搜索结果：Community dentistry and oral epidemiology

The increasing burden of oral diseases in low- and middle-income countries (LMICs) and limited access to and affordability of oral care disproportionately impact disadvantaged groups. Oral health research has been dominated by professional academic perspectives with limited contribution from the communities involved. The aim of this commentary is to provide a broad overview of the aims and objectives, principles, values, and study design of the CORE programme. The CORE (Community focused Oral health Research for Equity) programme is a multinational research initiative which aims to reduce oral health inequalities and improve access to dental services through collaborations between disadvantaged communities and academic and community partners in Brazil, Colombia, India and Kenya. Public health research interventions will be co-created and tested with local communities through a participatory action research approach and active community engagement and involvement. In addition, the programme aims to strengthen local oral health research capacity and advocacy. The CORE programme is comprised of three elements: (1) Programme management and governance; (2) Research components focused on oral health inequalities, commercial determinants and oral health system reform; (3) Overarching components including (i) community engagement and involvement, (ii) training and capacity building, (iii) monitoring, evaluation and learning. Through a collaborative community-based approach, the CORE programme will undertake high-quality research in LMICs to inform future pro-equity and health system reform policies.

This study aimed to examine the association between oral health indicators and intrinsic capacity among community-dwelling older adults, and to determine whether dietary variety or homebound status moderated this association. The study included 692 community-dwelling Japanese older adults. Oral health indicators included mastication, oral motor function, salivation, swallowing, oral frailty (integrating these four components) based on the latest international e-Delphi study and tongue pressure. All indicators were assessed using oral examinations or validated questionnaires. Intrinsic capacity deficits were assessed across five domains: vitality, psychological, cognitive, locomotive, and sensory. Intrinsic capacity was operationalized as the number of deficits across the five domains. Data on dietary variety and homebound status were also collected. The covariates included age, sex, education, smoking status, drinking status, and comorbidities. Modified Poisson regression models were used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for the associations between oral health indicators and intrinsic capacity deficits. Interaction terms between oral frailty and dietary variety or homebound status were also included. The prevalence of sensory, locomotive, psychological, cognitive, and vitality deficits was 41.2%, 7.4%, 11.9%, 22.0%, and 17.3%, respectively. In the multivariate model, individuals having more oral frailty deficits (RR, 1.16; 95% CI, 1.08-1.24), decreased tongue pressure (RR, 1.20, 95% CI, 1.04-1.39), lower oral motor function (RR, 1.22; 95% CI, 1.05-1.42), declined swallowing function (RR, 1.25; 95% CI, 1.08-1.46), and oral dryness (RR, 1.32; 95% CI, 1.15-1.53) were more likely to have intrinsic capacity deficits. No significant interactions were observed between oral frailty and dietary variety, or between oral frailty and homebound status, on intrinsic capacity. This study showed that cumulative declines in oral health were associated with intrinsic capacity deficits in community-dwelling older adults; moreover, effect modification by dietary variety or homebound status was not identified. Integrated dental services may help maintain intrinsic capacity in older adults; however, longitudinal studies are warranted to better understand this association.

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

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 B&#xf6;hm et&#xa0;al., Mackintosh et&#xa0;al. and Karan et&#xa0;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&#x2009;000 population, comparing adults aged &#x2265;&#x2009;65&#x2009;years with those aged <&#x2009;65&#x2009;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 &#x2265;&#x2009;65&#x2009;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.

