Oral Health Researchers Research Articles

Interviews with policymakers in Australian health policy: Understanding the process of policy development.

To determine the barriers and enablers oral health and chronic disease policymakers identify during policy development. Semi-structured interview questions were developed utilizing an interview guide and applying a knowledge mobilization framework. Reflective thematic analysis of the data was completed based on the research of Braun and Clarke encompassing a critical realist approach. Twelve policymakers were interviewed. Policymakers reported barriers to accessing evidence including the sheer volume of information and a lack of: research summaries, comprehensive oral health data sets, open access articles, consistency of reporting, and time. They did find relationships with experts and intermediaries crucial at times to policy development. Co-creation of research was also a key enabler for policymakers. This study highlights that policymakers find evidence crucial during the development of policy and often use it to advocate for policies. However, the links between poor oral health; and cardiovascular disease, diabetes, and cognitive impairment are not well recognized among chronic disease policymakers. It is important that oral health researchers and policymakers work to close this gap. The treatment of poor oral health is a global population health issue. It is imperative that evidence of these links is implemented into health policy for the treatment and prevention of chronic diseases and improved quality of life for individuals living with chronic diseases.

Protocol for developing a dashboard for interactive cohort analysis of oral health-related data

IntroductionA working knowledge of data analytics is becoming increasingly important in the digital health era. Interactive dashboards are a useful, accessible format for presenting and disseminating health-related information to a wide audience. However, many oral health researchers receive minimal data visualisation and programming skills.ObjectivesThe objective of this protocols paper is to demonstrate the development of an analytical, interactive dashboard, using oral health-related data from multiple national cohort surveys.MethodsThe flexdashboard package was used within the R Studio framework to create the structure-elements of the dashboard and interactivity was added with the Shiny package. Data sources derived from the national longitudinal study of children in Ireland and the national children’s food survey. Variables for input were selected based on their known associations with oral health. The data were aggregated using tidyverse packages such as dplyr and summarised using ggplot2 and kableExtra with specific functions created to generate bar-plots and tables.ResultsThe dashboard layout is structured by the YAML (YAML Ain’t Markup Language) metadata in the R Markdown document and the syntax from Flexdashboard. Survey type, wave of survey and variable selector were set as filter options. Shiny’s render functions were used to change input to automatically render code and update output. The deployed dashboard is openly accessible at https://dduh.shinyapps.io/dduh/. Examples of how to interact with the dashboard for selected oral health variables are illustrated.ConclusionVisualisation of national child cohort data in an interactive dashboard allows viewers to dynamically explore oral health data without requiring multiple plots and tables and sharing of extensive documentation. Dashboard development requires minimal non-standard R coding and can be quickly created with open-source software.

Mask-mouth syndrome: a looming oral health concern.

Mask-mouth syndrome: a looming oral health concern.

Equity, Diversity, and Inclusion Best Practices for Oral Health Researchers.

By following best practices related to equity, diversity, and inclusion, oral health researchers may be able to advance the study of health equity, grow a diverse research workforce, and better respond to pressing public health problems.

The Necessity of qualitative research for advancing oral health

Researchers are engaged with producing knowledge. Through this knowledge production, they make claims about the world. For applied health researchers, our knowledge production is both a scientific as well as a moral activity. Increasingly, oral health researchers are turning to qualitative research, a research approach that takes science and morality seriously. Qualitative research pushes researchers to think about the different worlds in which people live and work, and endeavours to generate data that reflect those worlds. This paper argues that humans are complex, and that qualitative approaches are necessary for understanding how we are all deeply embedded in historical, social, cultural and political contexts, and why this matters when thinking about oral health. This paper also dispels myths about the limitations of qualitative research and proposes future directions to improve the sophistication of qualitative oral health sciences.

