OBJECTIVE: To investigate the oral health status of adults on Sheffield's Learning Disability Case Register, and their reported use of dental services. DESIGN: A short questionnaire interview of subjects with learning disabilities or their carers followed by a standardised epidemiological examination, by one trained and calibrated examiner. SETTING: Residential homes, day centres or community homes of people with learning disabilities in Sheffield. SUBJECTS: A 20% random sample of adults (18-65 years) on the register. RESULTS: A response rate of 209 (67%) was achieved, 62% (n=130) of whom were living in the community. People living in residential care were significantly older (43.2 years) than those based in the community (36.3 years) (P<0.05). Both groups had similar mean DMFT scores; however, adults living in the community had significantly more untreated decay (DT = 1.6) and poorer oral hygiene than their counterparts in residential care (DT = 0.7). Adults in residential care had significantly more missing teeth (MT = 10.1) than those in community care (MT = 7.5). General and community dental services were the main providers of dental care. Subjects living in the community were significantly less likely to have a dentist and to use community dental services than their residential counterparts; they were more likely to attend only when having trouble. CONCLUSIONS: Adults with learning disabilities living in the community have greater unmet oral health needs than their residential counterparts and are less likely to have regular contact with dental services. Commissioners and providers of dental services have a responsibility to ensure that the health of adults with learning disabilities is not compromised by 'normalisation'.
Health guidelines are important resources for informing decisions made by health practitioners, patients, caregivers, policymakers, and other interest-holders. Interest-holder engagement in health guideline development can improve the relevance of recommendations, promote considerations of equity, and support implementation. To facilitate efficient and effective health guideline development, there is a need for a comprehensive, global, evidence-based guidance for interest-holder engagement in guideline development. This paper synthesises the barriers and facilitators to interest-holder engagement in guideline development. Several systematic reviews have examined the topic of interest-holder engagement in guideline development, but few have explicitly focused on barriers and facilitators to engagement and the majority of these were related to patients. With increased recognition of the value of broad interest-holder engagement, understanding the barriers and facilitators to interest-holder engagement is key to developing a relevant and inclusive health guideline. The objective of this review is to identify and synthesise the reported evidence on barriers and facilitators to interest-holder engagement in health guideline development. We address this objective through two research questions: 1. What are the reported barriers to interest-holder engagement in health guideline development across the 18 topics of the GIN-McMaster checklist? 2. What are the reported facilitators to interest-holder engagement in health guideline development across the 18 topics of the GIN-McMaster checklist? We searched five major electronic databases (MEDLINE (OVID), Cumulative Index to Nursing & Allied Health Literature (CINAHL; EBSCO), EMBASE (OVID), PsycInfo (OVID), Scopus, and Sociological Abstracts. We also conducted an extensive grey literature search using the websites of agencies who actively engage interest-holders in research and/or guideline-producing agencies, such as PCORI, WHO and GIN. We searched from database inception up to the 26th September, 2022. Backward and forward citation tracking was performed on included articles to identify other eligible studies. We included primary research studies which qualitatively reported on the barriers or facilitators to interest-holder engagement in health guideline development. This included qualitative or mixed method research studies using methods such as interviews, focus groups, or surveys to collect participant experiences; case studies of existing programmes; and process evaluation studies. We excluded non-empirical publications including commentaries and editorials. We excluded publications with incomplete data, including conference abstracts and protocols. We defined interest-holders as "any individual or group who is responsible for or affected by health- and healthcare-related decisions". We identified 10 types of interest-holders whose input can enhance the relevance and uptake of guidelines. We included studies that reported on the barriers or facilitators to engagement of one or several of these interest-holder groups at any step of the guideline development process. All identified citations from electronic databases were imported into Covidence for screening and selection. Documents identified through our grey literature search were managed and screened using an Excel spreadsheet. A two-part study selection process was used for all identified citations: (1) a title and abstract review and (2) full-text review. At each stage, teams of two review authors independently assessed all potential studies in duplicate using a priori inclusion and exclusion criteria. Data was extracted from each included article in duplicate and independently. We extracted information about study characteristics and methods. Additionally, we extracted qualitatively reported barriers and facilitators and conducted a framework analysis. We selected the Theoretical Domains Framework (TDF) for extracting our barriers and facilitator findings. Developed through a multidisciplinary consensus approach and subsequent validation, TDF consolidates overlapping behavioural theories into 14 domains encompassing 84 theoretical constructs, and provides a theoretical lens through which to view the cognitive, affective, social and environmental influences on behaviour and implementation. Two review authors conducted the analysis. Our qualitative evidence synthesis identified a total of 51 findings, encompassing 23 barriers and 28 facilitators to interest-holder engagement in health guideline development. While the large majority of reported