IntroductionCommunity outreach models have been developed to address persistent structural barriers in the delivery of oral healthcare. In response to these challenges, a community-based oral health programme known as Program Kampung Angkat Pergigian (PKAP) was locally established to strengthen community engagement by positioning community leaders and dental icon representatives as community implementers who mediate between oral healthcare professionals and the community. This study explores the roles and experiences of these community -implementers within this programme.MethodsAn exploratory qualitative design was employed, and participants were purposively sampled from three districts in Negeri Sembilan, representing urban, suburban, and rural communities. Data were generated from 10 in-depth interviews with community implementers, and interviews were guided by a semi-structured question guide. Audio recordings were transcribed verbatim and analysed using codebook thematic analysis approaches. Coding disagreements were resolved through team discussions, and data collection continued until saturation was reached.ResultsThe analysis identified three key themes: navigation of programme expectations with lived realities, trust and position of community implementers in influencing engagement, and bridging the gap between health systems and community. The findings highlight the significance of operational support, trust, contextual awareness, and the systemic limitations these community representatives have in delivering home visit services.ConclusionThese insights underscore the value these implementers bring in delivering community-driven interventions and the importance of sustaining this relationship.
To identify and explain the health system factors influencing private general dental practitioners (GDPs) engagement in state-funded, contracted primary oral healthcare for low-income adults in Ireland, in which circumstances, for which groups, how and why. Nineteen realist interviews were conducted with frontline GDPs, health system actors and academic subject experts from Ireland and elsewhere. Collected data were then transcribed, coded, and analysed to generate context-mechanism-outcome configurations (CMOCs) and develop an overarching realist programme theory to explain causation. Thirteen individual and abstracted CMOCs were crafted and subsequently consolidated into five high level CMOCs. GDPs' engagement with state funded care is influenced by a myriad of complex health system contextual factors. These include low political and resource commitment to oral health; cost containment measures characterised by limited and outdated baskets of care and low remuneration; overtly bureaucratic oversight or contract administrative processes; adversarial communications and the absence of consultative mechanisms between the health system and GDPs. Other factors such as oral healthcare 'market' dynamics, GDPs' professional networks and community ties can also influence engagement in state care. As Ireland looks to reform its primary oral healthcare system to widen population access to care and meet national oral health policy and WHO commitments on oral health, the findings of this study provide health system leaders with evidence to leverage system change and increase or sustain GDPs' engagement in state care. Leveraging such change has the potential to improve access to care for vulnerable populations and reduce oral health inequalities.
Objectives: Psychological disorders are prevalent medical conditions that can negatively affect oral health. Due to the increase in the elderly population, and higher risk of psychological conditions in this age group, this study assessed the association of mental health evaluated by the 28-Item General Health Questionnaire (GHQ-28) and oral health in the elderly patients. Materials and Methods: Overall, 150 elderly patients aged 60 years and higher presenting to the dental clinic of School of Dentistry, Tehran University of Medical Sciences in 2019 participated in this cross-sectional study. Oral and dental examinations were conducted to assess the dental caries status using the decayed, missing, and filled teeth (DMFT) index, number of existing teeth, and self-reported dry mouth. Sociodemographic status, oral hygiene behaviors, and medical history of the participants were also recorded. The GHQ-28 was used to assess their mental health. Data were analyzed by SPSS version 25 using the correlation tests (alpha=0.05). Results: Of all the participants, 64 (42.7%) were females, and the age range was 60 to 90 years (mean age: 67.56±6.42 years). The mean total GHQ score was 4±3.8. The DMFT score and number of teeth had significant associations with severe depression and social dysfunction (P<0.05). Dry mouth was directly associated with the total GHQ score and anxiety (P<0.05). Conclusion: Elderly people with severe depression suffered from poor oral health. Comprehensive oral and dental examination and paying close attention to mental health aspects should be considered in regular dental check-ups and oral health promotion programs for the elderly.
