Community Dental Health

The British Association for the Study of Community Dentistry (BASCD) is marking its 50th anniversary in 2023. The author of this article has been a member of BASCD for those 50 years, including a number as a member of the Council, and offers his personal reflections on some of the range of activities of the Association.

The British Association for the Study of Community Dentistry (BASCD) is marking its 50th anniversary in 2023. The author of this article has been a member of BASCD for those 50 years, including a number as a member of the Council, and offers his personal reflections on some of the range of activities of the Association.

Introduction: Looked-After-Children (LAC) frequently are more likely to have untreated dental caries, periodontal diseases or dental trauma (McMahon et al., 2018). The COVID-19 pandemic reduced the availability of dental appointments, including for LAC. This initiative piloted the inclusion of a dental pathway into the existing LAC care pathway in Buckinghamshire. The key principle was providing oral health messaging around maintaining good oral health and preventing disease in these children by training those involved with their care. Methods: A working group was convened, which included dental public health, clinical and training expertise. A care pathway was developed with resources drawn from existing programmes including mini Mouth Care Matters (mMCM). The care pathways were designed to identify children who needed care urgently due to pain or discomfort, signpost them to the relevant/most appropriate providers and provide oral health improvement advice for everyone. Local partners were engaged to ensure that the processes and training were appropriate. A pilot training session was then carried out for a range of staff engaged in the care of LAC within Buckinghamshire. Results: The pilot dental pathway, launched in March 2022, initiative was welcomed by all stakeholders, including dental commissioners. The pilot training session received positive feedback from participants, with requests for more sessions. Training sessions were subsequently translated into video sessions, accessible when needed, for new staff or as refresher sessions. Conclusion: There are opportunities to reduce future inequalities for these children by inculcating positive behaviours early in their care journey. This will reduce their need for care. Identifying and implementing the most appropriate initiatives requires collaboration and commitment from all stakeholders.

Introduction: Looked-After-Children (LAC) frequently are more likely to have untreated dental caries, periodontal diseases or dental trauma (McMahon et al., 2018). The COVID-19 pandemic reduced the availability of dental appointments, including for LAC. This initiative piloted the inclusion of a dental pathway into the existing LAC care pathway in Buckinghamshire. The key principle was providing oral health messaging around maintaining good oral health and preventing disease in these children by training those involved with their care. Methods: A working group was convened, which included dental public health, clinical and training expertise. A care pathway was developed with resources drawn from existing programmes including mini Mouth Care Matters (mMCM). The care pathways were designed to identify children who needed care urgently due to pain or discomfort, signpost them to the relevant/most appropriate providers and provide oral health improvement advice for everyone. Local partners were engaged to ensure that the processes and training were appropriate. A pilot training session was then carried out for a range of staff engaged in the care of LAC within Buckinghamshire. Results: The pilot dental pathway, launched in March 2022, initiative was welcomed by all stakeholders, including dental commissioners. The pilot training session received positive feedback from participants, with requests for more sessions. Training sessions were subsequently translated into video sessions, accessible when needed, for new staff or as refresher sessions. Conclusion: There are opportunities to reduce future inequalities for these children by inculcating positive behaviours early in their care journey. This will reduce their need for care. Identifying and implementing the most appropriate initiatives requires collaboration and commitment from all stakeholders.

Objective: To estimate the discrepancies between global ratings of oral health and general health and investigate the factors associated with self-rated oral health (SROH) and self-rated general health (SRGH). Methods: Data were collected from 502 participants aged 18 to 81 years. A structured questionnaire was used to obtain data regarding sociodemographic characteristics and self-reported conditions. Global self-ratings of oral health and general health were the main outcomes. Discrepancies between self-ratings of oral health and general health were stratified by independent variables. Bayesian ordinal logistic regression models were fitted to estimate the posterior distributions of parameters and 95% credible intervals (95% CrI). Results: The proportion of participants who rated their oral health worse than general health was 28.6% (95% CrI: 24.7-32.3). Negative discrepancies between SROH and SRGH were associated with being men, reporting gingivitis, and lower income. Sex (95% CrI: 1.12-2.25) impacted only on SRGH. Income (SROH – 95% CrI: 1.52-6.40; SRGH – 95% CrI: 1.08-4.56), tertiary education (SROH – 95% CrI: 1.13-2.53; SRGH – 95% CrI: 1.01-2.32), self-reported missing teeth (SROH – 95% CrI: 1.57-3.46; SRGH – 95% CrI: 2.21-4.92), self-reported gingivitis (SROH – 95% CrI: 1.10-2.40; SRGH – 95% CrI: 1.71-3.82), and self-reported chronic health problem (SROH – 95% CrI: 1.38-3.08; SRGH – 95% CrI: 1.61-3.59) impacted on both outcomes. Conclusions: Substantial discrepancies between self-rated oral health and self-rated general health were found and were associated with being male, reporting gingivitis, and having lower income.