evidence is about patient engagement, many findings are applicable to all interest-holder groups and should be considered by guideline developers who aim to apply a multi-interest-holder engagement approach. Many organisations that produce guidelines lack the resources to support interest-holder engagement. By implementing an organisational interest-holder engagement model, guideline developers can ensure that they have the necessary human and financial resources in place. The interest-holders which are recruited to a guideline project should be knowledgeable and experienced, and guideline developers should consider diverse perspectives, roles, and personal characteristics. Using a network approach for identification and recruitment can help identify appropriate and committed interest-holders. To prevent tokenistic engagement, guideline developers can promote the meaningful engagement of interest-holders by providing practical, technical and emotional support. This includes providing training to empower interest-holders and improve self-efficacy and confidence in guideline development skills. Training should focus on evidence-based methods such as systematic reviews and evidence-to-decision frameworks. Engagement throughout all stages of guideline development supports more meaningful engagement compared to occasional involvement. A skilled moderator/chair can manage group dynamics and support the contributions of all those involved in guideline development. They can also offer explanations and promote plain language as-needed. Finally, many interest-holders have limited time to contribute to guidelines, and developers should establish flexible processes and timelines, and consider interest-holders preferences for in-person and online engagement activities. Identifying and analysing barriers and facilitators to interest-holder engagement is important in order to optimise health guideline development. Knowing facilitators to engagement can support future interest-holder engagement work. More research is needed on the barriers that do not have potential facilitator solutions, to understand how to improve upon known challenges. This review calls for the development of training courses and tools to support and facilitate involvement of all interest-holders, both public and professionals. In addition, it calls for further research to be done with a focus on the dynamics of guideline development, perceived interactions within the group and their impact on decisions. Work should also be done to look at the implementation of guidelines and the influence of interest-holder engagement on uptake. What challenges do patients and other interest-holders face when creating health guidelines, and how can we support them? The review in brief: Health guidelines help many people, such as clinicians and patients, make decisions about healthcare. It is necessary to involve different types of people in the creation of health guidelines. This review summarises the challenges that people face when working together to create health guidelines and what kind of support helps them work together. Most of what we know about the experience of partnership when developing health guidelines is from patients. The main challenges facing patients are unclear roles, need for training and support, difficulty speaking up, and not having enough time to do the work. To support them, guideline developers should offer practical, technical and emotional support and work with flexible timelines and processes. More research is needed to understand the challenges faced by policymakers, practitioners, researchers and patients from different backgrounds and experiences. What challenges do patients and other interest-holders face when creating health guidelines, and how can we support them? Health guidelines are important documents that can help people, such as practitioners and patients, make decisions about healthcare. It is becoming more common to involve different types of people in the creation of health guidelines. We wanted to know what challenges people face when working together to create health guidelines, and what types of supports are useful. What did we do? We looked for literature that described people’s experiences when collaborating to create health guidelines. We specifically looked for information that described challenges they faced, how they overcame these challenges, and what type of supports they wished were in place. We were interested in documents that described ten different types of people who can contribute to the guideline development process, including patients, practitioners, and members of the public. We organised our results using a pre-existing checklist (GIN-McMaster Checklist for Guideline Development). What did we find? We found 40 documents that described challenges and ways to support people who are engaged in the guideline development process. Most of the evidence came from high-income countries and most of it was about patients and their experience being part of guideline development. These documents described how finding the right people to include in a guideline project can be challenging, since they need specific skills and knowledge or experience. People described not always understanding their role in the project, and needing more training and support in order to do their work. Organisations that develop guidelines did not always have the resources needed to support them. An important resource is the guideline chair, who leads the group discussions and can support everyone involved in creating the health guideline. The best way to support people is to provide them with choices and flexibility in how they engage in the guideline development process. People may prefer working in-person or online and need enough time to get the work done. What are the limitations of the evidence? Most of the evidence we found is about patients, and more research is needed about different interest-holders such as policy makers, health practitioners, and researchers. More information is also needed about how to involve people from diverse backgrounds, such as those who live in low-income settings. Additionally, we did not find evidence for all of the steps needed to create a guideline, such as priority setting. How up-to-date is this evidence? Evidence was included up to September 26, 2022.
