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Objectives: To describe the oral health-related quality of life (OHRQoL) and its potential influencing factors within the Myanmar population. Methods: Data were from the first national oral health survey, involving 3,513 participants aged 15-18 years, 35-44 years, and 60-74 years from 21 selected townships in Myanmar. Self-administered questionnaire-based surveys, conducted from December 2016 to January 2017, included socio-demographics, behavioral factors, self-reported oral conditions (number of teeth present, teeth and gingival conditions), and inquiries regarding OHRQoL (a set of 12 questions with 5 response options) using the recommended questions from WHO Oral Health Surveys. Results: The most prevalent oral health issues were difficulties in chewing (32.2%) and biting foods (30.8%). In bivariate analysis, older individuals, rural residents, and participants with higher educational levels were associated with OHRQoL. In multiple regression analysis, self-reported number of teeth, teeth and gingival conditions were strong predictors of OHRQoL in all age groups. Conclusion: Self-rated oral health conditions predicted quality of life due to oral problems. The development of national oral health policies and strategies is imperative to facilitate early detection of oral health problems and promote the awareness of oral health importance. [ABSTRACT FROM AUTHOR]

Initial impetus for action: Oral health is not equitably distributed. More deprived areas experience appreciably worse oral health outcomes. Oral health improvement programmes in Local Authorities (LA) seek to reduce these inequalities but have diminished in recent years following the COVID-19 pandemic. LAs have also endured funding cuts to public health budgets, placing a greater emphasis on the need for establishing a clear prioritisation matrix for oral health improvement interventions. Solution: A prioritisation matrix that considered both the importance and do-ability of oral health improvement interventions was developed. Both are composite measures. The importance comprised evidence of benefit, impact on inequalities, alignment with national/local priorities and cost-effectiveness of the intervention. The do-ability considered the available support from stakeholders, building/equipment requirements, workforce issues and investment funding. A working group was necessary to inform the do-ability aspect of the prioritisation matrix. Scores were assigned to each criterion, the sum of the scores informed whether the intervention was eliminated, aspirational or implemented based on predetermined thresholds. Outcome: The prioritisation matrix ensured a transparent and systematic approach for intervention selection, which reflected local resources and priorities. Moreover, this tool should help ensure the most effective, equitable, practical and sustainable interventions are chosen having the greatest impact on improving oral health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the association between tobacco advertising (TA) exposure and poor self-rated oral health (SROH) is mediated through secondhand smoke (SHS) exposure in Brazilian adults who have never smoked. Methods: Secondary cross-sectional analysis of The Brazilian National Health Survey 2019 data. The daily, weekly, or monthly exposure to SHS at home or at work was set as the mediator. Mediation analysis within a counterfactual approach used adjusted binary logistic regressions for both poor SROH and SHS exposure, to estimate the natural direct effect (NDE), natural indirect effect (NIE) through SHS exposure, and marginal total effect (MTE) of TA exposure on poor SROH. To assess the robustness of the results, we calculated the E-value for the MTE. Results: The sample comprised 53,295 never smoker adults. The MTE of TA exposure on poor SROH was 1.09 (1.03, 1.16), with the indirect effect through SHS exposure responsible for only 16.6% of the total (NIE: 1.01 [1.01, 1.02] and NDE: 1.08 [1.02, 1.14]). An effect of 1.42 would be required for an unmeasured confounder to explain away the association between TA and SROH. Conclusion: More individuals exposed to TA have poor SROH than those unexposed, with secondhand smoke exposure explaining only a small portion of this effect. Upstream tobacco policies should consider oral health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Adults who have learning disabilities are a vulnerable group, little is known about their oral health and how this affects their quality of life. The aims of this secondary analysis of data from the 2009 Adult Dental Health Survey (ADHS) were to describe the oral health status of adults with learning disabilities, determine if severity of learning disability is associated with oral health and identify some of the methodological complexities of working with this population. The survey yields the most recent representative data on the oral health of adults with learning disabilities in England and importantly, contains information about oral health related quality of life (OHRQoL). Basic research design: Secondary analysis of data from a supplemental survey of adults with learning disabilities collected alongside the 2009 ADHS. Participants: 607 participants with a diagnosed learning disability aged 18 years and over. Results: Adults with learning disabilities had similar levels of active dental caries, fewer natural teeth, and fewer fillings than comparable participants from the general population. Self-reported oral and general health were worse for adults with learning disabilities than the general population. Possible associations between the severity of learning disability and the numbers of decayed, missing or filled teeth were identified. However, large amounts of missing data limited the analysis. Conclusions: There are important questions relating to the accessibility of existing self-reported oral health questionnaires and the reliability of proxy-reported questions about OHRQoL that should be addressed to give a fuller picture of the oral health of adults with learning disabilities. [ABSTRACT FROM AUTHOR]