Objective: To estimate the discrepancies between global ratings of oral health and general health and investigate the factors associated with self-rated oral health (SROH) and self-rated general health (SRGH). Methods: Data were collected from 502 participants aged 18 to 81 years. A structured questionnaire was used to obtain data regarding sociodemographic characteristics and self-reported conditions. Global self-ratings of oral health and general health were the main outcomes. Discrepancies between self-ratings of oral health and general health were stratified by independent variables. Bayesian ordinal logistic regression models were fitted to estimate the posterior distributions of parameters and 95% credible intervals (95% CrI). Results: The proportion of participants who rated their oral health worse than general health was 28.6% (95% CrI: 24.7-32.3). Negative discrepancies between SROH and SRGH were associated with being men, reporting gingivitis, and lower income. Sex (95% CrI: 1.12-2.25) impacted only on SRGH. Income (SROH – 95% CrI: 1.52-6.40; SRGH – 95% CrI: 1.08-4.56), tertiary education (SROH – 95% CrI: 1.13-2.53; SRGH – 95% CrI: 1.01-2.32), self-reported missing teeth (SROH – 95% CrI: 1.57-3.46; SRGH – 95% CrI: 2.21-4.92), self-reported gingivitis (SROH – 95% CrI: 1.10-2.40; SRGH – 95% CrI: 1.71-3.82), and self-reported chronic health problem (SROH – 95% CrI: 1.38-3.08; SRGH – 95% CrI: 1.61-3.59) impacted on both outcomes. Conclusions: Substantial discrepancies between self-rated oral health and self-rated general health were found and were associated with being male, reporting gingivitis, and having lower income.

Objective: Previous observational studies reported an association of diabetes mellitus (DM) with oropharyngeal cancer (OPC), however, the potential causality of the association between them remains unclear. Methods: To explore this causal relationship in individuals of European descent, a two-sample Mendelian randomization (MR) study was conducted. A genome-wide association study (GWAS) of DM was used to represent the exposure factor (T1DM: n = 24,840; T2DM: n = 215,654), and GWAS of OPC represented the outcome (n = 3,448). Results: Forty-one single nucleotide polymorphisms (SNPs) related to T1DM and fifty-four SNPs related to T2DM were identified as effective instrumental variables (IVs) in the two-sample MR analyses. In IVW estimates, neither T1DM nor T2DM significantly contributed to an increased risk of OPC [T1DM: OR 1.0322 (95% CI 0.9718, 1.0963), P = 0.3033; T2DM: OR 0.9998 (95% CI 0.9995, 1.0002), P = 0.2858]. Four other regression models produced similar results. MR-Egger regression results [Cochran’s Q statistic was 47.1544 (P = 0.1466) in T1DM, and 35.5084 (P = 0.9512) in T2DM] suggested no horizontal pleiotropy between IVs and outcomes. Conclusion: Our findings suggest little evidence to support the genetic role of diabetes mellitus in OPC development in the European population.

Objective: Previous observational studies reported an association of diabetes mellitus (DM) with oropharyngeal cancer (OPC), however, the potential causality of the association between them remains unclear. Methods: To explore this causal relationship in individuals of European descent, a two-sample Mendelian randomization (MR) study was conducted. A genome-wide association study (GWAS) of DM was used to represent the exposure factor (T1DM: n = 24,840; T2DM: n = 215,654), and GWAS of OPC represented the outcome (n = 3,448). Results: Forty-one single nucleotide polymorphisms (SNPs) related to T1DM and fifty-four SNPs related to T2DM were identified as effective instrumental variables (IVs) in the two-sample MR analyses. In IVW estimates, neither T1DM nor T2DM significantly contributed to an increased risk of OPC [T1DM: OR 1.0322 (95% CI 0.9718, 1.0963), P = 0.3033; T2DM: OR 0.9998 (95% CI 0.9995, 1.0002), P = 0.2858]. Four other regression models produced similar results. MR-Egger regression results [Cochran’s Q statistic was 47.1544 (P = 0.1466) in T1DM, and 35.5084 (P = 0.9512) in T2DM] suggested no horizontal pleiotropy between IVs and outcomes. Conclusion: Our findings suggest little evidence to support the genetic role of diabetes mellitus in OPC development in the European population.