Combustible cigarette smoking is a well-established risk factor for poor oral health, but the implications of e-cigarette use and dual use remain uncertain. Distinguishing the effects of vaping from the lingering consequences of prior smoking is a persistent challenge in the literature. To assess how distinct nicotine use profiles relate to oral health-related quality of life, self-reported oral health indicators and self-rated dental health among adults in England, while differentiating e-cigarette users by smoking history. We conducted a cross-sectional analysis of 6027 adults (aged ≥ 16 years) from the nationally representative 2021 Adult Oral Health Survey for England. Participants were classified into five current smoking/vaping categories (never users, former smokers, exclusive cigarette smokers, exclusive e-cigarette users, dual users) and, separately, by combined vaping-smoking history. Outcomes included any oral health difficulty and the number of impacts derived from the 14-item Oral Health Impact Profile (OHIP-14), as well as loose teeth, gum disease history, dry mouth and self-rated dental health. Binary outcomes (any oral health difficulty, loose teeth, gum disease history) were analysed using logistic regression, and ordinal outcomes (number of OHIP-14 impacts, dry mouth, self-rated dental health) using ordered logistic regression, with adjustment for sociodemographic, behavioural and oral hygiene covariates. Compared with never users, exclusive cigarette smokers had the highest adjusted odds of reporting any oral health difficulty (OR = 1.85, 95% CI: 1.51-2.27), loose teeth (OR = 3.18, 95% CI: 2.47-4.09), gum disease history (OR = 1.94, 95% CI: 1.52-2.49) and poorer self-rated dental health (OR = 2.88, 95% CI: 2.36-3.52). Dual users showed similarly elevated odds for loose teeth (OR = 3.11, 95% CI: 1.95-4.97), the highest odds for gum disease history (OR = 3.21, 95% CI: 2.06-4.99) and elevated odds for any oral health difficulty (OR = 1.55, 95% CI: 1.04-2.30) and poorer self-rated dental health (OR = 2.45, 95% CI: 1.68-3.58). Exclusive e-cigarette users also showed elevated odds across outcomes, though generally of smaller magnitude. Estimates for the very small subgroup of never-smoking current e-cigarette users did not show significant excess odds across outcomes, but were imprecise and should be regarded as exploratory. In this cross-sectional population-based analysis, combustible cigarette smoking and dual use were associated with poorer self-reported oral health outcomes. Findings related to e-cigarette use require cautious interpretation because of prior smoking history, the sparse never-smoker vaping subgroup and the absence of detailed exposure data (e.g., smoking intensity, pack-years, time since cessation, vaping duration, device type and nicotine concentration). Smoking cessation should remain central to preventive dentistry.
To systematically evaluate the economic burden of preventable dental-related emergency department visits (PDEDV) and preventable dental-related hospital admissions (PDHA), identify reasons for these presentations, and synthesise recommendations to reduce avoidable utilisation. This systematic review followed the PRISMA 2020 guidelines. A comprehensive multiple database search was conducted in PubMed, Embase, Cochrane Library, EBSCOHOST, and Web of Science for studies reporting direct and/or indirect costs of PDEDV and PDHA in any age group, published in English from 2000 to March 2026. Three calibrated reviewers screened and critically appraised the identified studies. Data including patient characteristics, estimated charges/costs, reasons for PDEDV and PDHA, and recommendations to minimise the avoidable burden were extracted. Charges/costs were inflation-adjusted and standardised to 2024 US dollars. Of the 2600 total studies identified, 25 met the inclusion criteria. The majority were conducted in the United States and focused on direct medical costs. Uninsured individuals, public health insurance enrolees and residents of low-income areas were more likely to experience PDEDV. Mean charges per any PDEDV ranged from $409.73 to $2740.76. Mean charges per any PDHA ranged from $5234.46 to $62 298.25, while mean hospital costs ranged from $350.42 to $22 375.53. Dental caries was the commonest cause for PDEDV. Odontogenic infections were the costliest to manage, with mean charges of $2740.76 per PDEDV and $62 298.25 per PDHA. PDEDV and PDHA were primarily driven by financial barriers, socio-demographic disparities, limited access to routine dental care, and health workforce constraints. Proposed strategies focused on improving affordability and access to preventive dental care, enhancing oral health literacy, strengthening integration between medical and dental services, and expanding the dental workforce. PDEDV and PDHA, particularly those due to dental caries and odontogenic infections, impose a significant economic burden on healthcare systems, highlighting the need to reduce financial and access barriers to routine dental care for high-risk groups and priority conditions.