The study aims to analyze the association pathways of factors related to oral health behaviors among older diabetic patients in Shanghai, China, using the COM-B model. A convenience sample of 358 older diabetic patients was enrolled between July 2025 and December 2025 from one tertiary hospital and a community health service center in Shanghai. Information was collected via a general information questionnaire, the Older Oral Health Knowledge, Belief and Behavior Questionnaire, the 14-item Health Literacy in Dentistry Scale, the Perceived Social Support Scale, the Geriatric Self-Efficacy for Oral Health Scale, and the 5-item Geriatric Depression Scale. Descriptive statistics, univariate analysis, correlation analysis, and path analysis were adopted to analyze the relevant factors and pathways of oral health behaviors. The constructed structural equation model showed satisfactory goodness of fit (&#x3c7;2/df&#x202f;=&#x202f;2.173, NFI&#x202f;=&#x202f;0.987, TLI&#x202f;=&#x202f;0.976, CFI&#x202f;=&#x202f;0.991, RMSEA&#x202f;=&#x202f;0.07, and SRMR&#x202f;=&#x202f;0.0474). Capability factors, including oral health literacy (&#x3b2;&#x202f;=&#x202f;0.205) and oral health knowledge (&#x3b2;&#x202f;=&#x202f;0.155), the opportunity factor of social support (&#x3b2;&#x202f;=&#x202f;0.169), motivational factors covering oral health self-efficacy (&#x3b2;&#x202f;=&#x202f;0.377), oral health belief (&#x3b2;&#x202f;=&#x202f;0.225), and depression (&#x3b2;&#x202f;=&#x202f;-0.107), could all be directly associated with oral health behaviors. Oral health self-efficacy mediated the associations of oral health literacy (&#x3b2;&#x202f;=&#x202f;0.199), oral health knowledge (&#x3b2;&#x202f;=&#x202f;0.072), social support (&#x3b2;&#x202f;=&#x202f;0.049), and depression (&#x3b2;&#x202f;=&#x202f;-0.044) with oral health behaviors. Oral health belief mediated the relationships of oral health literacy (&#x3b2;&#x202f;=&#x202f;0.054) and oral health knowledge (&#x3b2;&#x202f;=&#x202f;0.135) with oral health behaviors. Depression acted as a mediator between social support (&#x3b2;&#x202f;=&#x202f;-0.056) and oral health behaviors. Capability factors, opportunity factors, and motivational factors are directly or indirectly associated with the oral health behaviors among older diabetic patients. This suggests that clinicians regularly conduct diabetes-related oral health education and cleaning skills training, encourage relatives to provide supervision, improve access to oral healthcare, and provide psychological counseling to improve patients' oral health behaviors in terms of capability, opportunity, and motivation.

BACKGROUND: Oral frailty, a decline in oral function, is increasingly recognized as a marker of general frailty and adverse outcomes in older adults. However, nationwide data in Thailand are limited. This study aimed to determine the prevalence of oral frailty among community-dwelling older adults in Thailand and to explore demographic factors associated with the condition using the validated Thai version of the Oral Frailty Five-Item (OF-5) screening tool. METHODS: A cross-sectional survey was conducted among 507 adults aged&#x2009;&#x2265;&#x2009;60 years, using proportional sampling from five major regions: North, Northeast, Central, South, and the Bangkok Metropolitan Region. Oral frailty was assessed using the OF-5 questionnaire, which includes five indicators: tooth loss, chewing difficulty, swallowing difficulty, dry mouth, and reduced articulatory oral motor skills. Participants scoring&#x2009;&#x2265;&#x2009;2 were classified as having oral frailty. Logistic regression was performed to identify demographic factors associated with the condition. RESULTS: Overall, 63.5% of participants were classified as having oral frailty. Prevalence increased significantly with age, from 40.0% in those aged 60&#x2013;65 to 79.4% in the 76&#x2013;80 age group (p&#x2009;<&#x2009;0.001). Sex and residential setting (urban/rural) were not significantly associated with oral frailty. However, regional differences were observed: participants from the Northern region had significantly higher odds of oral frailty compared to those from the Central region (OR&#x2009;=&#x2009;2.45; 95% CI: 1.21&#x2013;4.95; p&#x2009;=&#x2009;0.013). Age was the strongest predictor of oral frailty, particularly in individuals aged 76&#x2013;80 (OR&#x2009;=&#x2009;5.81; 95% CI: 3.24&#x2013;10.43; p&#x2009;<&#x2009;0.001) and over 80 (OR&#x2009;=&#x2009;4.85; 95% CI: 2.62&#x2013;8.97; p&#x2009;<&#x2009;0.001). CONCLUSIONS: This study reveals a high prevalence of oral frailty among older adults in Thailand, especially in advanced age groups. The findings highlight the need for region-specific and age-targeted oral health interventions. Incorporating validated tools like the OF-5 into community health programs may support early detection and prevention strategies for oral frailty.