Systemic Diseases with Oral Manifestations and Their Impact on Health-Related Quality of Life

Abstract Health-related quality of life is a multidimensional concept established to evaluate the physical, psychological, and social impacts of health conditions on individuals’ well-being. Various tools for measuring health-related quality of life can be categorized into two subsets: generic and disease–specific instruments. The oral cavity can be stricken by a broad range of local and systemic diseases and their systemic treatment modalities. The most common systemic illnesses associated with oral lesions are hematologic disorders, endocrinopathies, neurological disorders, gastrointestinal conditions, mucocutaneous and rheumatic diseases, and neoplastic processes. Their manifestations in the oral cavity are, in most cases, rather nonspecific but should not be overlooked. Oral health is one of the most important parts of overall health, thus it has been proposed that poor oral health may affect health–related quality of life. The presence of oral manifestations of systemic diseases has a negative impact on the daily functioning of patients, decreasing their overall well-being. This article will review the most common systemic diseases with oral manifestations and their impact on the health–related quality of life. Oral health researchers should put a stronger emphasis on the patient-reported quality of life as a primary outcome in future clinical trials. The significance of this area has still not been widely understood in the current dental literature even though it could help improve patients’ health-related quality of life.

Employing Indigenous methodologies to transform dental and medical education

Indigenous people in Australia experience considerably more dental and medical ill-health than non-Indigenous people. Cultural competence of dental and medical teams is crucial in the delivery of services to address these health disparities. Traditionally, cultural training has been incorporated later in health education curricula, resulting in students perceiving Indigenous health to be less important, relevant or useful in their future careers. Higher education institutions struggle to incorporate Indigenous culture into curricula to improve educational outcomes for Indigenous peoples and to increase cultural competence of staff and students. This study explores how a team of Indigenous and non-Indigenous researchers navigated the cultural interface to develop an Indigenous curricula model for dental and, potentially, medical programs in Australia. A team of Indigenous and non-Indigenous oral health, dental and social science researchers, together with a Cultural Competence Curriculum Review Reference Group comprising Indigenous and non-Indigenous members, successfully navigated the cultural interface. Collaborations between the reference group and research team at each phase of this research ensured authentication and validity of the data. This study highlights the importance of employing Indigenous methodologies when conducting Indigenous research to improve dental and medical health outcomes for Indigenous peoples.

Analysis of the Streptococcus mutans Proteome during Acid and Oxidative Stress Reveals Modules of Protein Coexpression and an Expanded Role for the TreR Transcriptional Regulator.

ABSTRACTStreptococcus mutans promotes a tooth-damaging dysbiosis in the oral microbiota because it can form biofilms and survive acid stress better than most of its ecological competitors, which are typically health associated. Many of these commensals produce hydrogen peroxide; therefore, S. mutans must manage both oxidative stress and acid stress with coordinated and complex physiological responses. In this study, the proteome of S. mutans was examined during regulated growth in acid and oxidative stresses as well as in deletion mutants with impaired oxidative stress phenotypes, Δnox and ΔtreR. A total of 607 proteins exhibited significantly different abundances across the conditions tested, and correlation network analysis identified modules of coexpressed proteins that were responsive to the deletion of nox and/or treR as well as acid and oxidative stress. The data explained the reactive oxygen species (ROS)-sensitive and mutacin-deficient phenotypes exhibited by the ΔtreR strain. SMU.1069-1070, a poorly understood LytTR system, had an elevated abundance in the ΔtreR strain. S. mutans LytTR systems regulate mutacin production and competence, which may explain how TreR affects mutacin production. Furthermore, the protein cluster that produces mutanobactin, a lipopeptide important in ROS tolerance, displayed a reduced abundance in the ΔtreR strain. The role of Nox as a keystone in the oxidative stress response was also emphasized. Crucially, this data set provides oral health researchers with a proteome atlas that will enable a more complete understanding of the S. mutans stress responses that are required for pathogenesis, and will facilitate the development of new and improved therapeutic approaches for dental caries.IMPORTANCE Dental caries is the most common chronic infectious disease worldwide and disproportionately affects marginalized socioeconomic groups. Streptococcus mutans is considered a primary etiological agent of caries, with its pathogenicity being dependent on coordinated physiological stress responses that mitigate the damage caused by the oxidative and acid stress common within dental plaque. In this study, the proteome of S. mutans was examined during growth in acidic and oxidative stresses as well in nox and treR deletion mutants. A total of 607 proteins were differentially expressed across the strains/growth conditions, and modules of coexpressed proteins were identified, which enabled mapping the acid and oxidative stress responses across S. mutans metabolism. The presence of TreR was linked to mutacin production via LytTR system signaling and to oxidative stress via mutanobactin production. The data provided by this study will guide future research elucidating S. mutans pathogenesis and developing improved preventative and treatment modalities for dental caries.