Childhood oral health represents a significant global public health concern shaped by biological, behavioral, and social determinants. Dental diseases, particularly dental caries, gingivitis, and periodontal conditions, remain among the most prevalent chronic diseases worldwide and are strongly associated with lifestyle factors, health literacy, socioeconomic status, and access to preventive services. This theoretical review aims to introduce the conceptual framework of dental sociology and highlight the importance of integrating social and behavioral perspectives into childhood oral health promotion. Drawing on national and international literature, the paper examines how preventive interventions implemented during early childhood at both individual and community levels can contribute to reducing the prevalence of oral diseases and addressing health inequalities. Special emphasis is placed on the role of multidisciplinary collaboration, systematic monitoring, and evidence-based preventive strategies in fostering sustainable health behaviors. Oral hygiene habits established during childhood may significantly influence long-term interactions with the healthcare system, ultimately affecting oral health outcomes, quality of life, and broader population health indicators across the lifespan. Orv Hetil. 2026; 167(25): 986-990. A gyermekkori szájüregi egészség kiemelt népegészségügyi jelentőséggel bír, amelyet biológiai, viselkedési és társadalmi tényezők egyaránt befolyásolnak. A fogászati megbetegedések, különösen a fogszuvasodás és a fogínygyulladás, valamint a fogágybetegségek világszerte a leggyakoribb krónikus betegségek közé tartoznak, és kialakulásuk szoros összefüggést mutat az életmóddal, az egészségműveltséggel, a szocioökonómiai háttérrel, valamint a prevenciós ellátásokhoz való hozzáféréssel. A jelen elméleti összefoglaló célja a fogászati szociológia szemléletének bemutatása, valamint annak hangsúlyozása, hogy a társadalmi és viselkedési tényezők figyelembevétele alapvető szerepet játszik a gyermekkori orális egészséget fejlesztő programok tervezésében és értékelésében. A hazai és a nemzetközi szakirodalom áttekintése alapján a tanulmány rámutat arra, hogy a korai életkorban megvalósított egyéni és közösségi szintű prevenciós beavatkozások jelentősen hozzájárulhatnak a szájüregi megbetegedések előfordulásának csökkentéséhez, valamint az egészségügyi egyenlőtlenségek mérsékléséhez. Kiemelt jelentősége van a multidiszciplináris együttműködésnek, a folyamatos monitorozásnak és az egyénre szabott prevenciós stratégiáknak, amelyek elősegítik a tartós egészség-magatartás kialakulását. A gyermekkorban kialakított szájhigiénés szokások hosszú távon meghatározzák az egészségügyi rendszerrel való együttműködést, valamint a későbbi életminőséget és általános egészségi állapotot. Orv Hetil. 2026; 167(25): 986–990.
Type 2 Diabetes Mellitus (T2DM) presents a major public health challenge globally, disproportionately affecting Indian migrants who are vulnerable to diabetes-related complications due to cultural, linguistic and systemic barriers that can limit access to timely and effective care. Health literacy is a key determinant of T2DM management, yet its association with medication adherence in this population remains underexplored. This study investigates the association between performance-based (objectively assessed) and self-reported (subjectively assessed) health literacy and medication adherence among Indian migrants with T2DM, while accounting for a range of demographic, socioeconomic and health-specific factors. A cross-sectional study design was employed. Participants (n = 309) were recruited through multicultural health services, and hospital diabetes clinics across Greater Western Sydney, a socioeconomically and culturally diverse area of Sydney, NSW, Australia. Eligible participants self-identified as Indian, were aged 18 years or older, had been diagnosed with T2DM for at least one year, and were currently prescribed diabetes medication. Data were collected via a structured survey and analysed using multivariate logistic regression. Low health literacy was prevalent among Indian migrants, with over 67.6% demonstrating low performance-based health literacy and 62.5% reporting low self-reported health literacy. Approximately 68.9% of participants had low medication adherence. Lower medication adherence was significantly and positively associated with lower health literacy, both performance-based (adjOR=9.14, 95%CI: 4.24-19.72; p = <0.001) and self-reported (adjOR=12.45, 95%CI: 4.55-34.10; p = <0.001). Key predictors of medication adherence included health literacy, private health insurance, BMI, glucose level, comorbidities and social support. Models differed slightly depending on the type of health literacy assessed. Health literacy plays an important role in diabetes self-management for Indian migrants. These findings highlight the need for culturally tailored interventions that address both health literacy support - such as improving understanding of medical information and navigating healthcare systems - and social or family support systems that influence health behaviours and decision-making.
Recent studies reveal high rates of dental issues among professional soccer players, worsened by poor hygiene, frequent sport drinks consumption and limited preventive care. Busy schedules, frequent relocations and changing clubs further disrupt dental routines, impacting performance and well-being. Therefore, we decided to assess the oral health status of professional Slovak soccer players and address these critical concerns. We assessed the oral health of 51 male soccer players from two elite Slovak soccer clubs during 2023/2024 season. Data collection included two paper-based questionnaires and a clinical oral examination by dentists. Additionally, clinical laboratory data were collected from saliva to test for presence of periopathogenic bacteria and DNA polymorphisms. Although 92.2% had valid health insurance, 36% did not attend dental check-ups in the past year, indicating underutilization of preventive care. While 86.2% brushed their teeth more than twice daily, only 48% practiced interdental cleaning and 35.3% used mouthwash. A significant 83.7% consumed sports drinks high in sugar and acid, influencing oral health risks. Clinical examinations revealed that 86.3% had a moderate to high DMF index (mean decayed teeth: 3.8) and 54.9% exhibited gingivitis. Bacterial analyses showed 25.5-74.5% carried highly periopathogenic bacteria, indicating a high risk for periodontitis. Additionally, 15.7% of players exhibited presence of DNA polymorphisms associated with risk of periodontitis onset. This study reveals a gap in preventive dental care among professional soccer players, emphasizing the urgent need for integrated oral health strategies within sports programs.