Objective: To determine whether different alcohol intake dimensions: average alcohol volume consumed (AVC), binge drinking (BD), and alcohol-related consequences (ARC) are associated with self-rated oral health (SROH). Methods: Secondary cross-sectional analysis of The Brazilian National Health Survey of 2019 data. BD was considered when an individual reported a past-month heavy drinking episode. ARC referred to experiences such as past-year blackouts, concerns from others, or failure in routine activities. Adjusted multivari-ate Poisson regression models with robust variance were employed to calculate the prevalence ratios (PR) and 95% confidence intervals (CI) of SROH across the entire sample and stratified by sex and age. Results: The sample comprised 88,531 participants aged 18 years or older. Individuals experiencing at least one past-year ARC had an 11% (95% CI: 1.07, 1.15) higher prevalence of poor SROH than their abstainers' counterparts. Associations were more pronounced among men aged less than 50 (PR = 1.09; 95% CI: 1.03, 1.15) and women aged 50 years or more (PR = 1.15; 95% CI: 1.01, 1.30). Conclusion: Alcohol-related consequences predicted poor SROH. Oral health inquiries should include the screening for ARC in addition to traditional measurements of AVC or BD, since such exposures may not fully capture the role of alcohol on oral health impairment. [ABSTRACT FROM AUTHOR]

Objectives: To critically appraise the methodological conduct and reporting quality of economic evaluations (EE) of community water fluoridation (CWF). Methods: A systematic literature search was conducted in general databases and specialist directories of the economic literature. The Consensus on Health Economic Criteria list (CHEC) appraised the methodological quality while the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) assessed the reporting quality of included studies. Results: A total of 1,138 records were identified, of which 18 met the inclusion criteria. Cost analysis emerged as the most prevalent type of EE, though a growing trend towards conducting full EEs is observed. CHEC revealed the items most frequently unfulfilled were the study design, measurement and valuation of costs and outcomes, while CHEERS also identified reporting deficiencies in these aspects. Furthermore, the review highlights subtleties in methodological aspects that may not be discerned by CHEC, such as the estimation of the impact of fluoridation and the inclusion of treatment savings within cost estimates. Conclusions: While numerous studies were conducted before publication of these assessment instruments, this review reveals that a noteworthy subset of studies exhibited good methodological conduct and reporting quality. There has been a steady improvement in the methodological and reporting quality over time, with recently published EEs largely adhering to best practice guidelines. The evidence presented will assist policymakers in leveraging the available evidence effectively to inform resource allocation decisions. It may also serve as a resource for researchers to enhance the methodological and reporting standards of future EEs of CWF. [ABSTRACT FROM AUTHOR]

Objective: Individuals with special needs requiring special care are more vulnerable to oral health problems. Sign language is a communication medium and language of instruction for individuals with hearing impairments. The purpose of this systematic review and meta-analysis was to assess the effectiveness of sign language-based educational interventions compared to other educational interventions in improving the oral health of hearing-impaired individuals. Methods: PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials databases were searched without any restriction on the publication date. Analytical and experimental studies that evaluated and compared the effectiveness of sign language with other educational intervention groups such as videos, posters etc were included. Results: Initially, 5568 records were identified. Three relevant publications from India were eligible and included in the systematic review and meta-analysis. Differences were reported in favour of sign language over other interventions concerning plaque status, gingival health, and oral hygiene status. Conclusion: Sign language-based interventions were found to be effective. However, further studies in different locations and populations are required to support their effectiveness. [ABSTRACT FROM AUTHOR]

Background: Powered toothbrushes are an effective alternative to manual toothbrushes. Previous research found parents view powered toothbrushes as fun and motivating, although are less confident using them when children demonstrate resistant behaviour. Resistant child behaviour is a recognised barrier to achieving parental supervised brushing. Parents discuss strategies to address toothbrushing resistance on online parenting forums. Objective: To explore how those posting on an online parenting forum discuss powered toothbrushes as a potential solution to toothbrushing resistance in young children. Design: Qualitative content analysis of threads retrieved from the UK parenting forum Mumsnet. Results: The Mumsnet sub-forums 'Behaviour/Development', 'Parenting' and 'Children's Health' were searched in April 2022. 204 relevant threads on toothbrushing resistance were identified and analysed. A further search of these threads identified posts on powered toothbrushes, yielding a sub-sample of 245 posts from 111 threads (of which 97 focused on resistant behaviour from a child/children aged under three). A coding frame was developed and included six categories: use of powered toothbrushes, descriptions of toothbrushes, positive aspects, reasons for not using, approaches to using, and discussions on Mumsnet. Posters suggested powered toothbrushes as a solution to toothbrushing resistance. Posters use Mumsnet to discuss the appropriateness of powered toothbrushes for young children. Conclusions: Powered toothbrushes offer a potential solution to toothbrushing resistance. Discussions on parenting forums can normalise the use of powered toothbrushes with under-threes. Further research on how parents and dental professionals use and recommend using powered toothbrushes with under-threes would be useful. [ABSTRACT FROM AUTHOR]

The adoption of Universal Health Coverage for oral health care will not be sufficient to ensure that health care resources are accessible in accordance with needs for care. Government intervention in planning and allocating resources will be required to replace traditional market forces if market failure is not to be replaced by government failure. In this paper we explore the limitations of current 'fixed in time' approaches to planning the oral health care workforce and present an enhanced dynamic model for workforce planning that responds directly to changes in population, evidence-based best practice and new models of care. [ABSTRACT FROM AUTHOR]

