Oral Care Cards as a Support in the Daily Life of Frail Older Adults: Experiences and Perceptions of Leaders in Municipal and Dental Care Settings.

Valuing oral health: Accomplishments and challenges

The authors describe the impact of the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program on the development, growth, and expansion of general and pediatric dentistry residency programs in the United States. They first briefly review the legislative history of the Title VII program as it pertains to dental education, followed by a historical overview of dental education in the United States, including a description of the differences between dental and medical education and the routes to professional practice. The authors then present an extensive assessment of the role of the Title VII grant program in building general and pediatric dental training capacity, diversifying the dental workforce, providing outreach and service to underserved and vulnerable populations, stimulating innovations in dental education, and engaging collaborative and interdisciplinary training with medicine. Finally, the authors call for broadening the scope of the Title VII program to allow for predoctoral training (dental student education) and faculty development in general and pediatric dentistry. In doing so, the Title VII program can more effectively address current and future challenges in dental education, dentist workforce, and disparities in oral health and access to care.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Improving health in the United States: Oral health is key to overall health

BackgroundParticipation by all actors involved in health planning is a prerequisite for person-centred care and healthy ageing. Understanding the multiple knowledge needs and the values that shape oral health assessments in home settings is important both to enable participation in oral health planning and to contribute to healthy ageing.ObjectiveThe aim of this study was to investigate decisional needs during oral health assessments in ordinary home settings from the perspectives of older adults, home health care nurses and dental hygienists.MethodsData was collected in ordinary home settings through 24 team-based oral assessments and 39 brief, semi-structured interviews including older adults (n = 24), home health care nurses (n = 8) and dental hygienists (n = 7). Data was analysed using content analysis with a deductive approach. The analysis was guided by the Ottawa Decision Support Guide.ResultsThe analysis revealed that all participants considered participation in decision-making important but until now, older adults might not have participated in making decisions regarding oral health issues. The older adults considered participation important because the decisions had a strong impact on their lives, affecting their health. The professionals considered decision-making important for knowing what step to take next and to be able to follow up and evaluate previous goals and treatments. Organizational and personal barriers for shared decision-making among home health care nurses and dental hygienists were identified. Of the 24 older adults, 20 had different oral health conditions that objectively indicated the need for treatment. An initial important decision concerned whether the older adult wanted to make an appointment for dental care, and if so, how. Another decisional conflict concerned whether and how assisted oral care should be carried out.ConclusionIt is important for key participants in ordinary home settings to participate in interprofessional teams in home health care. To further anchor this in theory, conceptual models for professionals from different care organizations (municipal care, dental care) need to be developed that also involve older adults as participants. Future research could bridge theory and practice by including theories of learning while exploring interorganizational oral health planning in home settings.

Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, known as severe acute respiratory syndrome. Dental care units and settings face various problems relating to the transmission of disease during treatment and dental operations. The degree to which the healthcare system is ready affects how well coronavirus illness is managed. Blood, saliva, and mixed water droplets possessing the virus cause contamination of equipment used for dental treatment. Both patients and workers may become transmitters and infectors of COVID-19 through direct contact during dental operations. It is possible for dental professionals and patients to contract COVID-19 and spread it to others. The dental care routine is very effective as we discussed below the prevention steps are very effective. All healthcare workers at the dentistry clinics should collaborate to prevent the spread of the COVID-19 virus among patients. The primary aim is to make dental health care providers aware of the pathophysiology of COVID-19 and to increase their preparedness and understanding of this challenge, which will aid in controlling transmission. The information and data that collected will be useful for the dental community in providing effective patient management through evidence-based recommendations for infection control and disinfection protocols.

