Oral Health Need Research Articles

Socio-economic inequalities in oral health among Portuguese older adults: a cross-sectional study

BackgroundAlthough the oral health status has improved in developed countries in recent years, oral diseases are still unequally distributed across socio-economic groups. Research on the impact of socio-economic factors on oral health care among older adults in Europe, including Portugal, remains limited. The main aim of this study was to investigate the association between socio-economic factors and oral health indicators in Portuguese older adults.MethodsThis retrospective cross-sectional study analyzed data from 915 participants (aged 65 years and older) from the third wave (2015–2016) of the Epidemiology of Chronic Diseases Cohort Study (EpiDoC), a population-based study. Socio-economic and demographic information, general health-related characteristics and oral health data (prosthetic need, oral hygiene frequency, and last dental procedure) were collected by questionnaire. Multivariate logistic and multinomial regression models analyzed the associations between socio-economic factors and oral health indicators.ResultsParticipants with lower education level, perceived lower income and a fewer number of private sector appointments were more likely to have poor oral health (need for prosthetic treatment, less frequent oral hygiene, and tooth extraction as last dental procedure). Other factors found to be associated with oral health were sex, age, geographical area, smoking habits, and body mass index.ConclusionsSocio-economic factors were associated with oral health in Portuguese older adults. These findings may contribute to future national public health strategies by expanding oral health services to ensure better access and coverage for at-risk groups.

Oral Health Data Gaps and Needs in North Carolina.

Effective oral health-related policymaking and program implementation rely on comprehensive, accurate, and timely data. This commentary will address the lack of data available and the need for a robust data dashboard, in addition to the importance of community water fluoridation.

California School Nurses Report on Oral Health Needs of Children and Willingness to Conduct Annual Oral Health Screenings

California School Nurses Report on Oral Health Needs of Children and Willingness to Conduct Annual Oral Health Screenings

More than a mouth to clean: Case studies of oral health care in an Australian hospital.

This study aimed to explore older patients' oral health status, their opinions about oral health care and their experiences with oral health care while in hospital. Improving older adults' oral health is considered an urgent priority at both the national and international levels, especially for hospitalised older patients who have been found to have poor oral health. However, a one-size-fits-all standardised approach to oral care delivery may not be the answer. This study was an embedded, multiple-case study, integrating qualitative and quantitative data. Seven patients were recruited from a geriatric ward of an acute hospital in Australia and participated in semi-structured interviews and oral health assessments using the Oral Health Assessment Tool (OHAT) in June-July 2022. Data were analysed descriptively and presented in case summaries. OHAT assessments identified oral health problems in all patients, but not all patients self-reported problems with their mouths. Each patient valued oral health care, but the reasons given varied. Patients had established, individualised oral health care routines, which they brought to hospital. Clinical observations of patient's oral health status might not match the patient's own judgement of their oral health and, if not explicitly addressed, may mask the need for oral health and hygiene intervention. Assessment and care planning needs to incorporate patients' own perceptions of their oral health and existing oral health care routines. Oral health histories may provide a means of facilitating this person-centred oral health care for older patients in hospital.

Behavioral/Mood Disorders and Opioid-Drug Use in Chicago Community Areas Associated with Oral Health and Oral Surgery Need

Introduction: We hypothesize gender, race in Chicago’s community areas (CAs) associated significantly with mood and depressive-behavior disorders, drug related hospitalizations (MDD/DRH) and oral health problems and need for oral surgery services. Methods: We reviewed 18,846 dental records (AxiUm) sorted by zip codes associated with CAs. “Med Alerts” and 185 (14 types) neurotropic medications identified MDD/DRH. Chicago’s Health Atlas 2.0, 77 CAs provided age-adjusted prevalence rates for 29 MDD/DRH related variables, with ORs at 95% confidence limit. Linear regression and relative risk (RR) predicted racial and gender associations for MDD/DRH and opioid prescriptions sites (DEA-2017+ARCOS database). We also tested significance at 95% CI for residents from 16 CAs for oral health association with high MDD/DRH probability by counting decay, missing, and filled teeth (DMFT), bleed on touch (BT), periodontal clinical attachment loss and use of oral surgery services. Results: CAs significantly associated to MDD/DRH variables. MDD/DRH and opioid use were also significantly associated to non-Hispanic Black (NHB) > other persons. NHB from specific geographic CAs showed ANOVA’s significant probability with OR (at 95% CI) and RRs for behavioral disorder indicators. Significantly (p<0.0001) oral health problems and need for oral surgery service consulting associated with medication users and MDD/DRH subjects identified by gender (F>M) and race/ethnicity (NHB>other). Conclusion: Limitations included self-reporting and reliance on dental college populations although we showed statistically significant odds ratios and relative risk for MDD/DRH related to race and gender’s oral health issues and oral surgery needs to suggest a broader role.