Objective: To conduct a capacity and needs assessment identifying important factors for the successful implementation of an oral health coach (OHC) at well-baby clinics. This Toddler Oral Health Intervention (TOHI) provides oral health promotion to parents to prevent early childhood caries. Methods: A two-round Delphi study was conducted with an expert panel consisting of OHCs and paediatric staff. The survey was based on the Consolidated Framework for Implementation Research (CFIR), consisting of 39 constructs divided over 5 domains: intervention characteristics (8), inner setting (14), outer setting (4), characteristics of individuals (5) and the process of implementation (8). Results: Constructs relating to the inner setting, outer setting and implementation process were identified as essential. Availability of resources, information on how to execute or facilitate the intervention, and the integration of the intervention into existing work tasks were also essential. Alignment and partnership between OHCs and paediatric staff, along with the prioritization of parents' and children's needs were emphasized. A formally appointed internal implementation leader within each organization, capable of transferring their enthusiasm to the team, and regular meetings for progress and experience sharing were considered essential. Conclusion: Specific strategies are needed in the implementation phase to increase the adoption, implementation and maintenance of the TOHI, ultimately leading to improved oral health in children. This study provides valuable insights into important factors for implementation of an oral health intervention in a public health setting. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: We assessed the prevalence of moderate and severe periodontitis and its association with social determinants of health in rural and urban population from the State of Chiapas, in Southern Mexico. Material and methods: A cross-sectional population-based study was conducted in 2013 comprising people 20 years and older. The determinants were categorized as proximal (age, sex, indigenous origin, diabetes, smoking, diet), intermediate (level of schooling, occupation, medical and dental care), and structural (type of institution of health care provision, residence area). Periodontal status was assessed using the Periodontal Screening and Recording (PSR) Index. Results: In total, 467 persons (72.4% women; mean age 43.0 years [s.d 14.7]) participated. Of them, 76.5% lived in rural areas and 56.7% were of indigenous origin. Participants with moderate and severe periodontitis had a significantly lower toothbrushing frequency (44.1% and 44.8%, respectively), and poorer oral hygiene (90% and 90.3%, respectively) compared with people without periodontitis (29.4% for toothbrushing frequency and 74.5% for oral hygiene). Moderate periodontitis was associated with poor oral hygiene (OR=2.63) and no schooling (OR=1.86). Severe periodontitis was associated with age (OR=1.05), poor oral hygiene (OR=3.99), no schooling (OR=2.08), and the interaction term of rural area and indigenous origin (RM=5.23). Conclusions: Social determinants of health play an important role in the development of periodontitis. Preventive oral health programs should thus focus on the specific social, economic, and geographical context of the population. [ABSTRACT FROM AUTHOR]

Objective: To assess Mashhad residents' self-perceived oral health level (OHL) and behaviors in relation to their perceptions of those of their fellow citizens. Methods: Cross-sectional telephone survey of 384 individuals recruited from communication centers. The interviews followed a validated Persian schedule with three main sections: 1) background information, 2) questions regarding self-reported OHL, and 3) questions regarding respondents' perceptions of the OHL of their fellow citizens. Results: Participants' mean self-rated OHL and tooth brushing frequency were higher than those of their fellow citizens. The correlation between self-reported and the estimated decayed and missing (DMT) was highest in the middle and lowest in the upper classes. Perceptions of the self- and others' OHL and DMT were positively correlated, with the latter being more so. Education level, age, and tooth brushing frequency affected self-perceived OHL and DMT. Conclusion: Participants' perceived OHL could be explained by their estimation of the general population's oral health. These findings suggest that social norm interventions could nudge improving oral health behaviors. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between residence place, socioeconomic conditions and oral health-related quality of life (OHRQoL) among schoolchildren from southern Brazil. Methods: Participants were 9-14-year-old schoolchildren from rural and urban municipal schools from Rosário do Sul, Brazil. The Child Perceptions Questionnaire (CPQ11-14) was used to assess OHRQoL. A structured questionnaire collected data on sociodemographic condition (family income), residence place (urban or rural), use of dental services, and behavioral variables. Clinical oral examination recorded the presence of missing teeth and the gingival bleeding index. Multilevel Poisson regression analysis with a hierarchical approach assessed the association between predictors and CPQ11-14 scores. Rate ratios (RR) and 95% confidence intervals (CI) were estimated. Results: A total of 373 schoolchildren were included (rural area=122; urban area=251), with a mean CPQ11-14 score of 11.83, ranging from 0 to 42. Low-income schoolchildren living in rural areas had 15% higher CPQ11-14 scores than high-income schoolchildren living in urban areas. In urban areas, family income predicted OHRQoL, with low-income school children having 9% higher CPQ11-14 scores than high-income children. In rural areas, schoolchildren with low household income had 19% higher CPQ11-14 scores than high-income children. Conclusion: Schoolchildren from low-income families had a poorer OHRQoL irrespective of their area of residence (rural or urban). The association between family income and OHRQoL was more pronounced among children living in rural areas. [ABSTRACT FROM AUTHOR]