BACKGROUND The American Dental Association defines oral health literacy as the degree to which individuals have the capacity to obtain, process, and understand information and services that allow them to make appropriate decisions about oral health. Parental oral health literacy influences children's dental health, as parents' knowledge and practices play a key role in prevention. The present study aimed to evaluate oral health literacy among 692 parents of children aged 2 to 12 years using the Health Literacy Dental Scale-14 (HeLD-14) and child oral health using the Decayed, Missing, and Filled Teeth (DMFT) index. MATERIAL AND METHODS This cross-sectional study included 692 parents of children aged 2 to 12 years. Data were collected via a purposefully developed self-administered questionnaire assessing demographics and parent-child oral health knowledge and practices. Children's dental caries were measured using the DMFT index, and quantitative data were analyzed using chi-square tests, correlations, and regression models. RESULTS Participants' OHL scores were significantly different by sex, residential area, and employment status (P<0.05). This study established a significant negative relationship between parental oral health literacy and mean DMFT scores, with a correlation coefficient of -0.41 at P<0.001. The DMFT scores of participants in the urban zone were lower than those from the rural areas (P=0.002). CONCLUSIONS Children's oral health is closely linked to parental knowledge and practices. Higher parental OHL correlates with lower DMFT scores, and targeted education, especially for rural or low-literacy parents, can improve children's oral health outcomes.
To examine whether a history of incarceration is associated with self-reported dental care utilization and oral health difficulties among low-income U.S. military veterans. Data were from Wave 5 of the National Veteran Homeless and Other Poverty Experiences study (N = 1384). Weighted logistic and multinomial logistic regression models were estimated to examine the association between a history of incarceration and (a) dental care utilization, and (b) oral health difficulties, adjusting for demographic, socioeconomic, military, and health insurance characteristics. In covariate-adjusted models, veterans with a history of incarceration had significantly higher odds of not having a dental visit in the past year compared to those without prior incarceration (adjusted odds ratio [aOR] = 2.393, 95% confidence interval [CI] = 1.357, 4.219, p = 0.003), and reporting a higher relative risk of occasional oral health difficulties in the past 3 months (RRR = 1.856, 95% CI = 1.027, 3.353, p = 0.034) compared to never/hardly ever experiencing difficulties. A history of incarceration may represent an important social driver of dental care utilization and oral health difficulties among veterans. Potential programmatic responses through the U.S. Department of Veterans Affairs and the criminal justice system are discussed.
Routine dental attendance is associated with better health outcomes, yet those from disadvantaged backgrounds are more likely to seek problem-driven, episodic care. The RETURN intervention, a brief behavioural intervention delivered by dental nurses in urgent care, was designed to support urgent care users to take up planned dental care. This study evaluates the cost-effectiveness of the RETURN intervention. A cost-utility analysis was conducted alongside a randomised controlled trial. Resource use and health outcomes, measured in Quality-Adjusted Life Years (QALYs) derived from the EQ-5D-5L questionnaire, were evaluated at 12 and 18 months. The primary analysis used a cost-effectiveness threshold of £20 000 per QALY. Multiple imputation was used to account for missing data. Objectives also included providing an estimated incremental cost per improved Oral health impact profile (OHIP-14) point. The intervention was found to be cost-effective with high confidence. At 12 months, intervention incremental cost was £18.83 with incremental Quality-Adjusted Life Year (QALY) gain of 0.014, and an incremental net health benefit (NHB) of 0.013 QALYs. The probability of cost-effectiveness was 90.5%. At 18 months, the incremental cost was £15.11 for a QALY gain of 0.009, and incremental NHB of 0.008 (probability of cost-effectiveness 70.9%). The findings were supported by complete case analysis, which showed probabilities of cost-effectiveness of 99.7% at 12 months and 98.5% at 18 months. Sub-group analysis gave the strongest evidence of cost-effectiveness in the most deprived populations. The RETURN intervention is highly likely to be a cost-effective use of National Health Service resources. Its impact appears particularly strong among those living in the most deprived areas, suggesting the potential to reduce inequalities in access to routine dental care. The RETURN trial was registered at isrctn.com (ISRCTN84666712).