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 (&#x2265;&#x2009;18&#x2009;years) diagnosed with RA within 5&#x2009;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&#x2009;women, 4&#x2009;men; median&#x2009;age&#x2009;68&#x2009;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.

To determine whether Dental Therapists and Dental Nurses could reduce plaque levels of dependent older adults residing in care homes and assisted living settings, when compared to 'treatment as usual'. A two-arm pragmatic cluster randomised controlled trial over a 6-month period was undertaken based on an a priori assumption of superiority. Forty-eight dependent settings across Wales, North-West England, London and Northern Ireland were recruited. Dependent settings were excluded if they solely focused on end-of-life or palliative care or were already participating in an oral health prevention programme. Residents were excluded if they were below 65&#x2009;years of age or if they were receiving end-of-life or palliative care. Dependent settings were randomised using an adaptive algorithm, which generated the randomisation sequence. After allocation, the Chief Investigator, Principal Investigators and the trial statistician were blinded until the trial was completed and the analysis was complete. Due to the nature of the intervention, outcome assessors, those delivering the intervention and the residents were not blinded. Dental Therapists provided routine dental care according to their Scope of Practice. Dental Nurses administered fluoride varnish, oversaw the use of high-strength fluoride toothpaste, and sought to improve the level of day-to-day prevention offered by the formal carers. Current practice formed the control arm. In the United Kingdom, this is often ad hoc and relies on dentists, if available, visiting residents presenting with clinical symptoms. The intervention period lasted for 6 months. The primary outcome measure was the proportion of residents that demonstrated a 50% reduction in the Silness and L&#xf6;e plaque index. Secondary outcome measures were the number of new carious lesions (coronal and root caries), bleeding on probing, Oral Impacts on Daily Performances, EuroQol five dimensions questionnaire (quality of life measure), oral symptoms, episodes of pain, and episodes of unscheduled care, and the number of onward referrals to dentists. Twenty-four dependent settings were allocated to receive the intervention and 24 continued with 'treatment as usual'. 41.7% of the settings were in London, 33.3% were in Wales or the Northwest of England, and 25.0% of the settings were in Northern Ireland. One hundred and twenty-two residents were allocated to the control arm and 142 residents in the intervention arm. The mean age was 85&#x2009;years and 67.2% were female. Levels of cognitive impairment were high in both arms (mean score 13.7 on the Six Item Cognitive Impairment Test). No statistically significant differences were found in the primary or secondary outcome measures at 6-months. No differences were apparent in the number of adverse events related to the trial by group. A 6-month intervention using Dental Therapists and Dental Nurses did not produce any measurable improvements in oral health within dependent settings when compared to treatment as usual. High levels of cognitive impairment may have contributed to the lack of any effect seen. The study was registered with ISRCTN: ISRCTN16332897 (https://doi.org/10.1186/ISRCTN16332897) on 3 December 2021 and the protocol was published in 2022 (https://doi.org/10.1186/s13063-022-06487-3).

The Katkari tribe in Goa, India, faces significant oral health challenges due to cultural beliefs, poor access to healthcare, and high tobacco consumption. This study aims to assess the oral health status, oral health beliefs, and tobacco habits within this isolated community. A descriptive cross-sectional study was conducted among 101 participants from tribal settlements in North and South Goa between October and December 2023. A structured questionnaire was used to collect data on sociodemographics, oral hygiene practices, myths about oral health, and tobacco use. Participants underwent clinical examination using the WHO Oral Health Assessment Form. Data analysis was performed using IBM SPSS version 20, with descriptive statistics and Chi-Square test and Fisher's exact test to explore associations between variables. The mean age of participants was 28.9 years, with 57.4% females. Most participants had low educational levels, and 64.35% reported using toothbrushes for oral hygiene. However, brushing habits were suboptimal, with 64.4% using incorrect brushing techniques. Myths such as "clove oil relieves toothache" (68.3%) and "tobacco relieves toothache" (51.5%) were prevalent. Tobacco use was high, with 66.3% consuming smokeless tobacco, and the most common reasons for use were family influence (37.6%) and peer pressure (28.7%). Education and occupation significantly influenced oral health behavior and tobacco habits. The study highlights the significant oral health challenges faced by the Katkari tribe, including poor hygiene practices, high tobacco use, and widespread myths. These issues are compounded by low education levels and limited healthcare access. Culturally sensitive health education, community-based interventions, and tobacco cessation programs are needed to address these challenges and improve the overall health of the community.