Objectives: To determine the relationship between diabetes and dental caries among US adults participating in the 2011-2018 National Health and Nutrition Examination Survey (NHANES). Basic research design: The NHANES was a cross-sectional study including clinical assessments, laboratory analysis, and interviews. The sample included 16,635 participants aged 20 years and older that represent 187,596,215 individuals in the US in a probability weighted sample. Outcome variables included overall total caries score (or number of decayed, missing, filled permanent teeth -- DMFT index) and the presence of caries. Bivariate analysis, Poisson regression for total caries score, logistic regression for the presence of caries were used for analysis. Results: Controlling for covariates, multiple Poisson regression revealed that total DMFT scores were associated with diabetes status (adjusted relative risk ratio (RR)controlled diabetes = 1.13, RRuncontrolled diabetes = 1.18; p<0.001), no college education, female sex, white race, elderly (≥ 65 years), cigarette smoking, obesity, yearly dental visits, seeing a dentist only for treatment. Similarly, multiple logistic regression shows that the odds of adults with diabetes having dental caries were higher than among those without diabetes (adjusted risk ratio (OR)controlled diabetes = 1.84, ORuncontrolled diabetes = 1.87; p<0.05). Conclusions: Diabetes was associated with a higher caries score and a greater risk for dental caries among US adults. [ABSTRACT FROM AUTHOR]

This paper summarises the proceedings of a workshop organised by the European Association of Dental Public Health, held in Montpellier in September 2022. The full proceedings were transcribed and are available on the Community Dental Health website (https://www. cdhjournal.org/article/973). The WHO Action Plan for Oral Health provides a golden opportunity to help raise the profile of oral health, to put oral health on the global public health agenda and ultimately improve oral health. It is to be applauded. However, delivery will present a challenge. Those challenges and opportunities are detailed in this paper. [ABSTRACT FROM AUTHOR]

Objective: Rapid review of the literature on strategies to increase participation rates in school-based epidemiological surveys. Basic research design: Rapid review. MEDLINE and Embase databases were searched for articles written in English from 2000 onwards. Synthesised evidence and primary research were included as data sources from peer reviewed journals and reports. Interventions: Any strategy aiming to increase participation in school-based health surveys. The comparator was usual procedure or an alternative strategy to increase participation. Main outcome measures: Primary outcomes included participation and consent rates. Secondary outcomes were feasibility, acceptability and adverse effects. Results: The search identified 591 unique records, of which 587 were excluded. Four studies were suitable for inclusion, including one systematic review, one randomised controlled trial, one cross-sectional study and one retrospective analysis. Based on very low certainty evidence, recommendations for maximising participation rates in one systematic review of US studies included: promoting the survey to school staff, parents and students; disseminating study information using direct rather than mediated methods; offering incentives to schools, staff and participants; following up non-responders; and employing a research team member to co-ordinate and monitor recruitment. However, UK studies found that different strategies did not increase participation more than that achieved by a standard approach (delivery of covering letter/consent forms via the child with no follow-up of non-responders). Conclusion: Given the lack of evidence of effectiveness of alternative strategies in the UK, additional measures beyond existing standard approaches for active consent cannot be recommended. [ABSTRACT FROM AUTHOR]

Objective: To determine whether social support explains ethnic inequalities in oral health among English individuals. Methods: Data from 42704 individuals across seven ethnic groups in the Health Survey for England (1999-2002 and 2005) were analysed. Oral health was indicated by self-reports of edentulousness and toothache. Social support was indicated by marital status and a 7-item scale on perceived social support. Confounder-adjusted regression models were fitted to evaluate ethnic inequalities in measures of social support and oral health (before and after adjustment for social support). Results: Overall, 10.4% of individuals were edentulous and 21.7% of dentate individuals had toothache in the past 6 months. Indian (Odd Ratio: 0.50, 95% Confidence Interval: 0.32-0.78), Pakistani (0.50, 95%CI: 0.30-0.84), Bangladeshi (0.29, 95%CI: 0.17-0.47) and Chinese (0.42, 95%CI: 0.25-0.71) individuals were less likely to be edentulous than white British individuals. Among dentate participants, Irish (1.21, 95%CI: 1.06-1.38) and black Caribbean individuals (1.37, 95%CI: 1.18- 1.58) were more likely whereas Chinese individuals (0.78, 95%CI: 0.63-0.97) were less likely to experience toothache than white British individuals. These inequalities were marginally attenuated after adjustment for marital status and perceived social support. Lack of social support was associated with being edentulousness and having toothache whereas marital status was associated with edentulousness only. Conclusion: The findings did not support the mediating role of social support in the association between ethnicity and oral health. However, perceived lack of social support was inversely associated with worse oral health independent of participants' sociodemographic factors. [ABSTRACT FROM AUTHOR]

Objectives: 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. Basic research design: 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. Results: 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. Discussion: 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. [ABSTRACT FROM AUTHOR]

Background: The circumstances of the area where people live may affect their health and ethnic minority groups are often overrepresented in deprived areas. This study explored ethnic inequalities in adult oral health and the contribution of area deprivation to explain such inequalities. Methods: Data from 15667 adults across 8 ethnicities (White British, Irish, Black Caribbean, Black African, Indian, Pakistani, Bangladeshi, Chinese) in the Health Survey for England 2010/2011 were analysed. Oral health was indicated by having a non-functional dentition, poor self-rated oral health and oral impacts on daily activities. Survey logistic regression and the Blinder-Oaxaca decomposition method were used. Results: There were ethnic inequalities in the non-functional dentition, but not in self-rated oral health or oral impacts. Compared to White British adults (19.7%, 95% CI: 18.9, 20.6), a non-functional dentition was more common in Irish (33.1%, 95% CI: 25.9, 41.2) and less common in Black Caribbean (14.9%, 95% CI: 9.9, 21.7), Black African (6.9%, 95% CI: 3.9, 11.9), Indian (10.5%, 95% CI: 6.3, 17.2), Pakistani (7.2%, 95% CI: 4.5, 11.5), Bangladeshi (12.7%, 95% CI: 4.3, 32.3) and Chinese (2.2%, 95% CI: 0.6, 7.9) adults. In decomposition analysis, observed population characteristics explained over half of the ethnic inequalities in the non-functional dentition. Age, area deprivation and SEP were the main contributors, although results varied by ethnicity. Conclusion: Ethnic inequalities in adult oral health varied according to oral health measure and ethnicity. Area deprivation and SEP contributed to, but did not fully, explain such inequalities. [ABSTRACT FROM AUTHOR]

