Community Dental Health

In 2019 the Sociedad Española de Epidemiología y Salud Pública Oral (SESPO, The Spanish Society of Epidemi- ology and Oral Public Health) approached BASCD and EADPH about using Community Dental Health as their offi cial journal. Very pleasant discussions between all parties mean that henceforth, SESPO will translate the abstracts of all papers published in Community Dental Health so that they may be placed on our website. The SESPO website will link to the translated abstracts.

In 2019 the Sociedad Española de Epidemiología y Salud Pública Oral (SESPO, The Spanish Society of Epidemi- ology and Oral Public Health) approached BASCD and EADPH about using Community Dental Health as their offi cial journal. Very pleasant discussions between all parties mean that henceforth, SESPO will translate the abstracts of all papers published in Community Dental Health so that they may be placed on our website. The SESPO website will link to the translated abstracts.

Objectives: Toothwear may impact on an individual’s everyday life, yet there is little research investigating the association between toothwear and oral health related quality of life (OHRQoL). The aim of the present study was to investigate the association between toothwear and OHRQoL in adults in the United Kingdom. Basic research design: This study involved secondary analysis of data from 5187 participants with toothwear in the Adult Dental Health Survey conducted in 2009. Toothwear was assessed using Smith and Knight criteria and the Basic Erosive Wear Index and classified as mild, moderate and severe. Main outcome measures: Correlation analyses were carried out between OHIP-14 total scores and toothwear type. Regression analyses investigated the association between toothwear and OHRQoL adjusting for demographic variables. Results: There was a significant association between toothwear and OHRQoL, with more severe toothwear associated with greater oral health impact on daily life. The association between erosive toothwear and OHRQoL was significant for moderate and severe severities only. The adjusted linear regression model identified that toothwear accounted for 0.02% of the variance in total OHIP-14 scores. Females, younger individuals and less deprived individuals showed a greater association between toothwear and OHRQoL. Conclusions: In this general population sample, there was a small significant association between toothwear and OHRQoL impacts. However, the association was only significant for more severe categories of toothwear.

Objectives: Toothwear may impact on an individual’s everyday life, yet there is little research investigating the association between toothwear and oral health related quality of life (OHRQoL). The aim of the present study was to investigate the association between toothwear and OHRQoL in adults in the United Kingdom. Basic research design: This study involved secondary analysis of data from 5187 participants with toothwear in the Adult Dental Health Survey conducted in 2009. Toothwear was assessed using Smith and Knight criteria and the Basic Erosive Wear Index and classified as mild, moderate and severe. Main outcome measures: Correlation analyses were carried out between OHIP-14 total scores and toothwear type. Regression analyses investigated the association between toothwear and OHRQoL adjusting for demographic variables. Results: There was a significant association between toothwear and OHRQoL, with more severe toothwear associated with greater oral health impact on daily life. The association between erosive toothwear and OHRQoL was significant for moderate and severe severities only. The adjusted linear regression model identified that toothwear accounted for 0.02% of the variance in total OHIP-14 scores. Females, younger individuals and less deprived individuals showed a greater association between toothwear and OHRQoL. Conclusions: In this general population sample, there was a small significant association between toothwear and OHRQoL impacts. However, the association was only significant for more severe categories of toothwear.

Background: The United Nations (UN) estimated the population of Iraq in 2005 at almost 29 million, of which nearly 14 million were children aged 0-14 years. Iraq is aiming to improve child oral health, and subsequent child general health, through school dental services, offered by primary health care centres. Objective: To develop and test a GIS-based planning approach for the Hillah district of Iraq as a model for the rest of the country. All data were gathered from open sources. Setting: The city has 98 neighbourhoods, with a total child population of 368 274, occupying 161 Sq. km2, with 14 fixed primary health care dental clinics. Design: Accessibility zones were created using GIS, based on the ability of dentists to make their way to schools. Outcome measures: A total of 23 307 of 0-4 year-olds (14%) and 74 384 (45%) of 0-15 year-olds lived outside the accessibility zones. Result: Areas where services are not available to the child population were identified, whether or not they attended primary schools. Conclusion: Reforming the existing dental health services in Iraq can be achieved by careful planning and appropriate utilisation of health resources.