Orphaned children face heightened vulnerability due to the absence of parental care and limited access to preventive services. Evidence linking oral health knowledge, attitudes, and practice (KAP) with clinical outcomes in this population remains limited. This study aimed to assess oral health KAP among orphaned children in Karaj, Iran, and examine their associations with clinical indicators of dental caries, gingival status, and oral hygiene. In this cross-sectional study, 72 children aged 6-12 years residing in four government-run quasi-family centers in Karaj were examined between October 2024 and January 2025 through a census sampling approach. Inclusion required age eligibility and informed consent, whereas children with systemic or developmental disorders or those receiving orthodontic treatment were excluded. Data were collected using a structured, validated questionnaire (&#x3b1;&#x2009;=&#x2009;0.83) to assess KAP and demographic factors. Clinical examinations were performed by a calibrated examiner (ZJ) (Kappa&#x2009;=&#x2009;87.68%) using the CAST, GI, and OHI-s indices. Logistic and linear regression models were used to examine predictor variables of KAP and oral health outcomes. The mean scores of knowledge, attitude, and practice were 3.16&#x2009;&#xb1;&#x2009;1.60 (out of 7), 33.52&#x2009;&#xb1;&#x2009;4.36 (out of 50), and 10.26&#x2009;&#xb1;&#x2009;2.72 (out of 20), respectively. Overall, 62.5% of children demonstrated fair oral hygiene (OHI-s&#x2009;=&#x2009;1.75&#x2009;&#xb1;&#x2009;1.58) with mild gingival inflammation. CAST assessment indicated that fewer than one-third of primary molars were sound, while more than half of permanent first molars showed enamel caries. Regression analyses showed that frequent toothbrushing (p&#x2009;=&#x2009;0.015, OR=0.52, 95% CI: 0.30-0.88) and more positive attitudes toward oral health (p&#x2009;=&#x2009;0.013, OR=0.70, 95% CI: 0.53-0.93) were significant predictors of improved oral status, whereas knowledge and self-reported practice were not consistent predictors. Orphaned children in Karaj demonstrated moderate oral hygiene, a high prevalence of untreated dental caries, and limited awareness of oral health. Addressing these behavioral and systemic gaps through targeted, evidence-based interventions-particularly oral health education, caregiver involvement, and routine dental monitoring-may help improve oral health outcomes in this vulnerable population.

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.

Despite evidence linking oral health to severe COVID-19 outcomes and its potential role in surveillance and service delivery, integration remained absent. This study enquired about: (1) representation of oral health in national COVID-19 taskforces and funding; (2) policy-level barriers to inclusion; (3) lessons from maintaining essential services; and (4) strategies for mobilizing oral health professionals in future emergencies. We conducted a scoping review guided by the PRISMA-ScR framework. Systematic searches were performed in PubMed/MEDLINE and Scopus (2000-2025) using tailored search strings combining key terms: oral health, pandemic preparedness, COVID-19, dentistry, health systems and related MeSH terms. Eligible evidence included peer-reviewed studies, reviews, policy documents and commentaries in English. Non-human studies were excluded. Data were charted using the WHO Health System Building Blocks framework. After dual-reviewer screening, 2569-3860 records were screened, yielding 5-8 eligible studies per question (26 studies total). The evidence revealed a consistent narrative of systemic exclusion yet operational resilience. For representation, oral health professionals were almost universally absent from national COVID-19 task forces, with dedicated financial support entirely lacking. Regarding barriers, policy integration was hindered by the framing of oral care as non-essential, its omission from global health security architectures like the International Health Regulations, and limited professional advocacy. In contrast, lessons from service adaptation demonstrated that essential care was maintained through the rapid adoption of triage, teledentistry, robust infection control and effective communication. On workforce mobilization, while consensus existed on the potential for OHPs to expand into roles such as vaccination and surveillance, implementation was obstructed by a lack of pre-emergency training, formal deployment mechanisms and regulatory frameworks with minimal linkage to international instruments. The review reflects systemic neglect of oral health, with the literature dominated by descriptions of clinical and operational adaptations rather than formal policy integration. We identify missed opportunities in leveraging OHPs for pandemic response and propose embedding oral health within One Health governance, financing, surveillance and emergency response structures to build more resilient health systems.