Introduction: Oral health inequalities existed before Covid, but the pandemic presented an unprecedented challenge for health services. Our aim was to determine whether patient groups at risk of health care inequality due to the pandemic could be identified from NHS dental claims. Methods: Secondary analysis of routinely collected NHS Business Services Authority data for patients treated by General Dental Practitioners in England and Wales between April 2019 and January 2022 to assess the effect of the Covid pandemic on claims for patients attending general dental practices. Data for treatment items claimed after the start of the first lockdown were compared to the pre-lockdown period. Results: The proportion of claims for child fillings, child extractions and child fluoride varnish application after March 2020 were lower than equivalent proportions for adults, in both England and Wales. Similarly, there were consistently fewer claims for fillings and extractions for patients claiming pension credit guarantee credit than all pensioners in both England and Wales. Conclusion: The Covid pandemic may have caused health care inequality for children and patients claiming pension credit guarantee credit. This may compound the inequality in oral health for these patients. [ABSTRACT FROM AUTHOR]

Objective: To assess dental caries, periodontal status, malocclusion and absenteeism from school among 12-year-olds in Bhopal district, Central India. Materials and Methods: Two-stage random sample of 1238 school children. Decayed missing filled teeth (DMFT), Significant caries index (SiC), community periodontal index (CPI) and dental aesthetic index (DAI) were used to record dental caries, periodontal status and malocclusion. Information on absence from school in the previous year due to pain/discomfort in the teeth or mouth was collected via interviews. Generalized structural equation modelling (GSEM) examined the direct and indirect predictors of absence from school. Results: A total of 39.1%, 17.3% and 23.9% of children had dental caries, calculus and gingival bleeding respectively. Mean DMFT and SiC scores were 1.82 ± 1.36 and 3.15 ± 1.47. 5,127 school hours were missed due to oral health problems per 1,000 children. None of the studied variables predicted absence from school. Utilization of dental care was associated directly with gender and malocclusion (p< 0.001). Periodontal status was associated with male gender, nuclear families, tobacco consumption, and malocclusion (p< 0.001). Higher DMFT was associated with male gender, malocclusion and experience of pain/discomfort (p< 0.001). Conclusions: Poor oral health and a high prevalence of untreated dental caries were noted. Despite a considerable number of missed school hours reported due to dental conditions, none of the studied variables predicted absence from school. [ABSTRACT FROM AUTHOR]

Background: Individuals with a stronger sense of coherence (SOC) often show healthier behaviors. As parents, especially mothers, are behavioral role models for their children, this study aimed to explore the role of the mothers' SOC in prediction of the risk of dental caries in a sample of children aged 11-12 years old. Design: Cross-sectional study with 173 mother-child pairs enrolled by multi-stage sampling from four public schools in Torbat-e-Heydarieh, Iran. The data were obtained, using a demographic-health information sheet and the SOC-13 scale. Dental examinations of children were performed using the decay, missing and filled teeth index for primary (dmft) and permanent teeth (DMFT). Poisson regression analyses estimated the role of the mothers' SOC in predicting the relative risk (RR) of children's dental caries. Results: Mean dmft and DMFT were 3.4 ± 3.1 and 2.7 ± 2.9 respectively (medium severity). After controlling for demographic and health variables in regression models, greater maternal SOC indicated a protective effect against dental caries in primary (RR: 0.96; 95% CI:0.96-0-97) and permanent teeth (RR: 0.96; 95% CI: 0.95-0.97) of their children. Conclusions: With greater maternal SOC, the risk of children's dental caries decreased. Whilst this relationship was not as strong as in previous studies in other countries, it can be a platform for further research and perhaps planning to identify children who are at a greater risk of dental caries before starting dental examinations in schools. [ABSTRACT FROM AUTHOR]

Objectives: Contemporary research, surveillance and monitoring of water fluoridation requires an understanding of the population coverage of this intervention. The aims of this research are to create the first publicly available record of water fluoride concentrations in England and to describe and visualise the observed variation in water fluoride concentrations and optimal fluoridation (>/= 0.7 mg F/L) between 2009-2020. Basic research design: Routine water quality sampling data were requested from water companies in England from 2009-2020 under the provisions of the Environmental Information Regulations 2004. Fluoride concentrations of Water Supply Zones (WSZs) were assigned to Lower Super Output Areas (LSOAs) using population-weighted centroids. Results: Between 2009-2020 4247 LSOAs (12.9%) had an annual mean water fluoride concentration of >/= 0.7 mg F/L in at least one year, and 3019 LSOAs (9.1%) had a grand mean fluoride concentration of >/= 0.7 mg F/L. Coverage of optimal fluoridation varied over time; from 10.9% of LSOAs in 2014 to 6.3% in 2016. Discussion: This study confirms previous work identifying variability in the coverage and achieved concentrations of water fluoridation programmes. The current provision for accessing, collating and utilising these data are a barrier to essential monitoring, surveillance and research. An annually maintained and publicly accessible database of water fluoride concentrations is urgently required. [ABSTRACT FROM AUTHOR]