STANDARDIZATION OF DENTAL PATIENT-REPORTED OUTCOMES MEASUREMENT USING OHIP-5 - VALIDATION OF "RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS".

Recently, "Recommendations for use and scoring of Oral Health Impact Profile versions" (here abbreviated as Recommendations Project) were proposed by an international group of oral health researchers to standardize assessment of perceived oral health. They recommended a four-dimensional measurement approach consisting of Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact as the set of dental patient-reported outcomes to be measured with the 5-item Oral Health Impact Profile (OHIP-5). This study aimed to validate the "Recommendations for use and scoring of Oral Health Impact Profile versions" by replicating the findings they are based on. OHIP data came from the "Dimensions of OHRQoL Project." Its Validation Sample (5,022 prosthodontic patients and general population subjects) as well as its Additional Sample (N = 583 prosthodontic patients and general population subjects) were used. Validation of the Recommendations Project's findings was performed in two steps. First, correlations among OHIP versions presented in the Recommendations Project were replicated in the Validation Sample. Second, participants of the Additional Sample were subjected to a hypothetical treatment program that assigned two treatments to them according to their level of perceived oral health impact using OHIP versions. The performance of abbreviated OHIP versions was evaluated. The high correlations among summary scores of 5-, 14-, 19-, and 49-item OHIP versions (r = 0.91-0.98), found in the Recommendations Project, were replicated. All short OHIP versions performed similarly when classifying participants for a hypothetical tailored treatment program. Findings reported in "Recommendations for use and scoring of Oral Health Impact Profile versions" were validated, thus supporting the feasibility of a standardized assessment of perceived oral health in all settings across all oral diseases. Psychometrically solid and practical assessment can be performed with OHIP-5.

Communicating a Scientific Story

Public health organizations typically try to raise literacy or counter misinformation with fact sheets and other data-centric messages. Yet research shows that disseminating more information does not necessarily combat myths. Storytelling offers the oral health community another option for engaging audiences and complementing the facts. The early–20th century research into fluoride is one example of an interesting story. Data and stories can complement each other. Using the elements of storytelling to report or summarize research findings could make such findings more relevant to health policy makers, whose decisions are often driven by values and evidence. Although the scientific literature has not produced a definitive template for instilling stories in a study manuscript, I provide several techniques and caveats for oral health researchers to consider.

Adopting the COM-B model and TDF framework in oral and dental research: A narrative review.

BackgroundRecent advances in the psychological understanding of health‐related behaviour have focused on producing a comprehensive framework to model such behaviour. The Capability‐Opportunity‐Motivation‐Behaviour (COM‐B) and its associated Theoretical Domains Framework (TDF) allow researchers to classify psychological and behavioural constructs in a consistent and transferable manner across studies.AimTo identify oral and dental health‐related studies that have used the TDF and/or COM‐B as frameworks to guide research and examine the ways in which these concepts have been practically used in such research.MethodNarrative review of published literature. To be included, the paper had to (1) state that the TDF or COM‐B had been used and to have targeted at least one construct identified in either framework, (2) include primary empirical data, (3) focus on a behaviour directly related to oral or dental‐related health (eg brushing, applying fluoride varnish, flossing) and/or attitudes, intentions and beliefs related to the behaviour. Studies could include any research design, and participants of any age or gender and include patients, parents or dental health professionals.FindingsNine studies were identified that had drawn on the COM‐B and/or TDF as the framework for their research. Seven of the studies were based on the TDF only, with one employing both the COM‐B and Health Belief Model, and one using the TDF with COM‐B. The nine studies covered a broad range of oral health‐related behaviours including child tooth brushing, fluoride varnish application and non‐ or micro‐invasive management of proximal caries lesions. The populations in the studies included dentists, dental teams and parents of children. All studies adopted only a subset of the constructs within the TDF, often without justification.ConclusionsIt is encouraging that oral health researchers are adopting standardized psychological frameworks to develop their research and oral health interventions. Future work should build on the small number of studies identified in this review and consider using standardized tools to do so.