In super-aged societies such as Japan, achieving "healthy longevity with well-being" requires not only medical and long-term care services but also a seamless continuum that integrates health promotion, frailty prevention, and community-based support, along with age-friendly physical and social environments that support functional ability, social participation, and independent living. Within this framework, oral frailty (OF)-defined as the accumulation of slight declines in oral function, including tooth loss, chewing and swallowing difficulties, oral dryness, and low articulatory oral motor skills-has emerged as a key indicator linking oral health to systemic frailty, disability, and mortality. Originating in Japan, the concept of OF emphasizes early detection and reversibility through multidisciplinary collaboration. The 2024 Consensus Statement issued by three academic societies (the Japan Geriatrics Society, the Japanese Society of Gerodontology, and the Japanese Association on Sarcopenia and Frailty) proposed a definition, conceptual model, and assessment using the Oral Frailty 5-item Checklist (OF-5). This review summarizes the development of OF initiatives within Japan's Community-Based Integrated Care System and discusses recent international trends, including the WHO Global Oral Health Action Plan (2023-2030), the FDI policy statement "Oral Health for Healthy Ageing," and emerging global research evidence. Practical examples, such as a community-wide campaign in Hiratsuka City, illustrate multisectoral collaboration to prevent and raise awareness of OF. Finally, we highlight future directions, including integration of oral health into community development, strengthening interprofessional collaboration, and leveraging digital technologies for monitoring and education. By integrating clinical, community, and policy perspectives, the Japanese concept of OF offers a promising, implementable model for global healthy aging.
To evaluate health system readiness for UHC for oral health in ageing populations, using a cross-country analysis of eight countries (Japan, India, Colombia, Rwanda, the UK, Nigeria, Australia, Canada). The analysis encompasses health system organisation, financing and service delivery; dental workforce volume and distribution; oral health policies and provisions for older adults; and age-based differences in oral disease burden. A narrative review was conducted across eight countries, purposively selected to represent diverse health system financing and governance arrangements using three established health system frameworks, by Böhm et al., Mackintosh et al. and Karan et al. Data were sourced from the WHO Global Oral Health Status Report and supplementary country-specific sources, and findings were organised thematically across four domains. Age-based differences in oral disease burden were quantified using disability-adjusted life years (DALYs) rates per 100 000 population, comparing adults aged ≥ 65 years with those aged < 65 years over the period 2001-2021, with both absolute and relative differences calculated. Considerable variation in readiness towards achieving UHC for oral health in ageing populations was observed. High-income countries nominally included essential dental services under UHC but often with shallow coverage, significant co-payments and limited rehabilitative services, leading to substantial out-of-pocket spending (notably Australia and Canada). Lower-income countries provided minimal public financing for oral health, leaving most dental care to private out of pocket expenditure (as observed in India and Nigeria). Dental workforce shortages and maldistribution were pronounced in low-resource settings (Rwanda and Nigeria recorded dentist-to-population ratios of approximately 1:57000 and 1:35000 respectively). Few countries had specific policies or programmes targeting oral healthcare for older adults (Japan and the UK). In most countries, adults ≥ 65 years had a higher oral disease burden than younger adults, especially in contexts with lower overall disease levels and greater longevity. Health systems are largely underprepared to deliver adequate coverage for oral health services for ageing populations. Strengthening financial protection, broadening coverage of preventive and restorative dental services, enhancing workforce capacity and embedding oral health in general health and ageing policies are critical to achieving equitable oral health outcomes for older adults.
Dental caries (tooth decay) remains the most common noncommunicable disease worldwide and continues to impose significant dental and systemic health and economic burdens despite being largely preventable. Untreated disease contributes to pain, infection, reduced quality of life, and increased demand for restorative dental care. Governments, therefore, face policy decisions regarding population-level prevention strategies. This analysis evaluates policy options related to population-level fluoride exposure, including maintaining existing community water fluoridation (CWF) programs, expanding fluoridation coverage, discontinuing fluoridation in favor of clinical prevention strategies, and implementing alternative delivery mechanisms such as salt fluoridation. Drawing on Bardach's Eightfold Path for policy analysis, options are assessed using public health policy criteria, including health impact, equity implications, economic considerations, safety, and implementation feasibility. Evidence shows that CWF can reduce caries prevalence and treatment needs at the population level, particularly in communities with limited access to preventive dental care. Economic evaluations indicate that fluoridation reduces expenditures associated with dental treatment. However, policy feasibility varies depending on infrastructure, governance systems, and public health capacity. For policymakers, fluoridation represents one component of broader health prevention strategies that combine population-level prevention with improved access to preventive services.