Objective: This study systematically reviews the evidence on the relationship between sense of coherence (SOC) and oral clinical conditions in adults and elderly people. Methods: PubMed, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences - Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Brazilian Dentistry Bibliography - Bibliografia Brasileira de Odontologia (BBO), Cochrane Library and grey literature were searched. Observational studies involving adults and elderly people that evaluated SOC with a valid instrument and investigated oral clinical measurements as outcomes were included. Two review authors independently assessed the studies for inclusion and extracted data. The quality of studies was assessed using the Downs and Black checklist. Meta-analysis used the random-effect inverse-variance method to obtain pooled odds ratios (OR) and 95% Confidence Intervals (CI) for each oral clinical condition. Results: From a total of 872 identified studies, ten observational cross-sectional and one longitudinal study were included. Nine studies were judged of medium or high risk of bias. Meta-analyses showed that adults and elderly people with higher SOC were less likely to present dental caries (OR 0.84; 95%CI = 0.73-0.96), periodontal disease (OR 0.58; 95%CI = 0.30-0.85), gingivitis (OR 0.54; 95%CI = 0.18-0.90) or dental biofilm (OR 0.65; 95%CI = 0.43-0.86). Conclusions: Current evidence suggests that better SOC is positively related to better oral clinical status in adults and elderly people. Longitudinal and intervention studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: To examine the patterns and predictors of dental utilisation in culturally and linguistically diverse (CALD) and non-CALD groups in New South Wales. Design: Secondary analysis of the 2013 and 2015 NSW Adult Population Health Survey (n=24,707). Main outcome: Dental utilisation, defined as a dental visit within the last 12 months. CALD groups were defined using country of birth and language. Andersen's theoretical model was used. Chi-square test and multivariate logistic regression analysis adjusted for potential confounding. Sample weights adjusted for sampling design. Results: Most (69%) of the population were Australian born; 20% spoke a language other than English at home. Dental utilisation was 58.9% and 63.9% for CALD and non-CALD groups respectively. The foreign-born non-English speaking group had the highest level of education (60%) but lower levels of dental utilisation (OR:0.81, CI 0.69-0.94) than all groups. Australian born non-English speakers had similar levels of dental utilisation to the reference group (OR:1.27, CI 0.99-1.63). Conclusion: There are significant disparities in dental care utilisation among CALD populations. Foreign born, non-English speaking CALD migrants, and people experiencing socioeconomic disadvantage, are at greatest risk of inadequate dental utilisation. Furthermore, the combination of predisposing factors, language and cultural barriers compound disparities in oral health care utilisation. This data highlights the need for oral healthcare services that are sensitive to population needs, to reduce disparities among CALD communities residing in NSW. [ABSTRACT FROM AUTHOR]

Background: Electronic cigarettes remain a divisive topic amongst public health experts and researchers. The division hinges on the the role of e-cigarettes in public health, i.e., whether e-cigarettes represent a potential to compromise decades of public health efforts by driving smoking rates up, or an effective tool to drive smoking rates down. Dental settings are a strategic place for stop smoking interventions, with large proportions of the population attending regularly and harms of smoking often presenting early in the mouth. Dental professionals should be equipped with the necessary information to provide evidence-based advice and recommendations to their patients. Objective: To update dental professionals and researchers on the current regulations, public health approaches, and oral health effects of prevailing novel nicotine products, with a focus on e-cigarettes. Methods: Narrative literature review. Principle findings: Regulatory approaches vary considerably around the world but in the UK and Europe, e-cigarettes are regulated as consumer or medicinal product, and their use is permitted. In the UK, e-cigarettes have increasingly been supported by public health institutions for smoking cessation as part of a Tobacco Harm Reduction strategy. The potential harms (including to oral health) from e-cigarette use are likely to be much less than from tobacco cigarettes. [ABSTRACT FROM AUTHOR]

Objectives: To assess the psychometric properties, including face, content, criterion and known-groups validity and reliability, of scales to measure oral health-related self-efficacy and fatalism in a regional Aboriginal adult population in Australia. Methods: Four hundred Aboriginal adults (aged 18-82 years, 67% female) completed a self-report questionnaire including items pertaining to oral health-related self-efficacy and fatalism. Structural validity was determined in exploratory factor analysis (EFA) with principal components analysis for each scale. Criterion validity was assessed between the instruments and theoretically related variables. Known-groups validity was investigated by comparing the scores in different population groups according to age, sex, education and employment. Reliability of the scales was assessed through internal consistency. Results: The EFA confirmed a single factor structure for self-efficacy and fatalism scales, with Cronbach's alphas of 0.93 and 0.89 respectively. The two scales were not correlated. Oral health-related self-efficacy was associated with toothbrush ownership and brushing the previous day supporting criterion validity. Oral health-related fatalism was associated with previous extractions and perceived need for extractions also supporting criterion validity. Both measures were associated with social impact of oral health as measured by the OHIP-14, supporting their criterion validity. Mixed findings were observed in terms of known-groups validity. Conclusions: There was initial evidence that measures of oral health-related self-efficacy and fatalism displayed adequate psychometric properties in this Aboriginal community. These constructs could have implications for approaches for improving oral health among Aboriginal people. [ABSTRACT FROM AUTHOR]