Healthcare access in low- and middle-income countries (LMICs) is constrained by structural and socio-cultural barriers, including language. Oral health, despite its importance to general health, is often overlooked in universal health coverage efforts. The Oral Health Impact Profile (OHIP-5) is a brief patient-reported outcome measure (PROM) for oral health-related quality of life (OHRQoL) but has not been adapted into indigenous Nigerian languages. This study aimed to translate and evaluate the Yoruba version (OHIP-5Yor), assess its psychometric performance using both English and Yoruba administrations, and explore its relevance for improving patient-centred oral healthcare access in LMICs. A cross-sectional survey of 143 adults was conducted at two dental centres in Ibadan, Nigeria. The OHIP-5 was translated using a forward-backward approach with pilot testing. Psychometric evaluation included internal consistency, inter-item correlation, convergent validity, and confirmatory factor analysis. Of the 143 participants, 52 completed the Yoruba version and 91 the English version. The mean OHIP-5 score was 6.6 ± 4.3. The instrument showed acceptable internal consistency (Cronbach's α = 0.67) and supportive construct validity. Structural validity indices, however, indicated that the factorial structure requires further evaluation in larger and more diverse samples. The findings provide preliminary support for the reliability and validity of the OHIP-5Yor as a culturally adapted tool for assessing OHRQoL among Nigerian adult dental patients. Beyond psychometric evaluation, the instrument may help address an important equity gap by enabling non-English speakers to participate more fully in oral health assessment, thereby supporting patient-clinician communication and highlighting unmet needs. Incorporation of such tools into routine care and public health surveillance represents a potential, scalable approach to strengthening oral healthcare access in low- and middle-income countries (LMICs). The OHIP-5Yor enables brief, culturally appropriate assessment of patient-perceived oral health impacts and may support more equitable oral healthcare delivery in multilingual settings.
This case-based review examines oral health challenges among LGBTQ+ populations and how discrimination and stigma contribute to negative outcomes. Two clinical scenarios illustrate the impact of minority stress and prior negative healthcare experiences on dental anxiety, care avoidance, and treatment outcomes. In one case, a nonbinary patient delayed care due to misgendering, resulting in untreated caries. In another, a transgender man's bruxism was associated with stress related to repeated use of his deadname. Both cases demonstrate how affirming care, including correct pronoun use, respect for chosen names, and supportive communication, can reduce anxiety and improve clinical relationships.A literature review complements these cases by identifying barriers to care and risk factors contributing to oral health disparities. LGBTQ+ individuals report higher rates of substance use, delayed dental visits, and limited access to culturally competent care. Certain subgroups, including bisexual adults, experience poorer oral health and greater barriers to care. These findings highlight the need for inclusive clinical practices, improved provider training, and structural changes such as nondiscrimination policies. Integrating affirming approaches into dental care may improve trust, treatment adherence, and oral health outcomes while promoting more equitable healthcare delivery.
Introduction The Falkland Islands are a remote archipelago of over 740 islands and host a diverse, multicultural society. Since 2013, consistent efforts to improve and protect children's oral health have been applied and evaluated, and the results after a decade are presented.Methods Child dental health surveys aligning with the World Health Organization methodology have been conducted annually since 2013 (exceptions: 2015 and 2020). Data analysis was undertaken to establish a mean dmft/DMFT (decayed, missing, and filled primary teeth/decayed, missing, and filled permanent teeth) for five-year-olds, 12-year-olds and 15-year-olds within the Falkland Islands.Results Mean dmft/DMFT results have trended down since 2013, with all age groups demonstrating a dmft/DMFT of below 1.0 tooth consistently since 2021. Response rates have been very good to excellent (69% to 97%) which increases confidence in the results.Conclusions Preventative interventions within the Falkland Islands appear to be improving child dental health. There is further scope, and need, for improvement, and additional screening should be investigated to understand the current oral health of the whole population of the Falkland Islands.
The use of virtual reality (VR) in health education is gaining attention; however, evidence regarding its effectiveness in oral health education remains limited. This pilot study involved 13 adolescents (ages 11-14) identified as school-aged English learners and emergent bilingual students enrolled in a nonprofit, community-based after-school academic enrichment program serving racetrack worker families. Participants engaged in two VR animations: one depicting being inside the mouth and fighting bacteria, and another on the anatomy of teeth. Additionally, a presentation that emphasized the importance of oral health on overall health was given, along with a demonstration of proper brushing and flossing techniques using dental models. Pre-survey results show that this group already has very good oral hygiene habits, with 85% of the respondents reporting that they brushed their teeth twice daily, primarily under the guidance of their parents (84%). After the VR activity, participants rated the experience on a 1-6 Likert scale, with 69% reporting being "highly satisfied" and 31% "satisfied". Similarly, students reported they "learned a lot" (31%), "a moderate amount" (38%), and "quite a bit" (15%), and most of the students rated oral health as "very important" for overall health (69%). These encouraging findings suggest that VR could be used as an engaging tool for oral hygiene education.
