.028). However, we did not identify a causal association between genetically predicted levels of other H. pylori antibodies and periodontal disease. For sensitivity analysis, heterogeneity was detected in studies of CagA antibody and acute periodontitis through Cochran’s Q tests, and one outlier was identified using MR-PRESSO. Upon exclusion of outliers, the results remained robust and were not influenced by other factors. Conclusions:The study results revealed a causal relationship between H. pylori UREA antibody levels and acute periodontitis, indicating that H. pylori UREA antibody levels are a protective factor against acute periodontitis.

Objective: Nonadherence to recommended twice daily toothbrushing with a fluoride toothpaste increases the risk of dental caries and periodontal diseases in children. This study aimed at assessing the prevalence and demographic and behavioural correlates of toothbrushing practices among Albanian children. Design and Setting: Cross-sectional study in Albania in 2022. Participants: A nationwide representative sample of 5454 schoolchildren aged 11, 13 and 15 years. Measures: Information on toothbrushing habits, other behavioural factors, and sociodemographic characteristics. Statistical Analysis: Binary logistic regression to assess the association of toothbrushing with demographic characteristics and behavioural factors. Results: Half (56%) of schoolchildren reported brushing their teeth more than once per day (46% in boys vs 66% in girls). Inadequate toothbrushing (≤once/day) was associated with male gender (OR = 2.7, 95% CI = 2.3, 3.0), age 13 (OR = 1.3, 95% CI = 1.1, 1.5), lower family affluence (OR = 1.5, 95% CI = 1.4, 1.8), smoking (OR = 1.4, 95% CI = 1.1, 1.7), inadequate physical exercise (OR = 1.5, 95% CI = 1.3, 1.7), non-daily breakfast consumption (OR = 1.2, 95% CI = 1.1, 1.4), and non-daily fruit consumption (OR = 1.8, 95% CI = 1.6, 2.1). Conclusions: Adequate toothbrushing (at least twice/day) among Albanian children is low compared with most European countries, which should be a cause of serious concern for policymakers and decisionmakers in this post-communist country. There is an urgent need to implement oral health promotion programs in Albania targeting especially boys and children from low socioeconomic families.

Objectives: Family context is recognised as a critical determinant of children’s health, with family functioning identified as a significant influence on children’s oral health outcomes. However, its association with oral health literacy (OHL) remains unclear. This study aims to examine the relationship between family functioning and OHL in 12-year-old Malaysian schoolchildren. Methods: A cross-sectional study was conducted among 375 12-year-old schoolchildren from public primary schools in Malaysia, selected through multistage random sampling. Two validated instruments were administered in a classroom setting: the Malaysian version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) and the Malay version of the FACES-IV package to evaluate family functioning. Results: Only 28% of schoolchildren demonstrated adequate OHL. Higher mean scores were observed for balanced cohesion (25.9, SD = 4.01) and balanced flexibility (26.09, SD = 4.46) compared to unbalanced family functioning scales. Weak but positive correlations were found between OHL and balanced cohesion (r = 0.242), balanced flexibility (r = 0.324), and family satisfaction (r = 0.292). Rigidity, an unbalanced scale, also showed a positive correlation (r = 0.231). Predictors of high OHL included rigid family functioning, lower family communication, greater family satisfaction, and being female. Conclusion: Participants demonstrated low OHL levels, with some associations observed between OHL and family functioning. This study highlights the value of family-centred approaches, underscoring the need for policies and interventions that promote positive family dynamics to support OHL in children.