Objective: To assess the experience, prevalence, need for treatment and economic impact of caries among students 6-12 years old in four cities in Mexico. Basic research design: Cross-sectional clinical study. Setting: Elementary public schools. Participants: 500 schoolchildren aged 6 to 12 years. Method: Oral clinical examinations using WHO criteria for caries in the primary (dmft) and permanent (DMFT) dentitions. Main outcome measures: Indicators of caries in the primary and permanent dentitions: experience, prevalence, severity and the Significant Caries Index. In addition, we calculated the treatment needs, dental care rate and cost of care. Results: dmft in the primary dentition was 2.59±2.83, and DMFT was 0.82±1.44 in the permanent dentition. Caries prevalence reached 67.7% in the primary and 34.1% in permanent dentition. The treatment needs index was 85.9% and 91.3% in the primary and permanent dentitions, respectively; the dental care index was 13.9% and 8.5%, respectively. The cost of care for caries in the primary dentition was estimated at $22.087 millions of international dollars (PPP US$) when amalgam was the restorative material used, and PPP US$19.107 millions for glass ionomer. For the permanent dentition, the cost was PPP US$7.431 millions when amalgam was used and PPP US$7.985 millions when resin/composite was used as restorative material. Conclusions: The prevalence and experience of caries in the primary dentition were 50% greater than those of other studies carried out in Mexico. In the permanent dentition they were less. There is considerable need for the treatment of caries and minimal experience with restorative care. The cost of care for caries may be assumed to be high for a health system such as Mexico's. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the effects of type 2 diabetes mellitus (T2DM), need for dental care, personal health practices and use of services on oral health-related quality of life (OHRQoL) in US adults. Basic research design: The sample included 2,945 participants (aged ≥ 20) selected from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 stratified probability sample that represented 124,525,899 individuals in the weighted sample. Two-stage structural equation modelling (SEM) assessed interrelationships between T2DM regressions on factors associated with OHRQoL in a simplified three-factor Andersen Behavioral Model (ABM). Results: SEM supported the hypotheses that T2DM directly predicted need (perceived need, evaluated need, general health condition) with a significant path coefficient of 0.49 (β=0.49, p<0.05). Need had direct (77%) and indirect (23%) effects on OHRQoL (βdirect=0.30, βindirect=0.09, p< 0.001). Need predicted personal health practices including use of services (reason for dental visit, frequency of dental visits, smoking status) (β=0.46, p<0.001). Need, in turn, predicted OHRQoL (β=0.19, p<0.001). In the model, 23.8%, 59.7%, and 18.1% of the variance was explained by need, personal health practices including use of services, and OHRQoL, respectively. Conclusions: The results confirmed T2DM predicted need, which in sequence had direct and indirect effects on OHRQoL. [ABSTRACT FROM AUTHOR]

Aim: To determine the magnitude of the association between social isolation and oral health in adults. Materials and Methods: Systematic review based on PRISMA guidelines. Observational studies and clinical trials were obtained by searching the electronic databases of PubMed/MEDLINE, Web of Science, Scopus, Cochrane Library electronic, SciELO, Science Direct and Embase. Hand searches and gray literature were included. Two researchers independently selected the studies, extracted data, and analyzed and assessed their methodological quality. The Rayyan QCRI web-based tool was used to manage and cite references, and the risk of bias was estimated according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was not performed due to insufficient data. Results: The search retrieved 2545 articles. Full texts of 14 articles were read, and 1 clinical trial and 3 cross-sectional studies were included. All the studies reported on oral function, but none assessed plaque or caries parameters. The cross-sectional studies presented high risk of bias. None of the studies associated social isolation with oral health. Conclusions: There is no strong evidence for an association between social isolation and oral health in adults. Regular oral hygiene practice should be encouraged, recommended and maintained at this time of social isolation, to maintain oral health. [ABSTRACT FROM AUTHOR]

Objective: To test periodontal status as a mediator between socioeconomic status (SES) and oral health-related quality of life (OHRQoL) in pregnant women. Basic research design: Secondary cross-sectional analysis of baseline data from a randomised clinical trial with 303 pregnant women. Main outcome measures: Demographic variables, SES, smoking, interproximal hygiene, and self-reported gingival bleeding were collected as independent variables. The Oral Health Impact Profile-14 was used to assess OHRQoL. The relationship between SES, periodontal status and OHRQoL was investigated in structural equation modelling. Results: There was a moderate association of SES with periodontal status (standardised coefficient SC = -0.26, p<0.01) and number of teeth (SC = 0.24, p<0.01). Periodontal status and the number of teeth were also associated with OHRQoL (respectively, SC = 0.25, p<0.01 and SC = -0.31, p<0.01), but SES was only indirectly related to OHRQoL (SC = -0.17, p<0.01). Socioeconomic inequalities in quality of life were mainly explained by the remaining number of teeth, contributing to about 47%, and periodontal status, contributing to about 41%. Conclusions: There was no direct effect of SES on OHRQoL in pregnant women. Periodontal status and missing teeth each explained almost half of the total indirect association. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic forced a UK-wide closure of dental services. An understanding of public concerns about dental care was urgently needed to inform careful resumption of paused dental services. Aim: To describe public concerns about dental care during lockdown. Basic research design: Framework analysis of relevant Twitter posts identified collected using the Awario tool. Results: Of 1863 tweets manually screened for eligibility, 285 were relevant, as they contained views expressed by the public. The number of tweets by country were proportionate to the population size. The key views expressed in tweets focused on: 'oral health impact' ('oral health and self-care', 'types of dental problems', 'managing symptoms at home', 'views on consequences of delaying treatment') and 'dental service or care provision' ('views on managing dental care response', 'experiences with access to dental care'). Conclusions: The impact of COVID-19 on dental services raised many physical and mental health concerns for the public, highlighting their importance. Online profiles and social media communication platforms can be used to provide convenient, and timely information on public perceptions of dental care. [ABSTRACT FROM AUTHOR]