COVID-19 Impact on Community-Based Participatory Randomized Controlled Trials-Lessons From the Oral Health Disparities in Children Consortium.

The COVID-19 pandemic has had a major impact on nearly every sector of science and industry worldwide, including a significant disruption to clinical trials and dentistry. From the beginning of the pandemic, dental care was considered high risk for viral transmission due to frequent aerosol-generating procedures. This resulted in special challenges for dental providers, oral health care workers, patients, and oral health researchers. By describing the effect that the COVID-19 pandemic had on four community-based randomized clinical trials in the Oral Health Disparities in Children (OHDC) Consortium, we highlight major challenges so researchers can anticipate impacts from any future disruptions.

The burden of oral cancer in China, 1990\u20132017: an analysis for the Global Burden of Disease, Injuries, and Risk Factors Study 2017

BackgroundOral cancer is among the most common malignant tumors worldwide, and it has become an increasingly important public health problem in China. This study systematically assesses the current state of oral cancer in China from 1990 to 2017, providing new information and perspectives for oral health researchers and public health policy makers.MethodsBased on the Global Burden of Disease, Injuries, and Risk Factors Study 2017 (GBD 2017), we evaluated the incidence rates, mortality and disability-adjusted life year (DALY) rates for oral cancer in China and their changing trends between 1990 and 2017, making comparisons by gender and age. We also assessed the DALY rates associated with oral cancer at the provincial level for 33 provinces and their trends over time.ResultsFrom 1990 to 2017, the number of new cases and the age-standardized incidence rate for oral cancer in China increased by 280.0% and 79.7%, respectively; the number of deaths and the age-standardized mortality rose by 196.8% and 29.0%, respectively; and the number of DALYs and the age-standardized DALY rate increased by 149.1% and 21.0%, respectively. The incidence rates for oral cancer rose after 30 years of age and peaked at 65–69 years; the mortality for oral cancer rose after 50 years of age and peaked at 65–69 years; and the DALY rates for oral cancer rose after 45 years of age and peaked at 65–69 years. The incidence rates, mortality and DALY rates for oral cancer in males were significantly higher than those in females and showed an upward trend, while there was a decrease or no significant change in females. The DALY rates increased in 21 provinces and decreased in 12 provinces, with the largest growth in Henan Province and the largest decline in Hong Kong Province.ConclusionsThe burden of oral cancer in China continues to increase continuously. More prevention, control and intervention measures should be taken and increased attention paid to common risk factors is essential for the prevention of oral cancer.

Dental Care and Oral Health under the Clouds of COVID-19.

This commentary provides a timely evidence-based overview on the impact of COVID-19 on dental care and oral health and identifies gaps in protection of patients and staff in dental settings. Oral symptoms are prominent before fever and cough occur. Dental professionals may play an important role in early identification and diagnosis of patients with COVID-19.

Effects of Racism on Oral Health in the United States.

This paper comments on the Effects of Racism on Oral Health in the United States (US). It provides the background and sets the stage to raise questions about race: how was race defined originally, what exactly is race, and how have racial categories been enumerated? Following this path, the paper broadens the scope of view regarding data attributable to racial categories pointing to social and cultural factors that influence overall health outcomes, particularly those related to oral health. Oral health researchers, advocates, providers, administrators, program planners, and funders, among others rely on data, often compiled by racial categories. We should be aware of potential vagaries that can accompany race-based data, and its interpretation and application, regarding oral health. The paper suggests we should be mindful of other influences that affect documented differences among populations regarding their oral health status.

