Community Dental Health

This editorial briefly considers the increasing epidemic of obesity and Type 2 diabetes, the underlying drivers of junk food and sugary drinks, and the recent scientific and campaigning movements culminating in the UK Chancellor's surprise announcement of a Sugary Drinks Levy.

In 1966, James published an article in the British Dental Journal (and reprinted here) which made recommendations on the teaching of dental public health. The following commentary reviews the ideas put forward by James and how these relate to concepts of dental public health in the undergraduate dental curricula of 2016.

Inequity of dental health and dental service use for Travellers in the UK. National guidance on improving community oral health, stresses an imperative to involve and engage with "those whose economic, social and environmental circumstances or lifestyle place them at high risk of poor oral health or make it difficult for them to access dental services".

Oral health promotion and simple treatments were provided on two Traveller sites from a mobile dental unit (MDU) over a 5-day period and patients with extensive oral disease were referred to a fixed-site clinic for continued care.

Most children, 60%, reportedly brushed once daily or less, only 40% brushed twice daily. Obvious visual caries were evident in 23 out of the 35 children (66%). A moderate to high risk of developing future caries was identified in 92% of Traveller children based on their existing diet, oral hygiene practices and caries experience.

Oral care was successfully provided on an MDU, but this is an expensive resource and should not be considered a permanent solution. Oral health promotion messages delivered in the families' homes or local community settings through their established health services, such as health visitors or community nurses, may help to reinforce good oral hygiene and diet practices and needs robust evaluation.

To categorize and tabulate layperson inquiries made to an Internet dental health support site to identify oral conditions and associated behaviors of concern.

A retrospective tabulation of wall postings was made from an established dental health support website hosted by WebMD over a 2-year period (April 2013-April 2015). A mixed method approach of content and thematic analysis was used. Content analysis identified content of oral health concerns, while thematic analysis using grounded theory identified themes and beliefs concerning associated behaviors.

The presence of non-descript growths on the tongue and swelling and/or discoloration of the lips elicited the most inquires. These were often self-diagnosed as oral candidiasis, a STD or a carcinoma, provoking high levels of self-concern. Unprotected sexual activity, excessive ingestion of soft and hard beverages, smoking and overexposure to the sun were the most frequently self-reported behaviors associated with their concerns. Many questions focused upon "normal" healing, including the amount of edema and discomfort that could occur following oral surgery or other dental procedures. Information concerning alternative treatments was often solicited, and many alluded that they had not been provided sufficient information to make informed decisions prior to dental treatment.

Laypersons have many oral health concerns particularly in relationship to the development of undiagnosed pathologies in conjunction with a history of volitional behaviors. The dental community should monitor these sites to provide advice and links to information about common oral health concerns and their possible association with detrimental behaviors.

To review articles exploring manifestations of avoidance of or non-attendance to dental care, to identify background and concomitant factors specifically associated with dental avoidance among adolescents.

PubMed, CINAHL and PsychINFO were searched using MeSH terms and keywords covering dental avoidance, non-attendance and non-utilization. Searches were limited to peer-reviewed studies in English, published in 1994-2014. Twenty-one research articles were included. Data were extracted, ordered, coded, categorized, and summarized according to the integrative review method.

The identified factors formed three common major themes: Environmental, Individual and Situational factors. Only seven studies, all from Sweden or Norway, investigated factors associated with dental avoidance. The remaining 14 studies were geographically widespread. Regarding avoidance, the main focus was found to be on individual and situational factors, while environmental factors were more often investigated for the outcome non-attendance.

Although a wide variety of environmental, individual and situational factors could be summarized in this review, factors specifically associated with dental avoidance in a context of free dental care still need to be investigated. The possible impacts of cultural background, of tobacco, alcohol or drug use and of psycho-social circumstances deserve further research. Clinical implications of today's knowledge may be to pay attention to the adolescents' individual background and everyday life situation, to offer agreed and individualized treatment, taking fears and attitudes into consideration, to avoid painful treatments, and to be alert for early signs of avoidance.

To estimate the association between the restorative material used and time to further treatment across population cohorts with universal coverage for dental treatment.

Cohort study of variation in survival time for tooth restorations over time and by restoration material used based on an Accelerated Failure Time model.

Primary dental care clinics

Members of Canada's First Nations and Inuit population covered by the Non-Insured Health Benefits program of Health Canada for the period April 1, 1999 to March 31, 2012.

Tooth restorations using resin composite or amalgam material.

Survival time of restoration to further treatment.

Median survival time for resin composite was 51 days longer than amalgam, for restorations placed in 1999-2000. This difference was not statistically significant (p⟩0.05). Median survival times were lower for females, older subjects. Those visiting the dentist annually, and decreased monotonically over time from 11.2 and 11.3 years for resin composite and amalgam restorations respectively placed in 1999-2000 to 6.9 and 7.0 years for those placed in 2009-10.

Resin composite restorations performed no better than amalgams over the study period, but cost considerably more. With the combination of the overall decrease in survival times for both resin composite and amalgam restorations and the increase in use of resin composite, the costs of serving Health Canada's Non-Insured Health Benefits population will rise considerably, even without any increase in the incidence of caries.

To investigate the impact of an integrated oral health promotion intervention, within the Syrian national immunisation programme, which provided free preventive dental health products, without health workers' counselling, on one-year-old infants' tooth-brushing and bottle-feeding termination practices.

a randomised controlled parallel-group trial.