Objectives: Oral frailty is a well-established risk factor for frailty and plays a significant role in progression to frailty. However, the association between oral frailty and pre-frailty in elderly individuals remains unclear. This cross-sectional study aimed to clarify the characteristics and risk factors of pre-frailty in elderly individuals with oral frailty. Methods: A total of 377 elderly individuals participated. Oral examinations comprised simple and non-invasive measures of chewing function, self-reported swallowing function, and oral moisture. The frailty screening index was used to assess frailty phenotypes. Results: The overall prevalence of pre-frailty was 63.1%, after excluding 40 frail and 99 robust individuals. The mean age of the pre-frail participants was 76.6 ± 5.8 years; 70.6% were women. 10.5% of the pre-frail elderly participants had oral frailty. In multivariate analysis diabetes mellitus, history of cancer, denture wearing, and malnutrition were independently associated with oral frailty among pre-frail elderly individuals (adjusted odds ratio (OR) 3.8, 95% confidence interval (CI) 1.06–13.54; OR 4.5, CI 1.32–15.36; OR 8.8, CI 1.76–43.78; and OR 3.6, CI 1.30–9.67; respectively). Conclusions: The prevalence of oral frailty was low among community-dwelling pre-frail elderly individuals. Early interventions involving oral, nutritional, and disease management may prevent or improve oral frailty in pre-frail elderly individuals and may prevent progression to frailty. Further studies are required to elucidate the underlying mechanisms.

Objectives: Oral frailty is a well-established risk factor for frailty and plays a significant role in progression to frailty. However, the association between oral frailty and pre-frailty in elderly individuals remains unclear. This cross-sectional study aimed to clarify the characteristics and risk factors of pre-frailty in elderly individuals with oral frailty. Methods: A total of 377 elderly individuals participated. Oral examinations comprised simple and non-invasive measures of chewing function, self-reported swallowing function, and oral moisture. The frailty screening index was used to assess frailty phenotypes. Results: The overall prevalence of pre-frailty was 63.1%, after excluding 40 frail and 99 robust individuals. The mean age of the pre-frail participants was 76.6 ± 5.8 years; 70.6% were women. 10.5% of the pre-frail elderly participants had oral frailty. In multivariate analysis diabetes mellitus, history of cancer, denture wearing, and malnutrition were independently associated with oral frailty among pre-frail elderly individuals (adjusted odds ratio (OR) 3.8, 95% confidence interval (CI) 1.06–13.54; OR 4.5, CI 1.32–15.36; OR 8.8, CI 1.76–43.78; and OR 3.6, CI 1.30–9.67; respectively). Conclusions: The prevalence of oral frailty was low among community-dwelling pre-frail elderly individuals. Early interventions involving oral, nutritional, and disease management may prevent or improve oral frailty in pre-frail elderly individuals and may prevent progression to frailty. Further studies are required to elucidate the underlying mechanisms.

Objective: Early Childhood Caries (ECC) has been common among preschoolers in Sri Lanka over decades. A broad spectrum of determinants that act upon different levels is responsible for its development. Therefore, the relationships among these determinants should be studied extensively to control ECC. Design: Descriptive cross-sectional study with multistage cluster sampling. Setting: Registered preschools in Gampaha District. Participants: A total of 1038 three to four-year-olds and their mothers. Main outcome measures: Direct, indirect, and total effects of the determinants of ECC in structural equation models. Results: Sweet consumption had direct effects from permissive parenting (β=0.26, p=0.00) and the sweet consumption behaviour of the family (β=0.17, p=0.01). Oral hygiene behaviours had direct effects from permissive parenting (β=-0.46, p=0.00) and maternal oral health related self-efficacy (β=0.23, p=0.00). The dental attendance pattern had total effects from knowledge (β=0.18, p=0.00) and permissive parenting (β=-0.16, p=0.00). Conclusions: Parenting style, family sweet consumption behaviour and maternal oral health related self-efficacy were the most influential second-line determinants that affected oral health behaviours: sweet consumption, oral hygiene, and dental attendance pattern for the development of ECC.

Objective: Early Childhood Caries (ECC) has been common among preschoolers in Sri Lanka over decades. A broad spectrum of determinants that act upon different levels is responsible for its development. Therefore, the relationships among these determinants should be studied extensively to control ECC. Design: Descriptive cross-sectional study with multistage cluster sampling. Setting: Registered preschools in Gampaha District. Participants: A total of 1038 three to four-year-olds and their mothers. Main outcome measures: Direct, indirect, and total effects of the determinants of ECC in structural equation models. Results: Sweet consumption had direct effects from permissive parenting (β=0.26, p=0.00) and the sweet consumption behaviour of the family (β=0.17, p=0.01). Oral hygiene behaviours had direct effects from permissive parenting (β=-0.46, p=0.00) and maternal oral health related self-efficacy (β=0.23, p=0.00). The dental attendance pattern had total effects from knowledge (β=0.18, p=0.00) and permissive parenting (β=-0.16, p=0.00). Conclusions: Parenting style, family sweet consumption behaviour and maternal oral health related self-efficacy were the most influential second-line determinants that affected oral health behaviours: sweet consumption, oral hygiene, and dental attendance pattern for the development of ECC.