Oral Health and Dental Treatment Needs in Thalassemia Major Patients

Abnormalities in haemoglobin is a defining characteristic of hemoglobinopathies, encompassing conditions such as sickle cell anaemia and thalassemia. Thalassemia major, a condition marked by profound anaemia resulting from insufficient haemoglobin production, impacts a significant global population. The objective of this study was to enhance comprehension of the oral health needs specific to individuals with thalassemia major, to improve the provision of healthcare services for this population. A descriptive multicentric cross-sectional study was undertaken including a cohort of 42 individuals diagnosed with severe thalassemia. The assessment of the participants' oral health was conducted with the DMFT/DMFT Index and the OHI-Simplified (OHI-S). The research revealed a significant occurrence of dentofacial abnormalities and dental treatment requirements, thereby emphasizing the importance of complete oral health care for those diagnosed with thalassemia. Individuals diagnosed with thalassemia major may present a distinctive facial attribute referred to as "Chipmunk facie" or "Rodent facie," which arises from the enlargement of the maxilla and zygomatic bone. Malocclusion, along with dental caries and oral ulcers, is a prevalent dental and facial abnormality observed within the study population. The findings of this study underscore the imperative of early detection and intervention of oral health concerns among individuals with thalassemia. Regular dental examinations and prompt intervention for dental and facial abnormalities confer advantages to individuals afflicted with thalassemia. The research highlights the importance of enhancing oral health awareness and providing education to the community as a means to enhance the provision of oral health care for those with thalassemia. The integration of dental care into thalassemia management necessitates the collaborative efforts of medical and dental professionals. Notwithstanding the perceptive conclusions drawn from the study, further research employing larger and more diverse sample sizes is necessary to substantiate and advance the obtained findings. The findings of this study will have significant implications for the development of enhanced management procedures and targeted oral health care programs for those diagnosed with thalassemia major, hence offering substantial benefits to this population. By emphasizing the significance of oral health in the context of thalassemia care, we can augment the overall well-being and quality of life of patients.

Comparing approaches to determining poor oral health among older adults in a national survey.

To compare the clinical validity of the three approaches in residential care facility residents. In NZ residential care facilities, the interRAI assessment tool is used by trained registered nurses for assessing oral status when new residents are admitted, but its validity has been questioned. Although Locker's global oral health item has been used to measure oral health in surveys and health services research, it is not routinely used in care facilities, yet its clinical validity has been demonstrated in population-based samples. Self-perceived oral health need may also be useful. Using a secondary analysis of clinical and self-reported data from a national survey of nursing home residents (the 2012 New Zealand Older People's Oral Health Survey, or OPOHS), we compared the validity of Locker's item, the interRAI tool and self-reported treatment need for identifying three key clinical indicators of poor oral health among dentate older adults; those were coronal caries (3+ teeth affected), root caries (1+ teeth affected) and xerostomia. Analyses were conducted using STATA, and survey weighting was used to obtain estimates for a source population of 25-843 individuals. The prevalence of 3+ teeth with coronal caries was 28.7% (23.9, 34.0), the prevalence of 1+ teeth with root caries was 33.7% (28.7, 39.0), the prevalence of xerostomia was 23.1% (18.4, 28.3). Marked gradients in prevalence risk ratio were seen across different categories of Locker's global oral health item and the interRAI assessment tooth for coronal caries and xerostomia. Locker's global oral health item gave a better fitting model and was more discriminative in detecting coronal caries than the interRAI assessment tool (Lockers AIC = 0.76, interRAI AIC = 0.81). None of the approaches was particularly discriminative for root surface caries experience. Self-reported approaches are discriminative for poor oral health. Standardised assessment tools used in residential care facilities should consider including a self-assessment component such as Locker's global oral health item.