Oral health and nutritional status are key determinants of healthy aging, yet population&#x2011;level evidence linking self&#x2011;assessed oral health to objectively defined nutritional risk in older adults is limited. We examined associations between self&#x2011;reported oral health domains and nutritional risk, defined by the Geriatric Nutritional Risk Index (GNRI), in a nationally representative sample of U.S. adults aged 60 years and older. Cross&#x2011;sectional data from the 2009-2014 National Health and Nutrition Examination Survey were analyzed for 3898 older participants with complete oral health questionnaire and covariate data, representing approximately 44.65 million noninstitutionalized U.S. adults aged &#x2265;60 years. Self&#x2011;reported measures included periodontal history and oral hygiene behaviors. GNRI was computed from serum albumin and body weight relative to ideal weight and dichotomized as high nutritional risk (GNRI&#xa0;<&#xa0;98) versus low risk (GNRI&#xa0;&#x2265;&#xa0;98). Weighted logistic regression models assessed associations controlling for demographic, socioeconomic, behavioral variables, and multimorbidity. Having ever received treatment for gum disease was associated with lower odds of nutritional risk [odds ratio (OR): 0.67, 95% confidence interval (CI): 0.45-0.99]. Frequent use of dental floss or interdental cleaning devices was also associated with lower odds of nutritional risk (OR: 0.57, 95% CI: 0.40-0.81). Other self&#x2011;reported oral symptoms were not significantly associated with GNRI classification. Specific self&#x2011;assessed oral health domains were independently associated with GNRI&#x2011;defined malnutrition risk in older adults. Targeted subjective oral health measures may aid in identifying individuals at elevated nutritional risk and support integrative screening strategies in geriatric care.

To explore how individuals who have lost or have missing teeth and subsequently received dentures make sense of the factors influencing their oral health and well-being. Thematic and structural narrative analysis was used to evaluate 19 semi-structured interview transcripts from a secondary dataset of United Kingdom adults (10 males and 9 females, aged 22-86&#x2009;years) living with dentures. When participants shared their denture experiences, they integrated their oral health challenges into the broader context of their daily lives. Four themes emerged: socioeconomic inequality, masking oral functioning, accepting vulnerability, and fear of social judgement. Analysing these themes demonstrated cyclical and complex links between oral health and sense of well-being (both hedonic and eudaimonic), with socioeconomic position and limited resources moderating these links. Structural inequality, emotional mediators, social and cultural context, plus personal background shaped how individuals perceive and respond to their oral health challenges. The study reveals the multifaceted and dynamic links between oral health and well-being by employing a case-centred narrative analysis of the underlying mechanisms. The narratives confirm the Oral Health Related Quality of Life (OHRQoL) framework and add depth by demonstrating how the impacts extend to eudaimonic domains such as autonomy, personal growth and self-acceptance. This highlights the individualised meaning of oral health conditions within one's life narrative. These findings suggest the integration of eudaimonic well-being domains into existing OHRQoL frameworks for a comprehensive understanding of oral health experience.