Objective: To develop a needs-based workforce planning model to explore specialist workforce capacity and capability for the effective, efficient, and safe provision of services in the United Kingdom (UK); and test the model using Dental Public Health (DPH). Basic Research Design: Data from a national workforce survey, national audit, and specialty workshops in 2020 and 2021 set the parameters for a safe effective DPH workforce. A working group drawing on external expertise, developed a conceptual workforce model which informed the mathematical modelling, taking a Markovian approach. The latter enabled the consideration of possible scenarios relating to workforce development. It involved exploration of capacity within each career stage in DPH across a time horizon of 15 years. Workforce capacity requirements were calculated, informed by past principles. Results: Currently an estimated 100 whole time equivalent (WTE) specialists are required to provide a realistic basic capacity nationally for DPH across the UK given the range of organisations, population growth, complexity and diversity of specialty roles. In February 2022 the specialty had 53.55 WTE academic/service consultants, thus a significant gap. The modelling evidence suggests a reduction in DPH specialist capacity towards a steady state in line with the current rate of training, recruitment and retention. The scenario involving increasing training numbers and drawing on other sources of public health trained dentists whilst retaining expertise within DPH has the potential to build workforce capacity. Conclusions: Current capacity is below basic requirements and approaching ‘steady state’. Retention and innovative capacity building are required to secure and safeguard the provision of specialist DPH services to meet the needs of the UK health and care systems.

Objective: To develop a needs-based workforce planning model to explore specialist workforce capacity and capability for the effective, efficient, and safe provision of services in the United Kingdom (UK); and test the model using Dental Public Health (DPH). Basic Research Design: Data from a national workforce survey, national audit, and specialty workshops in 2020 and 2021 set the parameters for a safe effective DPH workforce. A working group drawing on external expertise, developed a conceptual workforce model which informed the mathematical modelling, taking a Markovian approach. The latter enabled the consideration of possible scenarios relating to workforce development. It involved exploration of capacity within each career stage in DPH across a time horizon of 15 years. Workforce capacity requirements were calculated, informed by past principles. Results: Currently an estimated 100 whole time equivalent (WTE) specialists are required to provide a realistic basic capacity nationally for DPH across the UK given the range of organisations, population growth, complexity and diversity of specialty roles. In February 2022 the specialty had 53.55 WTE academic/service consultants, thus a significant gap. The modelling evidence suggests a reduction in DPH specialist capacity towards a steady state in line with the current rate of training, recruitment and retention. The scenario involving increasing training numbers and drawing on other sources of public health trained dentists whilst retaining expertise within DPH has the potential to build workforce capacity. Conclusions: Current capacity is below basic requirements and approaching ‘steady state’. Retention and innovative capacity building are required to secure and safeguard the provision of specialist DPH services to meet the needs of the UK health and care systems.

Objective: To examine the association between the level of marginalization and tooth loss in adults aged ≥50 years in Mexico. Methods: A retrospective cross‑sectional study was conducted on 2098 adults selected from communities presenting both high and medium levels of marginalization, with data obtained from the annual reports of the Epidemiological Surveillance System of Oral Pathologies 2019-2022. Analysis considered sociodemographic characteristics such as sex, age, and years of education. The prevalence of tooth loss was determined using the Decayed, Missing and Filled teeth (DMFT) index. Negative binomial regression was used to estimate rate ratio (RR) and 95% confidence intervals (CIs), using the presence of lost teeth as an outcome. Results: Most (62.4%) participants had lost at least one tooth, of whom 60.3% had a medium level of marginalization, 28.8% a high level, and 10.9% a very high level. More adults who lived in high or very high marginalization communities had lost teeth [RR=1.19 (95% CI 1.08 – 1.30)] than those living in communities with a medium level of marginalization. More males [RR=1.19 (95% CI 1.09 – 1.31)], adults ≥70 years [RR=1.77 (95% CI 1.57 – 1.99)], people who were illiterate [RR=1.60 (95% CI 1.35 – 1.88)] or who had poor oral hygiene [RR=1.26 (95% CI 1.15 – 1.38)] had also lost teeth. Conclusion: High and very high marginalization was associated with tooth loss in adults ≥50 years in Mexico. Effective oral health strategies are required to prevent tooth loss, as are interventions to improve access to and quality of dental services for marginalized communities.