Oral Site Specific Sampling Reveals Differential Location for Scardovia wiggsiae

Introduction: The newly discovered cariogenic pathogen Scardovia wiggsiae has been the subject of intense scientific interest due to the role it may play in the development or progression of caries and oral disease. The primary objective of this study was to perform DNA microbial screening from five specific oral sites, including the gingival crevice between the upper central incisors, biofilm of the upper first molar and lingual incisor, as well as the dorsum of the tongue – for comparison with unstimulated saliva. These data may provide significant insights into site-specific oral locations that harbor S. wiggsiae.
 Methods: More than one hundred previously collected clinical samples (n=105) were identified for inclusion in this study. DNA isolates were screened using a NanoDrop spectrophotometer to determine overall DNA quantity and quality. Samples with sufficient quality and quantity were screened for the presence of S. wiggsiae using validated PCR primers.
 Results: More than one hundred patient samples (n=105) were identified, which were comprised of mostly female (57%) versus male (43%) and minority (71%) versus White (29%). The average DNA concentrations ranged between 13.74 and 14.69 mg/mL, with A260:A280 ratios ranging between 1.62 – 1.70. Results of molecular screening using S. wiggsiae specific primers demonstrated only a small percentage of pooled samples (7.6%) harbored this DNA, which was highly concentrated among the samples from tooth surfaces (Upper First Molar, Lingual Incisor) and saliva compared with the gingival crevice and dorsum of the tongue.
 Discussion: These data provide novel information regarding specific oral locations, including tooth surfaces that harbor S. wiggsiae. In addition, these sites also provide new information regarding oral sites that do not appear to harbor this organism, including the gingival crevice and dorsum of the tongue. This information may be particularly useful to oral health researchers as they strive to limit and reduce the cariogenic microbiome among high-risk populations.

Trends in Academic Dentistry and Oral Health Research Funding by Gender.

Dental and oral health researchers compose a small share of the research workforce, and within this group female researchers form a much smaller share than male researchers. Additionally, a majority of full-time faculty appointments at dental schools are held by men, with women making up only 39% of full-time appointments. These factors suggest that there could be disparities between men and women in obtaining research funding. The focus of our study was to determine whether there are gender differences in award funding obtained from the National Institute of Dental and Craniofacial Research or the National Institutes of Health (NIH). NIH administrative data were analyzed by focusing on Research Project Grants (RPGs), the primary and most commonly used mechanism to support investigator-initiated research projects. Analyses involved 1 or 2 of the following variables: number of unique applicants or awardees, fiscal years 2007 to 2016, average age of unique applicants, awardee's degrees, awardee's age at first R01, and award rates. About two-thirds of RPG applicants and awardees were men. Although there were significantly more male applicants and awardees, there was no significant difference in award rate by gender, and there was no significant award rate variation through time or by degrees. The average ages of RPG applicants were similar for genders for all degrees, except that male dentists and PhD-dentists applying to the National Institute of Dental and Craniofacial Research were older and male MDs and PhD-dentists from dental schools applying to the NIH were older. This study demonstrated that men in the dental/oral health workforce submit more applications and receive more NIH awards than do women; however, there was no difference in award rates between women and men and no difference in ages by gender at which the first R01 awards are received. Analyses of the implications of this study by the academic dentistry and oral health community could lead to establishing opportunities to expand the representation of women in dental and oral health research. Increasing the number of applications submitted by women may help achieve an equitable balance of grantees in the workforce.