National policies have been introduced to promote the delivery of Culturally Safe dental care for Aboriginal and Torres Strait Islander Australians. However, the understanding of what constitutes Culturally Safe dental care and how it can be effectively implemented into clinical practice, remains limited. This study aimed to gain a deeper understanding of Culturally Safe oral health care through collaboration with Aboriginal people residing in regional Victoria. A Community-Based Participatory Research (CBPR) approach was utilised between the study team and a Victorian Aboriginal Community Controlled Health Service to design the study and develop yarning prompts. Following engagement, 40 individuals from the Victorian Aboriginal community participated in yarning groups that were audio recorded. Discussions were guided by a researcher who, through clinical work, had community familiarity. Following transcription and de-identification, the data were thematically analysed utilising a constructivist grounded theory approach. The data analysis revealed 13 themes that were categorised according to Ramsden's foundational work with Cultural Safety domains: Holistic care (physical, mental, social, spiritual), power (clinical interactions, agency, overseas-trained practitioners, vulnerable space and sense of belonging), access to services (cost and time) and trust (trust building and historical distrust). These themes discuss significant barriers to achieving Culturally Safe oral health care for Aboriginal Australians in regional Victoria. These are influenced by structural issues like limited oral health funding, deficit narratives and a limited Aboriginal dental workforce. Culturally Safe oral health care is a dynamic, relational practice that is embedded in Aboriginal worldviews. Achieving it requires structural reform, trust-based relationships and communication that empowers to ensure oral health is addressed holistically. These findings will help inform future policy, education and service delivery initiatives grounded in Aboriginal knowledge systems.

Social frailty and oral health literacy (OHL) may be influenced by the residential environment; however, evidence regarding regional differences among older adults remains limited. This study aimed to examine differences in social frailty and OHL between older adult study populations recruited from urban and rural areas. This cross-sectional study included 176 community-dwelling older adults (88 participants in the urban study population and 88 participants in the rural study population) enrolled between November 2024 and November 2025. Social frailty was assessed using a five-item assessment, and OHL was evaluated using a 16-item questionnaire. Oral health status was assessed using the Japanese version of the Oral Health Assessment Tool (OHAT-J), and health-related quality of life (QOL) was measured using the Short Form-8 (SF-8). Ordinal logistic regression and multinomial logistic regression analyses were performed to examine the associations of study population (rural vs urban) with social frailty and OHL, respectively, adjusting for demographic and health-related factors. Compared with the urban study population, the rural study population showed a higher prevalence of social frailty (p = 0.004) and low OHL (p < 0.001). In contrast, mental health-related QOL and oral health status were more favorable in the rural study population (p < 0.001). Multivariable analyses showed that participants in the rural study population had higher levels of social frailty and lower OHL than those in the urban study population. Participants in the rural study population demonstrated favorable mental health-related QOL and oral health status; however, higher levels of social frailty and lower OHL were also observed. Given the cross-sectional design and differences in participant recruitment settings between the two study populations, these findings should be interpreted as exploratory and hypothesis-generating rather than as definitive evidence of causal relationships. Nevertheless, these findings may inform the development of region-specific, integrated approaches that combine support for social participation with improved access to health-related information.

Despite well-documented adverse impact on both systemic and oral health, tobacco smoking remains a persistent issue in military populations. It contributes to the global burden of tobacco use and is often perceived as a means of coping with stress in military settings. This study aimed to assess the prevalence of tobacco use among military marines, its impact on oral health, and their level of knowledge regarding smoking, as well as to identify variables associated with their smoking habits. Thus, it provides a basis for implementing appropriate tobacco cessation and harm reduction strategies, particularly within the military. This study demonstrated a high prevalence of tobacco use among military marines, despite generally high levels of knowledge regarding tobacco smoking. A knowledge gap was still evident in relation to smoking behavior. The most frequently reported oral health impacts among smokers were tooth staining, halitosis, and taste impairment. Duration of military service and level of knowledge were significantly associated with smoking behavior. A validated and reliable online survey was administered to collect socio-demographic data, including age, education level, and length of military service. The survey also assessed smoking status, smoking behavior, its impact on oral health, and participants' knowledge of smoking-related risks. Data were analyzed descriptively, and associated factors were examined using multivariate analysis. A total of 475 military marines participated in the study. Of these, 44.8% were current smokers, 25.7% were former smokers, and 29.5% had never smoked. Overall, 71% of participants demonstrated good knowledge of smoking-related risks. The most commonly reported oral health impacts were halitosis, tooth staining, and impaired taste. Smoking status did not differ significantly by age (p = 0.095) or education level (p = 0.610), but differed significantly by length of military service (p < 0.05) and level of knowledge (p < 0.05). Multivariate analysis using multinomial logistic regression indicated that length of military service was a significant predictor of smoking behavior (p = 0.005; 95% CI: 0.282-0.800), with 1-5 years of service emerging as the most influential category. Based on the odds ratio, individuals with 11-15 years of service had a 1.8-fold higher likelihood of smoking. Despite a generally good level of knowledge regarding the health risks of smoking, the prevalence of tobacco use remains high among military marines. The most commonly reported oral health impacts were tooth staining, halitosis, and impaired taste. Length of military service and level of knowledge regarding smoking were identified as significant factors associated with smoking status.