Objectives: This study examines variations in access to dental care and oral health outcomes by residence for children and adolescents in the United States (US). Methods: This cross-sectional study of 50,277 children and adolescents derived child residence, child and caregiver demographic characteristics, as well as access to dental care and oral health from the 2021–2022 National Survey of Children’s Health. Access measures include dental care receipt, preventive dental visit, forgone dental care, and fluoride treatment; oral health outcomes include teeth condition, oral health problems, and tooth decay status. All descriptive, bivariate and multivariate analyses consider sampling weights for population-based estimates. Results: Rural versus urban children had lower rates of reporting excellent/very good teeth condition (71.1% vs 74.4%, p = 0.0015), higher rates of one or more oral health problems (18.7% vs 15.6%, p = 0.0009) and tooth decay (16.6% vs 13.5%, p = 0.0008), and lower rates of receiving fluoride treatment (18.3% vs 15.5%, p = 0.0043). Regarding access to dental care, in the unadjusted analysis, rural children were less likely to receive preventive dental care (81.7% vs 84.5%, p = 0.0012) and more likely to forgo needed dental care than urban children (2.6% vs 1.6%, p = 0.0082). After adjusting for other child and caregiver characteristics, there was no significant difference between residence and preventive dental care. Conclusions: This study provides updated and timely information for policymakers and community partners and shows that rural US children were both more likely to experience oral health problems and less likely to receive needed dental care.

Objective: This study assessed dental professionals’ perceptions of the benefits, barriers, and educational strategies for digital dentistry in Southeast Asia, focusing on low- and middle-income nations. Methods: A questionnaire assessing perceptions of digital dentistry was developed and distributed via a multi-country survey of dental professionals in Southeast Asian countries. The questionnaire explored the perceived benefits of digital technologies, barriers to adopting digital workflows, and preferred methods for digital dentistry education. The survey included five-point Likert scale items and multiple-choice questions. Responses were collected anonymously online and stratified by country and participant characteristics. Statistical analyses included the Kruskal–Wallis test, Mann–Whitney U tests (with Bonferroni correction), and regression analyses (α = 0.05). Results: Overall, 113 dentists from six Southeast Asian countries participated. Participants rated accuracy, productivity, and communication as key benefits. Most benefit ratings showed no significant cross-country differences except for profitability (p = .007). Clinical experience was positively associated with perceived communication benefits (p = .040). Cost was identified as the primary barrier to digital system adoption. Preferred educational methods included workshops, physical centers, and mentorships. A marginal association was observed between the country and likelihood of receiving on-site training (p = .065). Conclusion: Although expectations for the clinical value of digital dentistry were high across Southeast Asia, economic and infrastructural challenges remain significant barriers to adoption. Tailored education strategies should be developed considering each country’s context and practitioner needs.

Objective: To explore the impact of area-level deprivation on 5-year-olds’ (school year 1) oral health-related quality of life (OHRQoL) in Wales. Basic research design: During the 2022/23 academic year, a sample of 5-year-old children in state-maintained schools in Wales were selected to undergo a clinical examination. A random stratified sample of 15,625 children were invited to participate. The British Association for the Study of Community Dentistry diagnostic criteria was used to calculate d3mft (decayed, missing, and filled teeth) and PUFA (pulpal involvement, ulceration, fistula, and abscess) scores for each child. Main outcome measures: Before the examination, parents/guardians completed the Early Childhood Oral Health Impact Scale (ECOHIS), a validated measure of OHRQoL. Results and Conclusion: Data were gathered from 8,463 children from 612 schools, with a mean age of 5.95 years. 28.6% had experienced dental caries. Mean d3mft was 1.07 (3.39 in those with caries experience) and PUFA was present in 2.0%. 18.4% of parents/guardians reported a negative impact on the ECOHIS and this increased to 35.1% amongst children with caries experience (d3mft>0). The most common impacts reported were pain (11.6%, 23.6% if d3mft>0) and feelings of guilt in parents/guardians (6.7%, 16.5% if d3mft>0). The highest levels of impact were recorded amongst children from deprived communities, and this persisted after controlling for caries experience or untreated decay (p < 0.05). These data reinforce the need for measures to tackle early childhood caries alongside other efforts to minimise childhood disadvantage.