Background and Objectives: Dengue is emerging as a multifaceted public health challenge that extends beyond traditional vector-borne disease frameworks. Climate change, rapid urbanisation, environmental transformation, global mobility, and digital ecosystems are progressively reshaping transmission dynamics, outbreak patterns, and preparedness needs worldwide. This narrative review aimed to examine dengue from an integrated public health perspective, focusing on climate-sensitive transmission, urban health, surveillance and preparedness, digital epidemiology, artificial intelligence (AI), and health communication. Materials and Methods: A structured narrative review was conducted through targeted literature searches in PubMed, Scopus, and Web of Science between April and May 2026. To this end, a series of separate thematic search strategies were developed to explore the principal conceptual domains addressed in the review. The synthesis was organised around five interconnected preparedness domains: climate change and environmental transformation; urbanisation and urban health; surveillance, vaccination, and integrated preparedness; digital health, artificial intelligence, and mathematical modelling; and health communication and community engagement. The retrieved literature was analysed using a thematic narrative synthesis approach. Results: The retrieved evidence indicated the progressive expansion and redefinition of dengue risk across both endemic and historically non-endemic regions. Climate variability, environmental transformation, rapid urbanisation, and increasing human mobility have emerged as interconnected drivers capable of influencing vector ecology, transmission dynamics, outbreak frequency, and healthcare system vulnerability. Urbanisation has been frequently associated with infrastructural inequalities, environmental degradation, inadequate water and waste management, and territorial conditions favourable to vector proliferation. The extant literature has also placed significant emphasis on the growing importance of integrated surveillance systems and early warning approaches combining epidemiological, environmental, climatic, entomological, and mobility-related data. Digital epidemiology, AI-based predictive models, and digital surveillance tools may contribute to strengthening outbreak forecasting and preparedness capacity, although important limitations related to data quality, interoperability, interpretability, and implementation remain. In parallel, misinformation, risk communication challenges, and digital communication ecosystems emerged as relevant factors influencing public perception, preventive behaviours, institutional trust, and adherence to public health interventions. Conclusions: Dengue is a systems-level public health challenge shaped by climate change, urbanisation, environmental disruption, human mobility, health-system preparedness, and digital ecosystems. Conventional vector-control strategies alone are unlikely to adequately address this growing complexity. Strengthening dengue preparedness should therefore be considered a broader indicator of public health resilience and long-term health-system adaptation.
Oral disorders are an important disability driver in adults aged 70 and older, who often experience greater tooth loss and higher levels of untreated oral disease than younger persons. Despite the importance of regular dental visits, older adults attend dental services less frequently, facing several barriers. This study aimed to evaluate whether a low-threshold dental screening could increase the likelihood that older adults (≥ 65 years) contact a dental professional. A total of 194 community-dwelling adults aged ≥ 65 years without a dental check-up in the past 12 months were randomized (1:1) in a two-arm, single-blinded, controlled superiority trial. The intervention group received an oral screening, personalized oral health information, referral letters for a dentist and general practitioner, and a list of nearby dentists. The control group received only general oral hygiene flyers and a list of nearby dentists. The primary outcome was whether participants contacted a dental professional within 4 months following the intervention. Oral hygiene practices (i.e., tooth brushing frequency and use of brushing materials) were evaluated as secondary outcomes. No evidence for an effect of the intervention on contact with a dental professional was found (risk difference = -0.01 (95% CI: -0.12; 0.10)). Within 4 months, 14% of control group participants and 12% of those in the intervention group reported contacting a dental professional, mostly due to urgent issues (e.g., pain or broken teeth), rather than the intervention itself. Among those who did not seek care (n = 133), 79% cited a lack of perceived need. Furthermore, no intervention effect was found regarding oral hygiene practices. Motivating older adults to attend preventive professional dental care remains challenging. Greater integration of oral health into primary care, along with early-life promotion of positive oral health behaviours, is essential.