The aim of this study was to evaluate the oral health status of professional athletes in Georgia and to identify associated risk factors. A cross-sectional study was conducted among 470 professional athletes representing different sports disciplines and regions of Georgia. Data were collected using a structured questionnaire and standardized clinical examination performed under appropriate lighting conditions. Oral health was assessed using internationally recognized indices, such as DMFT (Decayed, Missing and Filled Teeth Index), OHI-S (Green-Vermillion Oral Hygiene Index), PMA (Papillary-Marginal-Alveolar Index), CPI (Community Periodontal Index), BEWE (Basic Erosive Wear Examination), and TWES (Tooth Wear Evaluation System). Statistical analysis was performed using SPSS version 23.0. Dental caries prevalence was high (85.5%), with a mean DMFT score of 3.24&#xb1;1.73 and a Significant Caries Index (SCI) of 4.94. A statistically significant association was observed between the frequency of sweet carbonated beverage consumption and caries intensity (Spearman r&#x209b;=0.33; p<0.001). The mean OHI-S score was 1.73&#xb1;1.29, indicating generally fair oral hygiene, although signs of gingival inflammation were common. According to the BEWE index, 58.7% of athletes had a low risk of erosive tooth wear, while 41.3% presented moderate to very high risk. Tooth wear was detected in 42.1% of athletes and showed a strong association with bruxism (p<0.001). In addition, psychological stress and dry mouth were significantly associated with higher caries intensity. The findings indicate a considerable burden of oral diseases among professional athletes in Georgia. These results highlight the need for preventive oral health programs, improved oral hygiene education, and the integration of regular dental screening into sports medicine practice. Oral health should also be considered an important component of overall athlete health and sports performance.

Access to dental care is often limited by financial, structural and social factors, contributing to persistent oral health inequalities globally. This scoping review systematically maps and synthesizes how financial pressures influence access, service utilization and oral health outcomes, particularly among underserved and vulnerable populations. Following PRISMA-ScR guidelines, 73 peer-reviewed studies published between 2004 and 2024 were included. The included studies spanned high-income countries (the USA, Canada, Japan, South Korea and Australia) and low- and middle-income countries (Iran, Tanzania, Uganda, Lesotho and Pakistan). Key outcomes were out-of-pocket expenditures, catastrophic health expenditure, delayed or foregone care, unmet needs, insurance gaps and utilization patterns. Study populations included adults, children, older adults and vulnerable groups such as racial and ethnic minorities and individuals with special needs. Between 17% and 63% of participants reported delaying or foregoing dental care due to cost, reflecting variation across populations and study contexts. Structural barriers, such as transportation limitations, provider shortages and clinic accessibility, further restrict care in low-resource areas. Social and cultural factors, such as discrimination, language barriers and mistrust, also reduced care-seeking among marginalized groups. These findings indicate the need for policies that address both financial and non-financial barriers to dental care. Reducing financial barriers requires more than expanding coverage alone. Policies should aim to provide comprehensive benefits, affordable essential services, adequate provider availability and strategies that address structural and social barriers to promote equitable oral health outcomes.