I read with great interest Kawakami et al.'s paper, “Examining the combined effects of social isolation and oral dysfunction on cognitive decline in community-dwelling older Japanese adults”.1 The research highlights a significant association between social isolation (SI) and oral dysfunction (OD), individually and in combination, with cognitive decline in older adults. Although the paper effectively presents these relationships, I propose an additional layer of understanding: that SI and OD are deeply intertwined, forming a self-perpetuating vicious cycle that accelerates cognitive decline. The study's conclusion regarding the combined factors of SI and OD, and their association with cognitive decline is particularly insightful.1 My opinion is that this association is strengthened by a bidirectional relationship between SI and OD, creating a feedback loop that intensifies their negative impact on cognitive function. This vicious cycle unfolds as follows: oral dysfunction often leads to social isolation. Challenges with eating, chewing and speaking, common manifestations of OD, can cause embarrassment and discomfort, leading to a reluctance to participate in social activities, especially those involving food or conversation. Consequently, individuals might withdraw, increasing SI and loneliness. This withdrawal reduces vital cognitive stimulation, directly contributing to cognitive decline. Specific issues in geriatric dentistry, such as significant tooth loss, complexities with dentures and dry mouth (xerostomia) often induced by polypharmacy, severely impact an older adults' confidence and ability to engage socially, further driving isolation.2 Conversely, SI can profoundly worsen oral dysfunction. A lack of social engagement can diminish an individual's motivation or access to maintain diligent oral hygiene, seek regular dental checkups or address emerging oral health issues.3 Without social support, self-care, including oral health, might be neglected. The psychological stress and potential depression associated with prolonged SI can also indirectly impact oral health by altering immune responses or reducing health-seeking behaviors.4 This deterioration in oral health then perpetuates the isolation, making social interaction even more challenging. Existing barriers to dental care in older adults, such as financial constraints, transportation difficulties, and limited access to geriatric dental specialists, are exacerbated by SI, as isolated individuals might lack the support networks necessary to overcome these hurdles.5 Negative attitudes and misconceptions regarding oral health in older adults, even among some healthcare professionals, further hinder access and motivation for care for those who are socially isolated. This interplay between SI and OD creates a powerful negative synergy, amplifying cognitive decline (Figure 1). Social isolation deprives the brain of crucial cognitive stimulation and increases psychosocial stress, both well-established contributors to cognitive impairment. Simultaneously, oral dysfunction can lead to malnutrition and chronic oral inflammation, which negatively impacts brain health.6 When these factors reinforce each other, cognitive reserve erodes faster, making individuals significantly more vulnerable to cognitive decline and dementia. The combined burden of increased oral disease risk (e.g. gum disease, tooth decay) and challenges in maintaining oral hygiene due to physical or cognitive impairments creates a cascade of health issues that collectively undermine cognitive resilience.6 Understanding this vicious cycle is critical for developing more effective and holistic interventions. Beyond promoting general social engagement and improving overall oral health, a comprehensive approach must consider several intervening factors. Integrated care models are essential, where dental professionals screen for SI and cognitive decline, and social workers understand oral health's impact on social participation. Psychological support is crucial to address distress and embarrassment. Nutritional counseling can mitigate cognitive risks from malnutrition. Community-based programs combining social activities with oral health education and accessible dental screenings offer dual benefits.7 Technology-assisted interventions, such as virtual platforms for social connection or digital reminders for oral hygiene, can support homebound older adults.8 Caregiver education on the interconnectedness of these factors is also vital. Crucially, targeted geriatric oral health initiatives are needed to directly confront specific challenges: effective xerostomia management, robust support for managing tooth loss and dentures, adaptive tools for oral hygiene despite limitations, and dismantling financial/transportation barriers to specialized dental care.9 Efforts must also shift negative attitudes and misconceptions about older adults' oral health. In conclusion, Kawakami et al.'s paper provides a vital foundation for understanding the combined impact of social isolation and oral dysfunction on cognitive decline. By recognizing the potential for a vicious cycle between these two factors, and by proactively addressing the specific challenges inherent in geriatric dentistry, we can move toward more comprehensive and impactful interventions. These integrated strategies will be instrumental in promoting healthier aging, and significantly mitigating the risk of cognitive impairment and dementia. No funding was received. The author declares no conflict of interest. All aspects of this work were carried out by the sole author. Data sharing is not applicable to this article, as no new data were created or analyzed in this study.

Chronic disease and use of dental services in Australia

Oral and dental health significantly impacts the quality of life and nutrition of the older population. While government action has been taken in Israel to reduce barriers to using dental care services by welfare recipients among the older adults, there are still disparities associated with socioeconomic status in the older adult population. In 2019, a dental care reform for the older adults was implemented in Israel assuring dental Universal Health Coverage (UCH) for them. This improves accessibility to dental services and reduce cost barriers. To explore the oral health disparities among 65+ age group by their economic situation and their additional barriers to using dental services at the start of the reform. Telephone interviews were conducted with a representative sample of 512 older adults aged 65+ from February to April 2020. The self-perceived oral health status was rated as better in the higher socioeconomic group (73.4% perceived their oral health status as good or very good), compared with the lower socioeconomic group (52.5%). In the lower socioeconomic group, 38.5% were edentulous, compared with 18.1% of the higher socioeconomic group. The latter had 4 more natural teeth, on the average, than the former. Double and triple gaps were also found in the prevalence of dental problems - loose, sore, and sensitive teeth, and difficulty chewing. Oral health behavior - as reflected in tooth brushing patterns and routine preventive check-ups - was found to be better in the higher socioeconomic group than that in the lower socioeconomic group. Dental care costs were found to be a barrier to dental care, primarily in the lower socioeconomic group (18.2%, compared with 4.8% of the higher socioeconomic group, were faced with a financial barrier). At the same time, (66.7% of the higher socioeconomic group were aware of the inclusion of dental care services for the older adult population in the basket of health services provided by the health plans, compared with 27.8% of the lower socioeconomic group. Lack of awareness to proper oral health behavior and to the legal rights are main barriers to dental care in the lower SEG. The dental practitioners have a vital role and an excellent opportunity to lower these barriers. Still existing disparities and barriers should be monitored as vital part of including dental care in UHC.