Objective: To examine the association between the level of marginalization and tooth loss in adults aged ≥50 years in Mexico. Methods: A retrospective cross‑sectional study was conducted on 2098 adults selected from communities presenting both high and medium levels of marginalization, with data obtained from the annual reports of the Epidemiological Surveillance System of Oral Pathologies 2019-2022. Analysis considered sociodemographic characteristics such as sex, age, and years of education. The prevalence of tooth loss was determined using the Decayed, Missing and Filled teeth (DMFT) index. Negative binomial regression was used to estimate rate ratio (RR) and 95% confidence intervals (CIs), using the presence of lost teeth as an outcome. Results: Most (62.4%) participants had lost at least one tooth, of whom 60.3% had a medium level of marginalization, 28.8% a high level, and 10.9% a very high level. More adults who lived in high or very high marginalization communities had lost teeth [RR=1.19 (95% CI 1.08 – 1.30)] than those living in communities with a medium level of marginalization. More males [RR=1.19 (95% CI 1.09 – 1.31)], adults ≥70 years [RR=1.77 (95% CI 1.57 – 1.99)], people who were illiterate [RR=1.60 (95% CI 1.35 – 1.88)] or who had poor oral hygiene [RR=1.26 (95% CI 1.15 – 1.38)] had also lost teeth. Conclusion: High and very high marginalization was associated with tooth loss in adults ≥50 years in Mexico. Effective oral health strategies are required to prevent tooth loss, as are interventions to improve access to and quality of dental services for marginalized communities.

What are mini-publics and under what circumstances could they be applied to public health dentistry? This question is explored with reference to water fluoridation in England, a policy intervention characterised by a visceral politics that has embedded a systemic preference for non-decision-making. Mini-publics can nevertheless inform decision-making by inviting a representative sample of the affected citizenry to consider the available evidence and come to a set of conclusions and/or recommendations that if all parties cannot agree, none can reasonably object. In doing so, mini-publics have the potential to break the policy deadlock by adding an additional layer of legitimacy to the decision-making process, albeit this is dependent upon decision-makers granting value to their findings

What are mini-publics and under what circumstances could they be applied to public health dentistry? This question is explored with reference to water fluoridation in England, a policy intervention characterised by a visceral politics that has embedded a systemic preference for non-decision-making. Mini-publics can nevertheless inform decision-making by inviting a representative sample of the affected citizenry to consider the available evidence and come to a set of conclusions and/or recommendations that if all parties cannot agree, none can reasonably object. In doing so, mini-publics have the potential to break the policy deadlock by adding an additional layer of legitimacy to the decision-making process, albeit this is dependent upon decision-makers granting value to their findings

Objective: Prognostic risk prediction models estimate the probability of developing head and neck cancer (HNC), providing valuable information for managing the disease. While different prognostic HNC risk prediction models have been developed worldwide, a comprehensive evaluation of their methods is lacking. We conducted a scoping review with a critical assessment aiming to identify the methodological strengths and limitations of HNC risk prediction models. Method: We searched Medline, Embase, Scopus, Web of Science, and CAB Abstracts databases and included full-text-available peer-reviewed published papers on developing or validating a prognostic HNC risk prediction model. Study quality was appraised using the PROBAST tool. Results: Nine papers were included. Although all had a high risk of bias, mainly in the analysis domain, only two studies had high concerns about clinical applicability. Conclusion: Currently published studies provide insufficient information on methods, making it difficult to judge the models’ quality and applicability. Future investigations should follow the guidelines in reporting the prediction modelling studies.

Objective: Prognostic risk prediction models estimate the probability of developing head and neck cancer (HNC), providing valuable information for managing the disease. While different prognostic HNC risk prediction models have been developed worldwide, a comprehensive evaluation of their methods is lacking. We conducted a scoping review with a critical assessment aiming to identify the methodological strengths and limitations of HNC risk prediction models. Method: We searched Medline, Embase, Scopus, Web of Science, and CAB Abstracts databases and included full-text-available peer-reviewed published papers on developing or validating a prognostic HNC risk prediction model. Study quality was appraised using the PROBAST tool. Results: Nine papers were included. Although all had a high risk of bias, mainly in the analysis domain, only two studies had high concerns about clinical applicability. Conclusion: Currently published studies provide insufficient information on methods, making it difficult to judge the models’ quality and applicability. Future investigations should follow the guidelines in reporting the prediction modelling studies.