A maternal and child health centre in Sweida city, Syria.

92 mothers of one-year-old infants, attending an infant vaccination clinic, were allocated into three groups: Test, Control One and Control Two.

The Test group received an oral health promotion package including an infant oral health pamphlet, a baby toothbrush, fluoride toothpaste (1,000 mg/L) and a trainer cup, without health workers' counselling. Control One received only the pamphlet, whilst Control Two received no intervention.

after one month, the presence of old plaque on infants' primary teeth was checked, to assess tooth-brushing behaviour. Also, a mothers' self-completed questionnaire was administered to assess bottle-feeding use

The response rate was 100% and the attrition rate was zero. There were differences in tooth-brushing and bottle-feeding termination practices between the three groups (P⟩0.001). Infants in the Test group were less likely to have old plaque and more likely to stop bottle-feeding than their counterparts in the two control groups. There were no differences in the abovementioned outcomes between the two control groups.

Providing free preventive dental health products, without health worker's counselling, in an integrated oral health promotion intervention, was an effective measure to promote infants' tooth-brushing and bottle-feeding termination practices. These findings should be supported by long-term follow up studies.

The popularity of cosmetic surgery has seen a rapid increase recently, with the trend mirrored in dentistry. The Department of Health expressed concerns about the potential for biological and psychosocial harm of these cosmetic procedures. Furthermore, the dental public health implications (DPH) of the growing uptake of cosmetic dental procedures have not been explored.

Conduct a scoping review to explore the DPH implications of cosmetic dentistry and identify gaps for future research.

A fivestage scoping review was conducted of studies identified using the search terms cosmetic AND dentistry. Data from the studies meeting the inclusion criteria were extracted, collated and summarised into themes.

Fifty-seven papers met the inclusion criteria (11 cross-sectional studies, 10 literature reviews and 36 opinion pieces). The DPH implications were summarised into five emergent themes: dento-legal and ethical, marketing, psychosocial, biological and workforce. These themes revealed patients' increased expectations, expanding commercialisation of the profession, psychological risks to vulnerable patients, the iatrogenic consequences of invasive cosmetic dental procedures and workforce implications of the current trends.

The scoping review found that existing literature on cosmetic dentistry is predominately anecdotal - professional opinions and discussions. Despite this, our findings demonstrated workforce training and governance implications due to increased demand for cosmetic dentistry. Further empirical research is needed to understand the DPH implications of the increasing demand and uptake of cosmetic dental procedures to guide evidence-based policy to safeguard patients and improve the quality of dental services.

The integration of qualitative and quantitative approaches introduces new avenues to bridge strengths, and address weaknesses of both methods.

To develop measure(s) for migrant dentist experiences in Australia through a mixed methods approach.

The sequential qualitative-quantitative design involved first the harvesting of data items from qualitative study, followed by a national survey of migrant dentists in Australia. Statements representing unique experiences in migrant dentists' life stories were deployed the survey questionnaire, using a five-point Likert scale. Factor analysis was used to examine component factors.

Eighty-two statements from 51 participants were harvested from the qualitative analysis. A total of 1,022 of 1,977 migrant dentists (response rate 54.5%) returned completed questionnaires. Factor analysis supported an initial eight-factor solution; further scale development and reliability analysis led to five scales with a final list of 38 life story experience (LSE) items. Three scales were based on home country events: health system and general lifestyle concerns (LSE1; 10 items), society and culture (LSE4; 4 items) and career development (LSE5; 4 items). Two scales included migrant experiences in Australia: appreciation towards Australian way of life (LSE2; 13 items) and settlement concerns (LSE3; 7 items).

The five life story experience scales provided necessary conceptual clarity and empirical grounding to explore migrant dentist experiences in Australia. Being based on original migrant dentist narrations, these scales have the potential to offer in-depth insights for policy makers and support future research on dentist migration.

To assess the prevalence of dental pain in the past year among adults in Tehran-Iran, and its determinants.

Cross-sectional population study.

A sample of 20,322 adults (18-64 years old).

A questionnaire survey was conducted across the 22 districts using the multi-stage random sampling method. Data were analysed applying the complex samples method. Multiple logistic regression analysis was used to adjust the effects of other variables on the outcome variable as dental pain in the past year.

Overall, 19,645 individuals with a mean age of 39.9 (SD=12.5) years responded. Dental pain in the past year was reported by about one sixth (14%) of subjects and associated with being widowed/divorced (OR 1.45, 95%CI 1.07-1.97, p=0.016), married (OR 1.24, 95%CI 1.04-1.47, p=0.016), Azari minority (OR 1.2, 95%CI 1.05-1.37, p=0.009) and having dental visit in the past year (OR 2.6, 95%CI 2.29-2.95,p⟨0.001). Older subjects (OR 0.76, 95%CI 0.59-0.97, p= 0.029), those with a high economic status (OR 0.84, 95%CI 0.72-0.98, p=0.03), good (OR 0.75, 95%CI 0.58-0.96, p=0.023) or moderate oral health behaviour (OR 0.79, 95%CI 0.62-0.99, p=0.042), and good self-perceived oral health (OR 0.52, 95%CI 0.45-0.61, pp⟨0.001) were less likely to report dental pain.

Dental pain in the past year was associated with being married/widowed, being a minority, and visiting a dentist in the past year. Older subjects and those with a high socio-economic status, good/moderate oral health behaviour, and good self-perceived oral health were less likely to report dental pain.