Objectives: Space maintainers are frequently used to prevent malocclusion problems in early primary tooth loss. Parents’ oral health literacy and awareness of space maintainers may influence children’s oral health outcomes. This study aimed to examine the direct and indirect roles of parents’ space maintainer awareness on their children’s untreated dental caries with a conceptual model. Methods: This cross-sectional study included 600 children and their parents. Sociodemographic data and space maintainer awareness survey was administered to parents face to face. Parents’ oral health literacy levels were measured with TREALD-30 and TREALD-30A scales. Children’s oral health status was evaluated using DMFT and PUFA indexes. Path analysis was performed to test the conceptual model (p < 0.05). Results: The conceptual model revealed significant effects of TREALD-30A scores on space maintainer awareness (ß = 0.384, p < 0.001), DMFT scores on space maintainer awareness (ß = 0.081, p = 0.023) and space maintainer awareness on PUFA scores (ß = 0.106, p = 0.017). Additionally, TREALD-30A (ß = −0.032, p = 0.002) and DMFT (ß = −0.008, p = 0.014) scores had significant indirect effects on PUFA through space maintainer awareness. The space maintainer awareness score has a mediating role. Conclusions: The path analysis has shown that the parents’ space maintainer awareness has a direct and indirect effect on the clinical outcomes of untreated dental caries in their children. Although oral health literacy alone was not effective, it reduced clinical consequences of untreated dental caries in children through space maintainer awareness. The model suggests that interventions to increase parents’ oral health literacy and space maintainers awareness will help parents pay more attention to their children’s oral health.

Objective: This study evaluated the readability level (RL) and textual content quality (TCQ) of Turkish websites providing information about “gingival recession” (GR) to understand their implications for public health, specifically concerning health literacy and access to care. Ensuring online health information is accessible is crucial for promoting informed decision-making and preventive health behaviors. Basic Research Design: Cross-sectional and assessment of RL and TCQ on Turkish websites. Subjects: After excluding ineligible websites, a total of 46 websites about GR obtained from the first 10 search result pages on Google were analyzed. Main outcome measures: RL was assessed using Ateşman’s and Bezirci-Yılmaz’s formulas, validated as Turkish formulas. TCQ was scored using six criteria. Analyses compared the mean values and revealed the associations between variables. Results: The Bezirci-Yılmaz formula indicated a master’s degree RL (17.96 ± 4.95), suggesting high reading difficulty for the public. The Ateşman formula indicated moderate readability (57.08 ± 12.74). The mean TCQ was low (2.89 ± 1.08), indicating insufficient information content. RL were positively associated with word count (p < 0.001 for both) but not with TCQ (p > 0.05 for both). Conclusion: Turkish websites on GR are significantly harder to read than recommended for public health materials and the average literacy level in Turkiye. This, combined with low content quality, creates a barrier to understanding essential dental health information, potentially worsening health disparities. Addressing this issue is a public health imperative to improve equitable access to crucial dental health information, empower individuals to take proactive steps for their oral health, and advance national oral health objectives.

Objectives: To examine the associations between oral health behaviours, quality of life, and caries experience, and to assess the extent to which these behaviours account for oral health disparities across socioeconomic groups. Participants: 879 adults aged 45–54 years from metropolitan Adelaide, South Australia. Research design: Data on socioeconomic status (SES, via household income), oral health behaviours (toothbrushing, mouth rinsing, interdental cleaning, dental visiting, and self-care) and quality of life were collected via questionnaire. Clinical examinations were completed for 709 participants to assess caries experience. Outcome measures: Quality of life, assessed via the 14-item Oral Health Impact Profile (OHIP-14), and caries experience via DMFT scores. Results: An inverse SES gradient was recognised for quality of life and caries experience. Lower-income participants had reduced dental visiting scores [17.5 (95% CI: 17.1–18.0)] than higher-income groups [20.0 (95% CI: 19.6–20.4)], and higher dental self-care scores [17.7 (95% CI: 17.3–18.0)] than mid-income participants [17.6 (95% CI: 17.2–18.0)]. Higher-income individuals were likelier to have visited a dentist in the last 12 months (39.5%) and brush daily (36.9%) than lower-income individuals (29.7% and 30.0%). Full behavioural adjustment attenuated SES disparities in quality of life (unadjusted β = −2.7, 95% CI: −3.4 to −2.1; adjusted β = −2.0, 95% CI: −2.7 to −1.3), but not caries experience (unadjusted β = −0.8, 95% CI: −1.3 to −0.3; adjusted β = −0.7, 95% CI: −1.2 to −0.1). Conclusions: Oral health behaviours were associated with reduced socioeconomic inequalities in quality of life. Insignificant associations were observed between oral health behaviours and caries experience, even after adjustment for SES.