Background: The United Nations (UN) estimated the population of Iraq in 2005 at almost 29 million, of which nearly 14 million were children aged 0-14 years. Iraq is aiming to improve child oral health, and subsequent child general health, through school dental services, offered by primary health care centres. Objective: To develop and test a GIS-based planning approach for the Hillah district of Iraq as a model for the rest of the country. All data were gathered from open sources. Setting: The city has 98 neighbourhoods, with a total child population of 368 274, occupying 161 Sq. km2, with 14 fixed primary health care dental clinics. Design: Accessibility zones were created using GIS, based on the ability of dentists to make their way to schools. Outcome measures: A total of 23 307 of 0-4 year-olds (14%) and 74 384 (45%) of 0-15 year-olds lived outside the accessibility zones. Result: Areas where services are not available to the child population were identified, whether or not they attended primary schools. Conclusion: Reforming the existing dental health services in Iraq can be achieved by careful planning and appropriate utilisation of health resources.

Objectives: Few studies have examined the effect of sucrose intake in coffee or tea (SCT) on dental caries, especially root caries, in elderly people. The purpose of the present study was to examine the associations between SCT and the prevalence of root or coronal caries in community-dwelling elderly Japanese. Methods: Participants were 370 elders aged 75 years from a larger cohort study of elders in Niigata City, Japan. Dietary habits during the preceding month were assessed with a validated brief self-administered diet history questionnaire (BDHQ): The caries examination was conducted using mirror and ball-pointed periodontal probes under artificial light. Poisson regression analysis was performed to analyze the prevalence–rate ratios (PRRs) between SCT and the root or coronal caries. The number of root or coronal caries was selected as the dependent variable for the analysis. Then, SCT (tertiles labeled low, medium and high) and other 4 variables were selected as independent variables. Results: The PRRs between the number of root caries lesions and SCT were signifi cantly higher in the second (medium intake, 1.38, p ⟨ 0.001) and third tertiles (high intake, 2.07, p ⟨ 0.001): Similar tendencies were seen for the number of coronal caries lesions (PRRs in the second and third tertiles 1.74 and 2.46, respectively, both p ⟨ 0.001): Conclusion: A significant positive relationship was observed between sucrose in coffee and tea and the number of coronal or root caries lesions in community-dwelling elderly Japanese

Objectives: Few studies have examined the effect of sucrose intake in coffee or tea (SCT) on dental caries, especially root caries, in elderly people. The purpose of the present study was to examine the associations between SCT and the prevalence of root or coronal caries in community-dwelling elderly Japanese. Methods: Participants were 370 elders aged 75 years from a larger cohort study of elders in Niigata City, Japan. Dietary habits during the preceding month were assessed with a validated brief self-administered diet history questionnaire (BDHQ): The caries examination was conducted using mirror and ball-pointed periodontal probes under artificial light. Poisson regression analysis was performed to analyze the prevalence–rate ratios (PRRs) between SCT and the root or coronal caries. The number of root or coronal caries was selected as the dependent variable for the analysis. Then, SCT (tertiles labeled low, medium and high) and other 4 variables were selected as independent variables. Results: The PRRs between the number of root caries lesions and SCT were signifi cantly higher in the second (medium intake, 1.38, p ⟨ 0.001) and third tertiles (high intake, 2.07, p ⟨ 0.001): Similar tendencies were seen for the number of coronal caries lesions (PRRs in the second and third tertiles 1.74 and 2.46, respectively, both p ⟨ 0.001): Conclusion: A significant positive relationship was observed between sucrose in coffee and tea and the number of coronal or root caries lesions in community-dwelling elderly Japanese

Objectives: Examine the relationship between supply of care provided by dental therapists and emergency dental consultations in Alaska Native communities. Methods: Explanatory sequential mixed-methods study using Alaska Medicaid and electronic health record (EHR) data from the Yukon-Kuskokwim Health Corporation (YKHC), and interview data from six Alaska Native communities. From the Medicaid data, we estimated community-level dental therapy treatment days and from the EHR data we identified emergency dental consultations. We calculated Spearman partial correlation coefficients and ran confounder-adjusted models for children and adults. Interview data collected from YKHC providers (N=16) and community members (N=125) were content analysed. The quantitative and qualitative data were integrated through connecting. Results were visualized with a joint display. Results: There were significant negative correlations between dental therapy treatment days and emergency dental consultations for children (partial rank correlation = -0.48; p⟨0.001) and for adults (partial rank correlation = -0.18; p=0.03). Six pediatric themes emerged: child-focused health priorities; school-based dental programs; oral health education and preventive behaviors; dental care availability; healthier teeth; and satisfaction with care. There were four adult themes: satisfaction with care; adults as a lower priority; difficulties getting appointments; and limited scope of practice of dental therapy. Conclusions: Alaska Native children, and to a lesser extent adults, in communities served more intensively by dental therapists have benefitted. There are high levels of unmet dental need as evidenced by high emergency dental consultation rates. Future research should identify ways to address unmet dental needs, especially for adults.