Introduction: An established body of literature highlights a higher prevalence of oral health concerns among Indigenous Australians including untreated dental caries and periodontal disease. In South Australia, access to and provision of culturally safe oral health care for these communities remains a challenge in dental services, and less is known around what culturally safe dental care means for Indigenous communities. Objectives: This study explored (1) the barriers to accessing culturally safe oral health care for Indigenous Australians and (2) the enablers to promote and support culturally safe oral health care. Methods: This qualitative study involved semi-structured interviews with 136 Indigenous South Australian adults who participated in a dental care intervention involving oral epidemiological examinations at baseline and 12-mo follow-up (after receiving formal dental care) and health assessments. Reflexive thematic analysis was used to analyze qualitative data on participants’ oral health care experiences more broadly, the dental care received as part of the study, and their perspectives on improving dental care for Indigenous communities, including culturally safe care. Results: Participants reported a range of experiences in formal dental care settings including discrimination, fear, and limited access to dental care due to cost or location. Various enablers to improve culturally safe dental care were highlighted, including continuity of care, Indigenous-led dental services, mobile services and at-home care, trauma-informed clinics, early intervention, oral health promotion, and improving accessibility through free or low-cost dental care. Conclusion: Overall, this study emphasized the need for further action to ensure cultural safety in Australian dental services. Knowledge Transfer Statement: This study found that Indigenous Australians’ access to culturally safe oral health care is limited. Culturally safe care was affected by discrimination and distressing experiences in dental care settings. Dental care remains costly and regional areas remain underserviced, affecting access. Mobile services, continuity of care, early intervention, and Indigenous-led care can improve access. Findings from this study may shape health services planning regarding models of care that are family-centered, affordable, accessible, and prioritize cultural safety.

Gap in Dental Care Can Lead to Diabetes, Other Disease Conditions

Introduction: this research is based on the framework of comprehensive oral health care for people deprived of liberty, to ensure that health services ensure their continuity of care, with a quality of care similar to that accessed by the population does not have this limitation. Objective: to develop a comprehensive oral health care strategy at the “El Guayabo” Penitentiary Center on the Isla de la Juventud from October 2021 to October 2022. Methods: an intervention study was carried out on 227 inmates, matching the universe and the sample. The variables were taken into account: age, oral diseases, level of oral health knowledge, oral health knowledge survey and results of the strategy. With prior informed consent, a survey of knowledge of oral health, Stomatological Clinical History, curative and rehabilitative treatment was carried out on each of the patients who were part of the research. Results: before the intervention was applied, dental caries and poor level of knowledge predominated in 71,3 % and 66,9 % of the inmates respectively; managing to reduce the prevalence of dental caries and improve the level of knowledge to be regulated in the majority of inmates after applying the educational strategy; In addition, 47 % of the sample was cured. Conclusions: the implementation of the comprehensive oral health care strategy had a significant impact on the reduction of oral diseases among inmates

BackgroundPatient participation is key in person-centred care, emphasizing individual choices in treatment. Oral health, integral to overall well-being, is sometimes a neglected part of health. This intervention introduces a novel approach to strengthen person-centred care in homecare settings, employing collaborative, interprofessional teamwork and shared documentation across care organizations. This protocol outlines the design of a cluster-randomized controlled trial (RCT) in Sweden, comparing traditional oral assessments with an interorganizational, team-based oral health care planning model facilitated by a shared digital platform for documentation. The overall aim is to evaluate a person-centred interprofessional and interorganizational model for oral health care planning supported by a digital platform to enable healthy ageing.Methods/designThe intervention, co-designed with older adults, academic institutions, healthcare providers in public dental care, and municipal organizations, will undergo ethical approval. The RCT will randomize older adults, dental hygienists (DHs) and nursing assistants (NAs) into two groups. The intervention group will attend a two-day workshop on a person-centred, three-step team-based model, while the control group will continue using standard procedures. Thereafter, the three-step collaborative model will be compared to standard procedures. Primary outcomes will be measured using the Revised Oral Assessment Guide (ROAG) and the General Oral Health Assessment Index (GOHAI). Secondary outcomes include health economic evaluations, participation rates and quality of care assessments. Qualitative studies from theoretical perspectives of change and learning based on interviews with key stakeholders will be conducted in both the test and control groups.DiscussionTaking a co-produced approach where theory and practice shape the research iteratively, a person-centred health care planning model supported by a shared digital platform for home settings is evaluated. Anticipated outcomes include improved oral assessments and a deeper understanding of effective person-centred care practices. The co-produced approach of the intervention is also expected to further develop knowledge regarding co-production within domains of healthy ageing from an oral health perspective. As such, the intervention shapes and fosters co-produced person-centred care and healthy ageing.Trial registrationClinicalTrials.gov NCT06310798. Registered on 13 March 2024.