Risk of bias over time in updates of Cochrane oral health reviews

ObjectivesTo assess the changes in the risk of bias (RoB) across different versions of the same Cochrane systematic review, and to identify characteristics of systematic reviews which may be associated with different RoB scores by means of regression analysis. MethodsWe examined changes in RoB ratings in domains of randomized controlled trials (RCTs) and controlled trials (CTs) included in original Cochrane systematic reviews and their updates published in oral health. First, we checked the number of domains assessed for RoB in the different versions of the systematic review. Then, we computed the percentage of different ratings of RoB (low, high and unclear) in these systematic review versions. All data selection, extraction and analysis were conducted independently and in duplicate by two assessors. Time trends were reported in the form of line graphs. We also assessed systematic review characteristics as predictors of RoB scores by means of regression analysis. ResultsA total of 173 reviews consisting of the original reviews and their updates were examined. The proportion of different ratings of RoB was kept stable over the different versions. However, in more recent versions, the proportion of unclear RoB slightly increased, and the proportion of high RoB decreased. Cochrane risk of bias domains were a significant RoB score predictor (Likelihood ratio test p-value < 0.001). ConclusionsMethodological improvements in RCTs and CTs included in Cochrane reviews are needed. This comprehensive information on the RoB trend may help oral health researchers improving the methodology related to specific domains. Clinical significanceMethodological improvements are necessary for primary studies included in Cochrane reviews in oral health. The increase of domains rated as unclear RoB is of concern and suggests that strategies should be developed to improve the level of communication between trialists and systematic reviewers.

The knowledge and use of population-based methods for caries detection

BackgroundSince the 1980s, a wide variety of methods have been proposed to measure dental caries in the population, demonstrating a lack of consensus regarding the procedure that should be used for this purpose. The current study investigated the methods that are known and used by public oral health researchers and professors as well as the reasons that lead to the choice of a particular method.MethodIn the context of an interview, a questionnaire was administered to public oral health researchers and professors who used caries indices and worked in Salvador and Feira de Santana, Bahia, Brazil from 2005 to 2015. A quantitative and descriptive approach was applied that adopted the multiple correspondence analysis (MCA) technique to assess the associations among responses.ResultsThe decayed, missing, and filled index (DMF) was the only measurement known by all respondents, and although 45 of the 47 professors/researchers were dissatisfied with this index, only six had used other methods. This index was chosen because of its comparability and ease of application. The MCA revealed response associations among older, male participants who graduated from the Federal University of Bahia (UFBA) and who continued to use this index because of its comparability and because it is the index recommended by the World Health Organization (WHO) and the Brazilian Ministry of Health (MS). Another group was also observed that consisted of younger females who graduated from the State University of Feira de Santana (UEFS) or another university and who used the DMF because it is well-known, simple, and easy to apply.ConclusionsThe DMF index was the most known and used method. Many respondents demonstrated a desire for change and were critical of the DMF; however, they did not know of and had not used newer methods for measuring dental caries. Greater importance should be placed on the problem of dental caries assessment in the population.

How Research Training Will Shape the Future of Dental, Oral, and Craniofacial Research.

This is a critical time in the history of the dental profession for it to fully embrace the responsibility to safeguard its reputation as a learned profession. In this golden era of scientific and technological advances, opportunities abound to create new diagnostics, preventions, treatments, and cures to improve oral health. Dental schools are the largest national resource entrusted with the responsibility to educate, train, and retain oral health researchers who can leverage such technologies and research opportunities that will benefit the profession at large as well as patients. This article reemphasizes the theme that research training and scholarship must be inextricably woven into the environment and culture in dental schools to ensure the future standing of the profession. An overview of the history of support provided by the National Institutes of Health and National Institute of Dental and Craniofacial Research for the training and career development of dentist-scientists is presented. In addition, new data on the outcomes of such investments are presented along with a comparison with other health professions. This overview underscores the need to expand the capacity of a well-trained cadre of oral health researchers through the reengineering of training programs. Such strategies will best prepare future graduates for team science, clinical trials, and translational research as well as other emerging opportunities. The urgent need for national organizations like the American Dental Association, American Dental Education Association, and American Association for Dental Research to create new alliances and novel initiatives to assist dental schools and universities in fulfilling their research mission is emphasized. To ignore such calls for action is to disavow a valuable legacy inherited by the dental profession. This article was written as part of the project "Advancing Dental Education in the 21st Century."