Objectives: Examine the relationship between supply of care provided by dental therapists and emergency dental consultations in Alaska Native communities. Methods: Explanatory sequential mixed-methods study using Alaska Medicaid and electronic health record (EHR) data from the Yukon-Kuskokwim Health Corporation (YKHC), and interview data from six Alaska Native communities. From the Medicaid data, we estimated community-level dental therapy treatment days and from the EHR data we identified emergency dental consultations. We calculated Spearman partial correlation coefficients and ran confounder-adjusted models for children and adults. Interview data collected from YKHC providers (N=16) and community members (N=125) were content analysed. The quantitative and qualitative data were integrated through connecting. Results were visualized with a joint display. Results: There were significant negative correlations between dental therapy treatment days and emergency dental consultations for children (partial rank correlation = -0.48; p⟨0.001) and for adults (partial rank correlation = -0.18; p=0.03). Six pediatric themes emerged: child-focused health priorities; school-based dental programs; oral health education and preventive behaviors; dental care availability; healthier teeth; and satisfaction with care. There were four adult themes: satisfaction with care; adults as a lower priority; difficulties getting appointments; and limited scope of practice of dental therapy. Conclusions: Alaska Native children, and to a lesser extent adults, in communities served more intensively by dental therapists have benefitted. There are high levels of unmet dental need as evidenced by high emergency dental consultation rates. Future research should identify ways to address unmet dental needs, especially for adults.

Objective: To identify determinants of oral health-quality of life (OHRQoL) and its association with overall quality of life (QoL). Basic research design: Cross-sectional analytic study. Predictors variables were selected based on Wilson and Cleary’s model for patient outcomes including individual factors and socioeconomic status (SES) to represent environmental and clinical/biological factors. Participants: 444 children aged 11 to 14 years. Main outcome measures: OHRQoL and overall QoL. Data were analysed using univariate correlation coefficients and structural equation modelling. The initial path was analysed for the goodness-of-fit. The level of significance adjusted at 5% and 95% confidence intervals. Results: In the final model, sense of coherence (SOC) and dental coping behaviour displayed direct and indirect effects on OHRQoL and QoL. Gingival condition and metabolic disease control displayed bidirectional effects on overall QoL. SES was directly and indirectly associated with OHRQoL. The fit of final model indicators was CFI = 0.99, GFI = 0.99. AGFI = 0.68, TLI = 0.97, RMSEA =0.03, χ² = 13.25, and χ²/d.f. ratio = 1.43 (p ⟩ 0.05). Conclusions: Enhancing the SOC and SE of early adolescents with T1DM may improve their oral-health related quality of life and overall quality of life.

Objective: To identify determinants of oral health-quality of life (OHRQoL) and its association with overall quality of life (QoL). Basic research design: Cross-sectional analytic study. Predictors variables were selected based on Wilson and Cleary’s model for patient outcomes including individual factors and socioeconomic status (SES) to represent environmental and clinical/biological factors. Participants: 444 children aged 11 to 14 years. Main outcome measures: OHRQoL and overall QoL. Data were analysed using univariate correlation coefficients and structural equation modelling. The initial path was analysed for the goodness-of-fit. The level of significance adjusted at 5% and 95% confidence intervals. Results: In the final model, sense of coherence (SOC) and dental coping behaviour displayed direct and indirect effects on OHRQoL and QoL. Gingival condition and metabolic disease control displayed bidirectional effects on overall QoL. SES was directly and indirectly associated with OHRQoL. The fit of final model indicators was CFI = 0.99, GFI = 0.99. AGFI = 0.68, TLI = 0.97, RMSEA =0.03, χ² = 13.25, and χ²/d.f. ratio = 1.43 (p ⟩ 0.05). Conclusions: Enhancing the SOC and SE of early adolescents with T1DM may improve their oral-health related quality of life and overall quality of life.