To evaluate the short-term effects of professional scaling and polishing on nine oral health and dental aesthetic outcomes in current smokers and never smokers. A total of 371 participants from the SMILE Study Cohort (305 smokers and 66 never smokers) were assessed at baseline (V0) and 14 days after scaling and polishing (V1). Outcomes included Modified Gingival Index (MGI), quantitative light-induced fluorescence parameters (ΔR30, reflecting the percentage of tooth surface covered by mature plaque, and ΔR120, reflecting the percentage covered by thicker deposits including calculus), MacPherson-modified Lobene Stain Index (MLSI) for buccal and lingual surfaces, Whitening Index for Dentistry (WID), Simple Oral Hygiene score (SOH), oral health-related quality of life (OHRQoL), and general health perception (EQ-VAS). Linear mixed model analysis was used for between-group comparisons of V0-V1 changes. At baseline, smokers exhibited significantly worse values across all objective indices. Following intervention, significant improvements were observed in MGI, MLSI, ΔR30, ΔR120, and SOH in both groups (p<0.0001). MGI improved by a median of -0.5 units in smokers (IQR: -0.8/-0.2) and -0.08 units in never smokers (IQR: -0.3/-0.02); the magnitude of improvement was significantly greater in smokers (p<0.0001). Similarly, greater reductions in buccal MLSI (p<0.0001), lingual MLSI (p<0.0001), and ΔR120 (p=0.010) were observed in smokers compared to never smokers. WID showed no significant changes in either group. OHRQoL improved slightly without between-group differences; EQ-VAS did not change significantly. Professional scaling and polishing produced consistent short-term improvements in objective oral health indicators in both smokers and never smokers, with greater gains among smokers reflecting their higher baseline burden. Regular professional mechanical plaque removal is clinically beneficial for smokers, producing measurable short-term improvements in gingival and aesthetic parameters even in the presence of ongoing tobacco exposure, although smoking cessation remains essential for long-term oral health.
To evaluate the association between Social Determinants of Health (SDOH), Social Capital (SC), and dental caries experience according to severity in 12-year-old children from a rural Peruvian community. A cross-sectional study was conducted with 61 schoolchildren and their families in Pampacolca, Arequipa - Peru. DMFT index (decayed, missing, and filled teeth) was assessed via clinical examination (kappa = 0.90). SDOH and SC were evaluated through household interviews with parents, using a survey based on the National Census and the short version of the Adapted Social Capital Assessment Tool (SASCAT), respectively. Data were analyzed using Spearman's correlation and the coefficient of determination (R2). The mean DMFT score was 5.25 ± 2.94. SDOH explained 3.99% of the variance in caries experience overall (p > 0.05). Significant associations were found when stratified by severity: in children with low severity (DMFT≤3), maternal education showed a significant correlation (r = -0.632, p = 0.007), explaining 39.9% of the variance. In children with high severity (DMFT≥5), limited access to health services was the most relevant factor (r = -0.605, p = 0.001), explaining 36.6% of the variance. Regarding social capital, only Cognitive SC showed a significant correlation (r = 0.494, p = 0.044), explaining 24.4% of the variance in the low-severity group. The findings suggest that SDOH and specific dimensions of SC are associated with dental caries, with effects varying by disease severity. While limited access to health services was linked to greater caries experience in high-severity cases, higher maternal education and cognitive social capital appeared to be associated with lower caries experience in children with lower severity. These results highlight the importance of context-specific social interventions.
With the global rise in ageing populations, dental education must prepare students to care for older adults with empathy and competence. Ageism, defined as negative bias towards older individuals, can hinder quality care and meaningful dentist-patient relationships. This study aimed to explore whether documenting and narrating oral health-related life experiences of older adults could promote positive intergenerational attitudes and enhance empathy among dental students. A reflective qualitative study was conducted among 3rd-year dental students enrolled in a Social and Behavioural Sciences module. A subgroup of students participated in an enhanced learning session that involved biographical interviews with older adults, focusing on their oral health journeys and related life stories. Students documented these narratives and produced reflective essays. Thematic analysis of the essays was performed to identify key domains of learning and professional development. Engagement with older adults' life stories fostered greater understanding of the psychosocial dimensions of ageing and oral health. Thematic analysis revealed enhanced empathy, improved communication skills and increased cultural sensitivity. Students recognized the importance of preparation, clear communication and digital tools for engagement. They also identified barriers such as financial constraints and access inequalities, demonstrating growing social awareness for older patients. Documenting and reflecting on oral health-related life experiences provided dental students with meaningful intergenerational learning opportunities that strengthened empathy, cultural sensitivity and readiness for geriatric dental care. Narrative-based reflection represents a valuable pedagogical tool to reduce ageist perceptions and promote inclusive care within dental education.