Playfulness-being and acting playful-is often associated with childhood, yet evidence suggests that it remains a meaningful resource throughout life. In later life, playfulness may support social connectedness, emotional well-being, and a sense of agency, even in contexts of illness or institutional living. Playfulness encompasses not only observable playful activities but also an inner disposition, such as curiosity, humor, or spontaneity, which may be constrained by environmental barriers, aging, or functional limitations. Despite its potential relevance for health and person-centered care, playfulness remains underexplored in gerontological and caregiving research. No validated instrument currently exists to assess playfulness among older adults in Swedish municipal care. This research program addresses this gap by clarifying the concepts of play and playfulness and by developing and psychometrically evaluating a new instrument, Play and Supportive Environments (PLAY-SE). The overall aim of the program is to clarify and operationalize the interrelated concepts of playfulness and playful activities among older adults receiving municipal care and to develop an instrument suitable for psychometric testing. The program applies a hybrid model of concept development combined with an exploratory sequential mixed methods design. Phase 1 involves literature reviews and qualitative studies with older adults and staff to explore and define the lived meanings of playfulness. These findings inform item generation and refinement of the PLAY-SE instrument. Phase 2 includes content validation, cognitive interviews, pilot testing, and large-scale psychometric evaluation using both classical test theory and Rasch measurement theory. Two PhD students were recruited to the program in September 2024 and September 2025, and an expert group was established in autumn 2025. The PhD students are funded, for four years each, by Kristianstad University (from 2024) and Red Cross University College (from 2025). Ethical approval for the qualitative studies in phase 1 was granted by the Swedish Ethical Review Authority (2025-00211-01; decision date: February 3, 2025). Data collection for qualitative interviews with older adults in municipal care was conducted between February and April 2025. Fifteen older adults (aged 68-100 y) were interviewed in nursing home settings. The phenomenological findings from phase 1.1 have been published in March 2026. Additional qualitative interviews and focus groups with staff are scheduled for 2026 to 2027. Pilot testing of the first version of the PLAY-SE instrument is planned for autumn 2026, followed by large-scale psychometric validation between 2027 and 2029. This program establishes a structured and theoretically grounded process for developing and validating an instrument to assess playfulness in later life. By integrating qualitative exploration with modern psychometric approaches, the PLAY-SE instrument is intended to support future research and contribute to the development of person-centered practices in municipal elder care.

: The study aimed to determine the correlation among knowledge and attitude with the behavior of pregnant women in dental and oral health care during pregnancy. The research was analytic observational and in terms of time used crossectional approach. The population in this study were pregnant women at Narmada Community Health Center whereas the sample obtained by 34 people who came to check Antenatal Care (ANC) in June 2015 taken by accidental sampling technique. Data collection of knowledge, attitude and behavior variables used questionnaire and Statistical analysis was performed by using Chi Square test. The research finding indicated that from 34 respondents, 17 pregnant women (50%) had lack knowledge level about oral and dental health care during pregnancy. The attitude of pregnant women in dental and oral care during pregnancy was 73.5% (poor attitudes), and in terms of respondents’ behaviour was the same like respondents’ attitude by 73.5% (poor attitude). Therefore, it can be concluded that there was a significant correlation between knowledge with pregnant women behavior in dental and oral health care (P value = 0.013) and there was significant correlation between attitude with respondents behaviour in oral and dental care during pregnancy (P value = 0.004). Suggestion: It is expected for Health Care Institutions and health workers need to do an effort of sustainable counselling to communities, especially pregnant women about risk factors that can cause dental caries which can affect the health of both fetus and mother, increasing promotive efforts, for instance the improvement and maintenance of health and preventive efforts for communnities and pregnant women in order to have a good knowledge and attitude in maintaining oral an dental health care during pregnancy can be preserved and further enhanced, hence the sense of responsibility in terms of a behavior in the community or pregnant women concerning dental and oral health increases in line with knowledge improvement and developing attitudes.

Oral health trends for older Americans