Translational Systems Approach to Clinical Dental Research: A Primer for Precision and Personalized Oral Health in Resource-Constrained Settings

Resource-constrained regions such as sub-Saharan Africa urgently need to leverage innovative approaches to dental care provision and research, using available scarce resources. Even though a lot of clinical dental research has emerged in Africa, from the use of clinical dental samples (or data) and carried out by dental healthcare personnels, the principles of clinical dental research (CDR) and the embellishment of a translational dental research (TDR) pipeline is not widely used and considered. Neither has this principle trickled down to curriculum-integrated mechanisms at many academic dental schools on the continent. Equipping future dental professionals with robust clinical dental research skill need to be implemented in an integrated and systematized manner on the continent. It is therefore important to define the precise parameters of CDR and what it should entail, as well as what the exact purpose of carrying out such research should be. Furthermore, key concepts in TDR, as well as precision and personalized oral health (PPOH) need to be established, in the era of precision and omics-based dentistry. Hence, this paper discusses an integrative implementation framework and models for optimizing the use of TDR for cost effective CDR in resource-limited settings. We also proposed the utilization of a CDR and TDR model that uses a systems-oriented, multiscale integration of CDR, TDR and PPOH within the clinical dental practice settings, dental research environments, as well as incorporation of these concepts into the pedagogical curriculum of undergraduate and postgraduate dental training programs. Using the proposed integrative implementation framework for CDR and TDR in resource-constrained regions, it is envisaged that cost- and labour-effective practices will be instituted. Not least, effective incorporation of PPOH and one health into CDR and TRD will hopefully translate into beneficial global oral public health policies and systems reform in Africa.

Crisis in Providing For Fundamental Oral Health Needs

Crisis in Providing For Fundamental Oral Health Needs

Cross Sectional Observational Study of Current E-Cigarette Use and Oral Health Needs among Adolescents, Population Assessment of Tobacco and Health Study, Wave 5

Adolescents are vulnerable to marketing and normalization of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS). ENDS/ENNDS have lung and neurological impacts and a potential for oral health consequences. The aim of this study is to compare adolescents who use ENDS/ENNDS with adolescents who do not use ENDS/ENNDS in oral healthcare needs. A cross-sectional design was used with U.S. Population Assessment of Tobacco and Health wave 5 (PATH5; 2018–2019) data, (n = 12,098 adolescents, ages 12–18 years). The Wave 5 response, weighted to be nationally representative was 83.5%. This study included 9538 adolescent/parent dyads. The outcome variable was parent/guardian report of their child’s oral health need(s). The independent variable was self-reported current use/non-use of ENDS/ENNDS. Chi square and logistic regression analyses for oral health need were conducted. The Adjusted Odds Ratio for oral health needs comparing ENDS/ENNDS use vs. no use was 1.26 (95% CI: 1.01, 1.58; p = 0.0451) controlling for sex/gender, age, race, highest education in the household, physical activity of 60 min daily, self-perceived health, and language spoken at home. ENDS/ENNDS use continues to be a public health concern for U.S. youth. In this study, adolescents who used ENDS/ENNDS were more likely to have oral healthcare need than adolescents who did not use ENDS/ENNDS.