Head and neck cancer (HNC) survival is improving, increasing the need to address long-term survivorship issues. Dental survivorship-care before, during, and after treatment-remains inconsistent across services. We conducted a review of systematic reviews and emerging evidence to inform contemporary dental survivorship care for HNC patients. This review followed PRISMA guidelines. Eligible studies included adults with HNC receiving oral and dental interventions before, during, or after treatment. Medline and CINAHL were searched in September 2025, with two reviewers screening and extracting data. Risk of bias was assessed with study-specific tools. Due to heterogeneity, findings were synthesized narratively and grouped thematically. Our search identified 2985 studies, of which 41 met inclusion criteria. For prevention of dental caries, fluoride was consistently effective, while evidence for casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and intra-oral devices was mixed. Dental optimization before radiotherapy, including extraction of teeth with poor prognosis where indicated, is widely recommended; however, the effect of extraction timing on ORN risk remains uncertain. Hyperbaric oxygen and the PENTO protocol (pentoxifylline with tocopherol) showed limited or conflicting benefit in reducing ORN risk when used as an adjunct to tooth extractions. For dental implants, immediate placement at the time of surgery (and, therefore, prior to radiotherapy) may improve prosthetic rehabilitation. Where reconstruction was required after oncologic surgery, fibula free flap reconstructions yielded favorable outcomes for dental implant survival. Inclusion of dental professionals in the HNC multidisciplinary team improved oral outcomes, quality of life, and adherence to preventive protocols. Referral proformas and community dentist involvement in survivorship care increased compliance and access. Overall, evidence supports preventive dental interventions and early integration of dental professionals in HNC care. Findings from this review will guide planned consensus practice guidelines to reduce variations in HNC dental survivorship care across services.
The aim was to test a structural equation model examining the direct and indirect pathways between early childhood caries (ECC) severity and oral health-related quality of life (OHRQoL) in Brazilian preschool children, incorporating dental pain, treatment urgency, dental visits, anterior open bite (AOB), and maternal schooling into the model. A population-based study was conducted using data on five-year-old children from the 2023 Brazilian National Oral Health Survey (SB Brasil). The Brazilian version of the SOHO-5 was used to measure the impact of oral health conditions on OHRQoL. Calibrated dentists assessed ECC (dmft and pufa indices), AOB (Foster & Hamilton), and urgent oral health care needs. Parents or caregivers answered a questionnaire addressing dental pain, dental visits, and mother's schooling. Structural equation modeling was performed. Children with greater ECC severity (β = 0.674; p < 0.001) and dental pain (β = 0.241; p < 0.019) were more likely to require urgent care. Greater ECC severity was also directly associated with worse OHRQoL by both by the self-report (β = 0.261; p < 0.001) and proxy-report (β = 0.303; p < 0.001), and indirectly mediated by dental pain in both the self-report (β = 0.426; p < 0.001) and proxy report (β=0.401; p<0.001). Dental pain was associated with worse OHRQoL according to both self-report (β = 0.633; p < 0.001) and proxy-report (β = 0.597; p < 0.001). The structural model demonstrated that ECC severity negatively impacts OHRQoL through direct effects and indirect pathways mediated by dental pain. ECC and dental pain were also associated with a higher likelihood of urgent treatment.
The oral frailty index-8 (OFI-8) is a measure of oral frailty to identify impaired oral function. However, its validity and associations with health outcomes remain unclear. We aim to evaluate its construct validity and associations with appetite, muscle health, falls, functional outcomes, and quality of life (QoL). Cross-sectional analysis of 300 community-dwelling older adults (mean age 67.4 ± 7.10 years; 68.7% female). Exploratory factor analysis (EFA) assessed OFI-8's factor structure. Participants were classified as oral non-frail (ONF), pre-frail (OPF), or frail (OF) based on total scores. Associations with outcomes were assessed using logistic regression, adjusted for relevant covariates. Outcomes included appetite (SNAQ), muscle health (DEXA muscle mass, handgrip strength, SARC-F), falls risk (STEADI), function (IADL), life-space mobility (LSA), mood (GDS), and QoL (EQ-5D-5L). EFA revealed OFI-8's 3-factor structure: swallowing and oral conditions, dental care, and dietary and social habits. Prevalence of ONF, OPF, and OF was 62%, 16%, and 22%, respectively. Compared to ONF, OF showed worse appetite, handgrip strength, SARC-F scores, falls risk, IADL function, and mood (all p < 0.05). In adjusted models, OF was associated with poor appetite (OR = 1.97, 95% CI: 1.07-3.65), increased falls risk (OR = 2.64, 95% CI: 1.21-5.74), and low mood (OR = 5.51, 95% CI: 2.07-14.69). OPF was not associated with any outcomes. No differences were observed across groups in muscle mass, LSA, or QoL. Our findings provide preliminary support for OFI-8's validity as a multi-dimensional tool to identify community-dwelling older persons with oral frailty, which is associated with adverse outcomes. Further research is needed to refine cut-offs and evaluate longitudinal predictive validity.