Objective: Assess interventions and health outcomes in studies giving data on economic evaluation (EE) of school-based caries prevention. Basic research design: Systematic review. Both partial EE that included cost description, cost-outcome description, cost analysis and full EE that included both cost and outcome of at least 2 interventions were included. Quality assessment used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Results: An electronic search of 6 databases identified 558 titles and abstracts. Paper eligibility screening identified 32 full papers which met the inclusion criteria. Most were conducted in the United States and cost effectiveness analysis was the most common type of EE. Nine were model-based studies and 17 derived their data from single studies. Sealants were most frequently evaluated followed by fluoride mouthrinse. Many CHEERS criteria were not met in the included studies. The following were found to be cost-effective: school-based, under general supervision, longer duration of program and targeting high caries risk groups. Conclusions: The deficiencies in the existing studies warrant more investigations of the economic aspects of school-based activities interventions to prevent caries.

Objective: Assess interventions and health outcomes in studies giving data on economic evaluation (EE) of school-based caries prevention. Basic research design: Systematic review. Both partial EE that included cost description, cost-outcome description, cost analysis and full EE that included both cost and outcome of at least 2 interventions were included. Quality assessment used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Results: An electronic search of 6 databases identified 558 titles and abstracts. Paper eligibility screening identified 32 full papers which met the inclusion criteria. Most were conducted in the United States and cost effectiveness analysis was the most common type of EE. Nine were model-based studies and 17 derived their data from single studies. Sealants were most frequently evaluated followed by fluoride mouthrinse. Many CHEERS criteria were not met in the included studies. The following were found to be cost-effective: school-based, under general supervision, longer duration of program and targeting high caries risk groups. Conclusions: The deficiencies in the existing studies warrant more investigations of the economic aspects of school-based activities interventions to prevent caries.

Objective: Examine the association between marginalization and fluorosis with caries experience in Mexican rural children aged 8-12, in Oaxaca, Mexico. Methods: Cross-sectional study of 283 rural schoolchildren selected from two locations with high and medium levels of marginalization where the water fluoride concentration ranged from 2.0 to 2.5 ppm/F. Caries was evaluated using the DMFT index and dental fluorosis with the Thylstrup-Fejerskov Index (TFI). Socioeconomic data were collected from participants’ parents, with data on the children’s characteristics collected from them via a questionnaire. Results: The prevalence of caries was 72.4% (DMFT ≥1) in the permanent dentition. The prevalence of fluorosis was 98.0% (TFI ≥4=71.4%). 54.8% of the children brushed their teeth two or more times daily. In logistic regression children living in high levels of marginalization were more likely to present caries (OR=2.11, 95% CI 1.13 – 3.93) than children living in medium levels. Children with severe fluorosis (TFI ≥4) (OR=1.93, 95% CI 1.06 – 3.53) were more likely have caries than those with TFI ⟨3. Conclusion: Rural children with a high level of marginalization and fluorosis (TFI ≥4) were more likely to present caries. Poor oral hygiene and low dental service levels were found in both marginalized areas. Populations with medium/high marginalization are more susceptible to caries.

Objective: Examine the association between marginalization and fluorosis with caries experience in Mexican rural children aged 8-12, in Oaxaca, Mexico. Methods: Cross-sectional study of 283 rural schoolchildren selected from two locations with high and medium levels of marginalization where the water fluoride concentration ranged from 2.0 to 2.5 ppm/F. Caries was evaluated using the DMFT index and dental fluorosis with the Thylstrup-Fejerskov Index (TFI). Socioeconomic data were collected from participants’ parents, with data on the children’s characteristics collected from them via a questionnaire. Results: The prevalence of caries was 72.4% (DMFT ≥1) in the permanent dentition. The prevalence of fluorosis was 98.0% (TFI ≥4=71.4%). 54.8% of the children brushed their teeth two or more times daily. In logistic regression children living in high levels of marginalization were more likely to present caries (OR=2.11, 95% CI 1.13 – 3.93) than children living in medium levels. Children with severe fluorosis (TFI ≥4) (OR=1.93, 95% CI 1.06 – 3.53) were more likely have caries than those with TFI ⟨3. Conclusion: Rural children with a high level of marginalization and fluorosis (TFI ≥4) were more likely to present caries. Poor oral hygiene and low dental service levels were found in both marginalized areas. Populations with medium/high marginalization are more susceptible to caries.