The Relationship between Tooth Loss and Quality of Life Based on OHIP-14

Introduction: The loss of natural teeth, whether replaced with dentures or not, can affect quality of life, particularly oral health-related quality of life. The loss of one or more teeth causes functional impairment that has a very negative impact on quality of life. Severe tooth loss greatly affects a person's quality of life and affects their survival. Methods: This study used a descriptive approach with a cross-sectional design. The 97 samples in this study were taken by accidental sampling method. The research instrument used in this study was the OHIP-14 questionnaire. The research data were then processed and analyzed with the Pearson correlation test. Results: Pearson correlation analysis obtained p (<0.05) which indicates that there is a significant relationship between tooth loss and quality of life related to the oral cavity. Conclusion: Tooth loss is associated with quality of life related to the oral cavity. Therefore, promotive and preventive efforts for oral health need to be improved for better health.

Perspective of pediatricians about early childhood caries (ECC) in lumbini province Nepal: A major virulent dental problem

Early childhood caries (ECC) is a significant worldwide oral health problem that needs to be looked after by parents. Some parents do not care about the oral health of their children, and they more frequently visit pediatricians. So, pediatricians are one of the most reliable profession for preventing children’s oral diseases, and promoting awareness. The aim of the study was to know the knowledge and awareness of pediatricians’ about early childhood caries (ECC) in lumbini province, Nepal.A total of 40 pediatricians were selected by using census sampling method and were requested to fill out an objective questionnaire pertaining to individual’s knowledge about ECC, without providing any oral health information taking duration of the study from March 2021 to September 2021.About 23(56.5%) of pediatricians understood the importance of pediatric dentistry. About 34(86.2%) of pediatricians performed oral examination regularly. Around 17% of pediatricians had knowledge of the ECC. Only 14(33.3%) of pediatricians acknowledged the cariogenicity of sugar containing medical syrups.The study shows poor knowledge regarding ECC, oral health, and dental treatment need in children among the surveyed pediatricians although having good knowledge about pediatric speciality and importance of primary dentition. Thus, there is a need to update the Pediatricians on recent recommendations about ECC and its early screening.

Pregnant Women's Oral Health-Related Quality of Life and Lifestyle Factors.

Pregnancy is often associated with a number of oral manifestations. There is a change in lifestyle factors and dental care during pregnancy. We conducted this cross-sectional study to determine how lifestyle factors affect oral health-related quality of life (OHRQOL) in pregnant women residing in Bero block, Jharkhand. The study included a total of 400 pregnant women aged 18-45. The assessment of lifestyle factors and OHRQOL was done using Health Practice Index (HPI) Index and Oral Health Impact Profile-14 (OHIP-14), respectively. Data was collected through face-to-face interviews. Forty percent of the pregnant women showed low OHRQOL. The majority of them were not using mouthwash and were brushing their teeth using faulty techniques. The results of logistic regression analysis showed that women with poor lifestyle scores (Odds Ratio [OR] =3.8, P-value <0.0001*), and systemic diseases (OR = 2.6, P-value < 0.001*) were more likely to have poor OHRQOL. Pregnancy is associated with poor OHRQOL and poor lifestyle scores. Effective policies for oral health need to be drafted for this group.

Establishment and clinical practice of the global diagnostic and theraputic concept of dental esthetic restoration

Dental esthetic restoration covers from facial esthetics to dental esthetics, from the realization of macroscopic to microscopic esthetic restoration goals. As an esthetic restorative dentist, he has to face and solve the increasingly high diagnosis and treatment needs of patients, the increasingly standardized needs of the dental industry, and the need for oral health to become an important part of the Healthy China strategy. Dentists engaged in esthetic restoration field should establish a concept and practice system of global esthetic restoration centered on esthetic diagnosis, interdisciplinary esthetic restoration as a means, and characterized by fine microscopic restoration. Dental esthetic restoration dentists should be the designer of esthetic restoration plans and treatment plans, as well as the implementers of the final esthetic effect. Dentists should accurately grasp the global diagnosis concept and practice system of esthetic restoration, and provide standardized and high-quality oral diagnosis and treatment services for more patients.