Social capital is an important social determinant of health linked to oral health and health-related behaviours. Several studies assessed its association with dental service utilisation; however, findings remain inconsistent. This study aimed to examine the association between individual- and community-level social capital and dental service utilisation within the past 12 months among Japanese older adults. This longitudinal study utilised self-report data from the Japan Gerontological Evaluation Study in 2019 and 2022. Individual-level civic participation, social cohesion, and reciprocity were assessed and aggregated to community-level using factor analysis. The outcome was dental service utilisation (preventive, treatment, and overall dental visits). Multilevel Poisson regression analysis was used to examine their associations. The mean age of 11,642 participants from 48 municipalities was 73.8 years (range: 65-95), and 51.4% were female. Participation in three or more civic groups was associated with 22%, 12%, and 16% higher likelihood of preventive (prevalence ratio [PR] = 1.22, 95% confidence interval [CI] = 1.15-1.30), treatment (PR = 1.12, 95% CI = 1.06-1.18), and overall visits (PR = 1.16, 95% CI = 1.10-1.22), respectively. Higher community-level civic participation was positively associated with preventive (PR for the highest tertile group = 1.20, 95% CI = 1.02-1.42), treatment (PR = 1.11, 95% CI = 1.02-1.21), and overall visits (PR = 1.13, 95% CI = 1.03-1.24). Individual- and community-level civic participation was positively associated with dental visits. Promoting civic participation could improve utilisation of dental care by older adults.
In the United Kingdom (UK), disabled people face barriers accessing dental care, leading to poor oral health. To understand these barriers, the present study examined how disability is defined and conceptualised in UK oral health policy documents, and explored the implications of these framings for the provision of dental care for disabled people. A qualitative documentary analysis was conducted using a seven-phase framework. Oral health policy documents published between 2000 and 2023 were identified through targeted website searches, supplementary web searches and consultation with an expert panel. Twenty-six national and international documents were included. Data were extracted using a structured matrix and analysed using a directed approach informed by the social model of disability. Coding was organised into three themes: disability terminology, underlying models of disability and vision for oral healthcare. Of the 26 documents analysed, 15 provided explicit definitions of disability, predominantly within Special Care Dentistry (SCD) guidance, while general oral health documents rarely defined the term. Most general dental policies adopted a medical model, focusing on individual impairments, whereas SCD and international documents were more likely to incorporate social or biopsychosocial approaches. Consideration of barriers to care, infrastructure requirements and workforce competencies was inconsistent and largely absent from general dentistry documents. A clear, system-wide vision for the provision of inclusive oral healthcare for disabled people was evident in only a small number of documents. UK oral health policy documents demonstrate inconsistent and often limited conceptualisations of disability, with a predominance of medical model approaches in general dentistry. The lack of clear definitions and absence of barrier-focused frameworks may contribute to ongoing inequalities in access to and outcomes of dental care for disabled people. Greater explicitness in defining disability, alongside the adoption of inclusive, barrier-oriented policy frameworks and increased attention to workforce development and service design, is required to support equitable and accessible oral healthcare.
Dental care utilization in later life may reflect changing health needs, access to healthcare, and social inequalities that persist across the aging process. We examined trajectories of dental care utilization before and after dementia diagnosis and evaluated whether these patterns differed by race/ethnicity and educational attainment. We linked Health and Retirement Study data with Medicare claims (1992-2020) among 2,838 dentate adults aged 65 years and older with incident dementia. Mixed-effects logistic regression models estimated changes in dental care utilization relative to the year of dementia diagnosis. Dental care utilization declined in the years preceding dementia diagnosis, increased immediately after diagnosis (adjusted odds ratio [AOR] = 1.45, 95% confidence interval [CI]: 1.04-2.03), and subsequently plateaued. Non-Hispanic Black participants had lower dental care utilization compared with White participants (AOR = 0.21, 95% CI: 0.10-0.44), although trajectories of change surrounding dementia diagnosis did not differ by race/ethnicity. Racial and ethnic disparities persisted even among participants with higher educational attainment. Dementia diagnosis represents a potential transition point associated with temporary increases in dental care engagement, but it does not eliminate longstanding disparities in oral healthcare utilization. These findings highlight the importance of examining oral healthcare access as part of broader aging-related inequalities and ensuring equitable integration of dental care into the continuum of care for older adults with dementia.