Objective: To determine the association between maternal oral health and Early Childhood Caries (ECC) and discover the role of maternal and child behaviours in explaining this association. Basic research design: A cross-sectional analytic study. Clinical setting: Public Healthcare Services in Pasto, Colombia. Participants: 384 mothers and their 2-5-year-old children. Methods: Mothers completed a questionnaire to provide information on sociodemographic and behavioural factors and were examined for caries experience (DMFS index) and periodontal status (Community Periodontal Index, CPI). Children were examined for dental caries (dmfs index). The association between maternal dental indicators and child dmfs was assessed in negative binomial regression adjusting for confounders. Results: About 96% and 33% of mothers had caries experience and periodontal disease, respectively. The mean dmfs was 7.4 (SD: 9.5, range: 0-71). Maternal DMFS, but not CPI, was positively associated with children’s dmfs (Rate Ratio: 2.51, 95%CI: 1.59-3.97) after adjustments for sociodemographic and behavioural factors. Conclusions: Maternal caries experience, but not periodontal status, was positively associated with ECC in their children. Maternal and child behaviours explained little of this association.

Objective: To determine the association between maternal oral health and Early Childhood Caries (ECC) and discover the role of maternal and child behaviours in explaining this association. Basic research design: A cross-sectional analytic study. Clinical setting: Public Healthcare Services in Pasto, Colombia. Participants: 384 mothers and their 2-5-year-old children. Methods: Mothers completed a questionnaire to provide information on sociodemographic and behavioural factors and were examined for caries experience (DMFS index) and periodontal status (Community Periodontal Index, CPI). Children were examined for dental caries (dmfs index). The association between maternal dental indicators and child dmfs was assessed in negative binomial regression adjusting for confounders. Results: About 96% and 33% of mothers had caries experience and periodontal disease, respectively. The mean dmfs was 7.4 (SD: 9.5, range: 0-71). Maternal DMFS, but not CPI, was positively associated with children’s dmfs (Rate Ratio: 2.51, 95%CI: 1.59-3.97) after adjustments for sociodemographic and behavioural factors. Conclusions: Maternal caries experience, but not periodontal status, was positively associated with ECC in their children. Maternal and child behaviours explained little of this association.

Objective: To describe dentists’ perceptions of their professional roles, including the reasons why they make, accept or decline patient referrals within primary dental care in England. Basic research design: Qualitative semi-structured interviews, conducted via Skype, telephone or face-to-face. Transcripts were analysed using thematic analysis and typologies were developed. Participants: Ten general dental practitioners (GDPs) and 12 community dentists working in England. Results: Five main themes were identified: professional independence, the nature of dental care, the business of dentistry, obscure rules and ‘no man’s land’. This final theme described a notional gap between GDPs’ and community dentists’ responsibilities towards vulnerable people, who were perceived by participants to include frail older people, anxious and socially marginalised adults and children with high levels of disease. Three typologies of dentists were generated. ‘Entrepreneurs’ felt no allegiance to the National Health Service and no obligation to treat vulnerable patients. ‘Altruistic carers’ were committed to caring for exceptionally deserving patients. ‘Pragmatic carers’ tried to provide relational dental care (time and emotional support) for vulnerable patients but encountered discouraging systemic barriers. Conclusion: Dentists’ perceptions of their roles may influence whether and how they provide access to primary dental care for vulnerable people through referral systems. Access issues may exacerbate the oral health inequalities experienced by vulnerable groups. Based upon the findings, approaches are proposed that may encourage and enable the dental workforce to support vulnerable people actively to receive primary dental care.

Objective: To describe dentists’ perceptions of their professional roles, including the reasons why they make, accept or decline patient referrals within primary dental care in England. Basic research design: Qualitative semi-structured interviews, conducted via Skype, telephone or face-to-face. Transcripts were analysed using thematic analysis and typologies were developed. Participants: Ten general dental practitioners (GDPs) and 12 community dentists working in England. Results: Five main themes were identified: professional independence, the nature of dental care, the business of dentistry, obscure rules and ‘no man’s land’. This final theme described a notional gap between GDPs’ and community dentists’ responsibilities towards vulnerable people, who were perceived by participants to include frail older people, anxious and socially marginalised adults and children with high levels of disease. Three typologies of dentists were generated. ‘Entrepreneurs’ felt no allegiance to the National Health Service and no obligation to treat vulnerable patients. ‘Altruistic carers’ were committed to caring for exceptionally deserving patients. ‘Pragmatic carers’ tried to provide relational dental care (time and emotional support) for vulnerable patients but encountered discouraging systemic barriers. Conclusion: Dentists’ perceptions of their roles may influence whether and how they provide access to primary dental care for vulnerable people through referral systems. Access issues may exacerbate the oral health inequalities experienced by vulnerable groups. Based upon the findings, approaches are proposed that may encourage and enable the dental workforce to support vulnerable people actively to receive primary dental care.