Oral Health Needs and Barriers to Care in Children with Learning Difficulties

Introduction: Children with learning difficulties (LD) have poorer oral health compared to those without LD due to barriers in maintaining oral care. However, the scarcity of data for this population in Malaysia has left a huge gap in understanding their problems and how to overcome those barriers. Therefore, this study was conducted to evaluate the unmet dental needs and barriers to care perceived by the guardians of children with learning difficulties (CWLD) attending the Special Education Integrated Programmes of a mainstream primary school, in comparison to children without learning difficulties. Methods: This cross-sectional study surveyed the guardians of CWLD (case) and those without LD (control), aged 6-12 years old. A total of 225 questionnaires were distributed to the guardians with a response rate of 40.4% (N=91). Unmet dental needs and barriers in both groups were analysed using the chi-square test. Barriers with significant Chi-square results were further tested with logistic regression to investigate possible confounders. Results: Unmet dental needs of 23.1% of CWLD were found. Most of the guardians agreed that regular dental check-ups were the most needed dental treatment (27.1%) compared to other treatments. The child’s behaviour and the unwillingness of the dentists to treat were among the significant barriers to dental care within the CWLD group. Conclusion: Despite regular dental visits, guardians of CWLD perceived that their children had the most unmet dental needs compared to other children without LD, with significant barriers in terms of accessing professional dental services.

Self-reported oral health status: Perspectives of patients undergoing therapy for cancer of the head and neck region, in the eThekwini District, KZN

There is a dearth of published evidence related to understanding oral health needs for patients undergoing therapy for cancer of the head and neck region in South Africa. This study aimed to assess perceived oral health status of patients undergoing therapy for cancer of the head and neck region, in eTthekwini district, KwaZulu-Natal. This was a cross-sectional case study using quantitative data to determine patients’ perspectives of oral health status and need. The study population comprised 235 voluntary patients (aged between 20-70 years old), undergoing treatment or follow up for cancer therapy of the head and neck region, in a public tertiary referral hospital in the eThekwini district, KwaZulu-Natal. Purposive sampling technique was used for participant selection. The research instrument comprised a combination of two previously validated questionnaires: a core questionnaire (EORTC QLQ-C30, Version 3.0) and the head and neck cancer specific module (EORTC H&amp;N-35). Data was analysed using the statistical package for software sciences (SPSS), version 24. More than half of the study population were male (60%;n= 141). The mean age was 54.38 (SD= 12.30). The results indicate that 14.5% (n=34) were employed, 46.4% (n=109) were unemployed because of cancer and 39.1% (n=92) were unemployed due to other reasons (old age, housewife). Oral cavity cancer was the most common (n=91; 38.7%), followed by laryngeal cancer (n= 53; 22.6%) among all the other head and neck cancers. Males(n=50; 21.3%) were more affected by oral cavity cancer as compared to females (n=41; 17.4%). With reference to treatment, 20.4% (n=48) were on radiotherapy, 28.5% (n=67) were on chemotherapy and 9.8% (n=23) were on CCRT, 17.4% (n=41) had surgery, 8.5% (n=20) were recently diagnosed with cancer of the head and neck and 23.4% (n=55) were on follow up. Oral health-related symptoms were experienced to varying degree by the participants. The majority of participants (n=125; 53.2%) did not report any pain and discomfort. More female participants (n=7; 7.4%) in the age group of 41-60 reported of severedifficulty in swallowing liquids than males of the same age group. Most participants (n=148; 63.0%) had difficulty in swallowing solid foods. Similarly, the majority of participants experienced problems with their teeth (n=162; 69.0%), reported xerostomia (n=159; 67.7%). With reference to trismus, a higher proportion of females (n=27; 28.7%) reported severe trismus compared to male participants (n=33; 23.4%). With reference to increased viscosity of saliva, 34.0% (n=32) of females reported extremely sticky saliva as compared to 29.8% males (n=42).

Who are the 10%? Characteristics of the populations and communities receiving fluoridated water in England.