This study aims to identify the direct and indirect pathways associated with Oral health literacy (OHL) among Chinese older adults and to inform targeted oral health promotion strategies for older adults. This cross-sectional study included 423 community-dwelling adults aged 65-74 years from a nationally representative key population surveillance project in China. Standardized clinical dental examinations and validated questionnaires were conducted. OHL was assessed using oral health belief (OHB) scores (0-4) and oral disease awareness (ODA) scores (0-8). Variables were categorized according to Andersen's behavioral model into predisposing, enabling/behavioral, and need factors. Poisson regression identified associated factors, followed by path analysis, mediation decomposition, and exploratory multi-group analyses. Median OHB and ODA scores were 3 (IQR: 3-4) and 5 (IQR: 3-6), respectively. In the path analysis, gender and education level were indirectly associated with OHL through mediating factors; root decayed and filled teeth (Root DFT) were directly and positively associated with both OHB and ODA; dental prosthesis use was directly associated with higher OHB, whereas dental visit was directly associated with higher ODA. Sweetened beverage consumption ≥ 1/day showed a negative direct association with OHB, although this estimate was based on only 10 participants and should be interpreted with caution. Three total indirect effects and five specific indirect pathways reached (marginal) significance. In exploratory subgroup analyses, the patterns of path coefficients varied descriptively across education and residence subgroups, but no interaction term was statistically significant. Among older Chinese adults, OHL was associated with a combination of predisposing, need, and enabling/behavioral factors. Dental treatment encounters may provide opportunities for reinforcing oral health education. Subgroup-tailored oral health education strategies may be beneficial.
This study examined the association between life functioning and oral functional problems among Korean adults aged ≥65 years and assessed whether health literacy serves as an explanatory factor in this association. We conducted a cross-sectional analysis using nationally representative data from 1,698 participants in the 2024 Korea National Health and Nutrition Examination Survey. Life functioning was measured using the Life Functioning Scale-10 (LFS-10), with higher scores indicating better functioning. Oral functional problems were assessed using self-reported chewing and speaking difficulty items, with higher scores indicating poorer oral function. Health literacy was measured using the 10-item Health Literacy Index for the Community. Survey-weighted linear regression models were adjusted for sociodemographic characteristics, health behaviors, and comorbidities, and cross-sectional explanatory associations were evaluated using complex-sample hierarchical regression. Participants with low LFS-10 scores reported greater oral functional problems than those with high scores (4.66 vs 3.89). In adjusted models, LFS-10 scores were inversely associated with oral functional problems (B = -0.050; p = 0.006) and positively associated with health literacy (B = 0.159; p < 0.001). After health literacy was added to the model, the coefficient for LFS-10 was modestly attenuated but remained statistically significant (B = -0.043; p = 0.016), while health literacy was inversely associated with oral functional problems (B = -0.050; p = 0.013). The attenuation was approximately 14%, with a small increase in explained variance (ΔR² = 0.009). These findings indicate that lower life functioning is associated with greater oral functional problems and that health literacy modestly explains this association; however, causality cannot be inferred because of the cross-sectional study design.
To investigate the association between multiple perceived discrimination sources and dental pain in Brazilian adults aged 50 years and older. This cross-sectional study analyzed data from 5713 individuals aged 50 years or older who participated in the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Data were collected through household interviews. Perceived discrimination was measured using the Everyday Discrimination Scale and specific domains (healthcare services, social settings, workplace, family, and housing). Dental pain was assessed based on self-reported dental pain in the previous 6 months. Associations were estimated using Poisson regression models adjusted for sex, self-reported skin colour, age, marital status, household wealth, education, area of residence, self-rated general health, and tooth count. The prevalence of dental pain was 11.0%. Higher frequencies of dental pain were observed among individuals reporting any form of discrimination. The strongest associations were identified in the contexts of social meetings (PR = 2.20, 95% CI:1.70-2.84), family (PR = 2.04, 95% CI:1.35-3.08), and due to the place of residence (PR = 1.93, 95% CI:1.25-2.97). These findings suggest that discrimination may represent a psychosocial stressor related to oral health and highlight the importance of public health strategies aimed at reducing social inequalities and promoting equitable dental care.