To explore how Dutch adults with rheumatoid arthritis (RA) perceive their oral health around the diagnostic process and the early disease course. The primary objective was to describe these perceptions in depth, and a secondary objective was to identify areas for future patient-centred research. A phenomenological qualitative study was conducted at Reade, a specialized rheumatology clinic in Amsterdam, The Netherlands. Adults (≥ 18 years) diagnosed with RA within 5 years prior to the start of recruitment, without multimorbidity and irrespective of oral complaints, were eligible. After completing brief sociodemographic/RA and oral-care questionnaires, semi-structured interviews in Dutch (face-to-face or virtual) were conducted with a trained interviewer with lived RA experience. Data were coded inductively in ATLAS.ti using thematic analysis. Eleven adults (7 women, 4 men; median age 68 years) were interviewed. Five themes were identified: (1) fluctuating symptoms demanded continual lifestyle adjustments and, for some, financial losses from reduced work hours; (2) the diagnosis carried a wide emotional burden-humour and symptom-downplaying helped, yet most still camped with accepting the disease, its medication and side-effects; (3) relationships with healthcare professionals varied-participants adhered to rheumatologists' recommendations but followed dental advice less consistently, and they viewed dentists and hygienists as having distinct roles; (4) oral hygiene ability varied-hand- or wrist-flare ups briefly hindered routines for some, and awareness of RA-related oral health risks (e.g., temporomandibular-joint involvement) was low; and (5) tailored information linking RA and oral health was scarce, and participants preferred clear guidance from clinicians while firmly rejecting oral hygiene guidance from friends and family. This exploratory study of Dutch adults with RA showed that perceptions of oral health, particularly around the diagnostic process and early disease course, highlighted five patient-centred research areas: determining the optimal timing and provider of RA-oral health information, mapping educational gaps among dental and rheumatology professionals and students, refining ergonomic toothbrush design, addressing socioeconomic barriers to dental care and validating routine TMJ screening tools. These findings may also serve as a foundation for the development of dental guidelines that reflect the patient perspective.
This study is one component of a multi-year research project directed at increasing oral health providers' adoption of an evidence-based clinical practice guideline. Research-to-practice gaps present a significant barrier to patients' receiving quality oral healthcare. Moreover, increasingly in the US, oral healthcare is provided by private corporations employing contracted providers. The relative autonomy of the actors working in these healthcare contexts presents challenges to efforts that support adoption of evidence-based practices. Participatory engagement can usefully support efforts to implement evidence-based practice. How providers orient towards participatory engagement is one challenge not yet considered by researchers. Our analysis sought to discover whether oral health providers exhibited evidence of citizenship behavior (i.e., oriented as citizens) in their deliberations over how to implement an evidence-based clinical practice guideline. We devised and employed a coding scheme based in an Occupational Citizenship Behavior framework to conduct a directed content analysis of transcripts from online deliberative forums among oral healthcare workers who practice within a network of clinics managed by a private healthcare system. In their deliberations, participants exhibited three citizenship behavior types; these behaviors were directed at reinforcing the status quo of relationships, practices, and norms operating in their specific clinics. Further, participants expressed suspicion and fear of outside forces influencing their practice; outside forces included the organization that employs them and professional organizations for oral health providers. An analysis focused on citizenship behavior revealed the reasoning providers advance in relation to their choices about whether and how to implement evidence-based practice guidelines. Moreover, it captured information about barriers and facilitators operating in these providers' localized contexts (i.e., specific clinics) that had not been captured by other methods. More needs to be learned about the citizenship orientation exhibited by participants. The sense of allegiance expressed by participants to their clinic-as-community and their expressions of suspicion and fear about outside forces seem to pose significant barriers to efforts to implement evidence-based guidelines and to close research-to-practice gaps. The Dissemination and Implementation of Sealant Guidelines in Organizations (DISGO) project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 12/18/2020. https://clinicaltrials.gov/ct2/show/NCT04682730.
Periodontitis is a prevalent inflammatory disease characterized by progressive loss of periodontal attachment and alveolar bone. Conventional diagnostic approaches, including periodontal probing and radiographic interpretation, are influenced by examiner variability, limiting consistency in large-scale and community-based assessments. Machine learning-driven models may support standardized screening for periodontal health and periodontitis. To develop and validate a machine learning algorithm to classify periodontal health and periodontitis using clinician-measured and validated radiographic alveolar bone loss obtained from bitewing radiographs, aligned with the 2018 American Academy of Periodontology/European Federation of Periodontology (AAP/EFP) classification of periodontal and peri-implant diseases and conditions. In this retrospective study, 1,537 of 2,162 bitewing radiographs were included. Alveolar bone loss was measured from the cemento-enamel junction to the alveolar crest using MiPACS software and validated by calibrated examiners (κ=0.94). Data were preprocessed, balanced, and split into training, validation, and test sets. Multiple classifiers were benchmarked, with Random Forest (RF) selected after hyperparameter tuning. Performance was assessed using accuracy, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUC). The RF model achieved 96.4% accuracy on the validation dataset and 92% on the independent, previously unseen test dataset. Sensitivity was 100% for periodontitis and 93% for healthy cases in the validation set, with an AUC of 0.99. On the unseen test dataset, sensitivity was 94% for healthy and 92% for periodontitis, with an AUC of 0.97. The machine learning algorithm accurately classified periodontal health and periodontitis from bitewing radiographs, providing an automated assessment aligned with the 2018 AAP/EFP classification. It may improve diagnostic consistency, support early intervention, and enable community-based screening and triage for large-scale periodontal assessment. Automated classification of periodontal status from bitewing radiographs may improve diagnostic consistency and facilitate efficient screening and triage in large-scale and community-based dental care.