In England, around 10% of the population receive optimally fluoridated water. This coverage has evolved through a combination of historical local decision-making and natural geography, rather than being strategically targeted at the national level. It is important to understand if the current distribution is equitable according to indicators of oral health need and to identify any population-level differences in socio-demographic characteristics that could introduce bias to studies evaluating the effectiveness of water fluoridation. Descriptive analysis comparing the census characteristics of populations that received optimally fluoridated (=/⟩ 0.7 mg F/L) and non-fluoridated water (⟨0.7 mg F/L) between 2009 and 2020. Populations receiving fluoridated water between 2009-2020 were on average slightly younger, more urban, more deprived, with lower education levels, higher unemployment and lower car and home ownership than the populations who received non-fluoridated water. They are more ethnically diverse, with a higher proportion of Asian ethnicity and a lower proportion of White ethnicity, compared to the non-fluoridated population. This descriptive analysis provides evidence that water fluoridation coverage within England is targeted reasonably equitably in relation to population-level indicators of need. It also confirms the need to consider the impact of underlying differences in age, deprivation, rurality, and ethnicity when evaluating the impact of water fluoridation on health outcomes in England.

The Greater Manchester Child Friendly Dental Practice Scheme: Using a Transformational Commissioning Approach to Align Paediatric Dental Service Provision with Childhood Oral Health Needs in Greater Manchester.

In response to the impact of the COVID-19 pandemic on access to already oversubscribed specialist paediatric dental services, a pilot of an enhanced primary care paediatric dental pathway, known as the Child Friendly Dental Practice (CFDP) scheme, was commissioned by the Greater Manchester Health and Social Care Partnership. Supported by a transformational commissioning approach, the ambition of the CFDP pilot was to manage or stabilise the oral health of high-need paediatric patients who had been referred to specialist dental services within Community or Hospital Dental Service settings, through timely access to primary care clinicians who were confident and experienced in treating children. The theory of change of the CFDP pilot proposed that rapid access to enhanced primary dental care would reduce the need for onward referral to specialist paediatric dental services, whilst also stabilising the oral health of children who require more complex management in specialist services. A formative evaluation of the phase one pilot implementation of the CFDP Scheme has demonstrated the potential of the CFDP Scheme to improve access to dental services for paediatric patients referred from their General Dental Practitioner. Comparison of waiting times between the CFDP pathway and the standard paediatric dental referral pathway have revealed substantially reduced waiting times to access care along the CFDP pathway, while less than 30% of those who attended CFDPs required onward referral to specialist paediatric dental services. Encouragingly, similar attendance and treatment completion rates were noted among patients from all levels of socio-economic deprivation, reducing concerns regarding the potential for service-based interventions to increase oral health inequalities. Following successful completion of the phase one pilot implementation and evaluation, the CFDP Scheme has now been rolled out across all localities in Greater Manchester as part of a second phase pilot implementation. Public Health Competencies; Equitable healthcare provision, Partnership working, Evidence-based public health, Systems thinking, Transformational commissioning, Healthcare evaluation.

'Good oral health needn't cost the Earth'

'Good oral health needn't cost the Earth'

Oral Health Needs and Barriers among Children in Saudi Arabia.

(1) Background: Understanding oral health needs and barriers is important to overcome the oral disease burden, especially after the COVID-19 pandemic. The aim of this study was to assess oral health needs and barriers among Saudi children after the COVID-19 pandemic wave started. (2) Methods: Parents of healthy children aged 3–11 years from five regions of Saudi Arabia were surveyed using an electronically administered validated questionnaire from Febuary-2021 to July-2021. Oral lesions/manifestations during the last 12 months reported by parents included tooth discoloration, ulcers, abscess, swelling of the gingiva, halitosis, gingival bleeding, dry mouth, pain while eating, difficulty in speaking or eating, burning sensation, and white spots. Barriers were assessed according to the WHO Oral Health Questionnaire. (3) Results: Children experiencing toothaches were reported by 1098 (72.4%) respondents. When reported, oral manifestations and lesions were associated with a higher inability to visit a dentist (p < 0.001). Barriers to dental care were more frequent among parents with lower education (p < 0.001; adjusted-odds ratio (AOR), 1.815) and a greater number of children (p < 0.001; AOR, 1.197). (4) Conclusion: Parents reported a high frequency of unmet oral health needs. Education could play an important role in improving oral health care in children and as a predictor of public health concerns.