Background: Severe COVID-19 results in substantial economic burden and impacts quality of life. Assessing how mild COVID-19 impacts health utilities during acute infection and long term is important to estimate the full economic impact of SARS-CoV-2 infection. Methods: We analyzed EQ-5D-3L survey data from SARS-CoV-2 infected adults (aged ≥16 years) and children (aged 8-15 years) from 3 community and household cohorts in the United States (2020-2022). EQ-5D-3L scores were analyzed at 3 time points after symptom onset or first positive SARS-CoV-2 test result and converted to health utilities on a scale of 0-1 (1 = perfect health). Among adults, regression models were used to compare differences in health utility by demographic/clinical characteristics. Results: Among 575 participants with SARS-CoV-2 infections and EQ-5D-3L surveys, mean utilities were nearly 1 throughout the observation period. During days 0-14 after symptom onset, vaccinated participants had higher health utilities (beta, 0.57; 95% CI: 0.07, 1.07). Seeking medical care and having gastrointestinal symptoms (vs none), were associated with lower health utilities (beta, -0.96; 95% CI: -1.60, -0.31; and beta, -0.76; 95% CI: -1.30, -0.21, respectively). During days 15-30 after onset, unemployment was associated with lower health utility (beta, -0.64; 95% CI: -1.15, -0.14). During days 31-90 after onset, underlying conditions were associated with lower health utilities (beta, -0.32; 95% CI: -0.54, -0.09). Results for children were similar to those for adults. Conclusion: Mild COVID-19 may have minimal overall impact on quality of life; however, health utilities differed by vaccination status, presence of gastrointestinal symptoms, employment status, and presence of underlying conditions. Vaccination may play an important role in minimizing illness impact from SARS-CoV-2 infection.
Implementation science has gradually entered the field of oral health, with important contributions to the adoption of clinical guidelines and recent debates on the deimplementation of low-value care. Yet, its application remains limited in scope, leaving critical opportunities underexplored. This perspective article argues that implementation science in oral health should move beyond a predominant focus on guideline uptake, provider behavior, and individual-level barriers toward a broader agenda that addresses digital transformation, community-driven implementation, environmental sustainability, misinformation, and commercial and colonial determinants of health. By applying an equity-driven and decolonial lens, this article highlights how power, trust, communication, governance, and structural inequities shape whether evidence-based oral health interventions are adopted, adapted, sustained, and equitably delivered. We propose a forward-looking agenda that positions implementation science not only as a field concerned with closing the evidence-practice gap but also as a pathway for advancing epistemic justice, sustainability, and structural change in oral health systems. Advancing these directions can support more effective, sustainable, and just oral health care worldwide.Knowledge Transfer Statement:This perspective article reframes implementation science in oral health by integrating digital health, equity, sustainability, and structural determinants, guiding researchers and policy makers toward context-sensitive, participatory, and just oral health interventions.
(1) Background: Obesity and dental caries disproportionately affect low-income South Asian (SA) immigrant children in the US. This CHALO! study aimed to reduce the risk of obesity and oral health risk in young SA children in the US. (2) Methods: CHALO! is a randomized controlled trial. A total of 350 low-income Bangladeshi mothers of 6-month-old children were recruited and randomized to intervention or control. Intervention participants received six home visits and six phone calls from trained community health workers who delivered health education and support. The primary outcome was frequency of combined bottle/sippy cup use over 18 months measured via self-report. Secondary outcomes included sugar consumption, maternal feeding practices, oral hygiene practices, and dental utilization measured via self-report. Secondary clinical outcomes included the presence of dental caries at follow-up (12 months post baseline) assessed through intra-oral camera, and obesity risk, measured as weight gain velocity, at each 6-month period. (3) Results: Bottle/sippy-cup use increased less in the intervention group (Poisson rate ratio = 0.36, 95% CI: 0.34-0.39, p < 0.0001) vs. controls (Poisson rate ratio = 0.58, 95% CI: 0.56-0.61), and while consistent results were noted in sugar consumption, oral hygiene practices, dental visits, and other secondary outcomes, no difference was found in caries prevalence or weight gain velocity. (4) Conclusions: The intervention improved self-reported bottle use and child diet in the intervention group. There were no significant changes in caries prevalence or weight gain velocity. Social context, particularly social networks, may act as a barrier to adopting new healthy behaviors, impacting changes in caries and obesity outcomes.