Objective: Silver diamine fluoride (SDF) is an effective cariostatic agent, although staining associated with treatment is a significant impediment to its acceptability. Basic Research Design: A cross-sectional study of Syrian refugees to identify acceptance of SDF treatment. Methods: Information was collected on: sociodemographics, medical/dental child history, dental status (dmft/DMFT), andperceptions of photographs of SDF-treated teeth. Associations between clinical findings and the acceptability were assessed. Results: Of 258 parents or guardians, 37.8% accepted SDF treatment for their children. Acceptance was related to the location and type of teeth, being higher for primary than permanent teeth, and posterior than anterior teeth in both dentitions. Uncooperative behavior during previous dental treatment, the presence of dental discoloration, history of child dental pain, and number of filled teeth were all associated with better parental acceptance. Acceptance was also related to parental age, level of education, and their relation to the child. Conclusion: Parents' acceptance of SDF treatment is low. However, staining on posterior teeth was more acceptable than staining on anterior teeth and on primary more than permanent teeth. [ABSTRACT FROM AUTHOR]

Objective: To evaluate evidence of the effectiveness of school-based behavioural interventions to improve the oral health of children aged 3-18 years in a rapid review of randomised controlled trials (RCTs). Methods: Three independent reviewers searched MEDLINE, EMBASE, Web of Science and other sources between January 2000 and December 2020 for eligible published and unpublished studies in English and extracted data. Primary outcomes were caries increment, plaque levels, gingival health, reported frequency and/or amount of free sugars intake and oral hygiene behaviour. Risk of bias was assessed using the Cochrane criteria. Results: Eight cluster RCTs met the inclusion criteria and had substantial heterogeneity. Three trials assessed caries increment and one found significant reductions in the intervention group. Another trial found similar benefits, but these were limited to children from high socioeconomic groups. The third trial found an increase in dental caries in the intervention group. Three studies reported significant reductions in plaque scores and improvements in gingival health with modest effects. Interventions delivered by peers (at adolescence) or with parents' involvement (at pre-adolescence) showed significant reductions in plaque scores compared to those delivered by dentists or teachers only. Most interventions showed significant improvements in self-reported behaviours. Conclusions: There is limited evidence of clinical benefit to dental health from school-based behavioural interventions. There is a need to conduct well-designed trials of behavioural interventions that are theory-derived and include environmental elements (e.g. supervised toothbrushing). Future trials would benefit from cost-effectiveness analysis and assessment of interventions' effect on oral health inequalities amongst children. [ABSTRACT FROM AUTHOR]

Objective: To synthesize English or Spanish-language literature on community health workers' (CHWs') roles, training, and impact in oral health. Basic research design: A scoping review conducted in accordance with the Arksey and O'Malley (2005) methodological framework. Method: Electronic literature searches were conducted in Medline (Ovid), Embase (Ovid), DOSS, CINAHL, Web of Science, and Global Health CAB from inception of the databases to April 2020. Three reviewers independently conducted the title and abstract and full-text reviews. This was followed by data charting by three reviewers and data summarizing by two reviewers. Results: Out of the 36 articles that met the inclusion criteria, most took place in the United States (n=15) with most published between 2012 and 2019 (12). CHWs were incorporated in programs that focused on access to dental care (n=10), oral health promotion only (9), early childhood caries (8), oral health promotion and services (5), and oral cancer screening (4). Common roles included providing oral health education and behavior change motivation to community members, facilitating utilization of dental services, and the delivery of diagnostic and dental services to community members. Training and outcomes were not consistently described across studies. Conclusion: CHWs have been used in oral health programs and interventions across a wide range of locations and contexts. The implementation and scaling-up of oral health CHW programs requires appropriate provision of training as well as community embedded monitoring and evaluation structures based on rigorous methods with clearly defined outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The NHS Long Term Plan prioritises NHS action to reduce health inequalities and give children a good start in life. A Sustainability and Transformation Partnership (STP) is a collaborative working arrangement between local authorities and the NHS covering a defined population and geography. Within the STP in Devon, England, all three local authorities had separate supervised toothbrushing programmes; all were precariously funded. Devon has limited access to routine NHS dentistry and children in deprived areas have high rates of general anaesthetics for dental extractions. Consolidating the supervised toothbrushing programmes presented an opportunity to address oral health inequalities across Devon STP. Objectives: 1. Reduce oral health inequalities for children in deprived areas. 2. Reduce treatment need for children who have limited access to routine NHS dentistry. 3. Invest in prevention. Methods: A proposal, supported by local authorities in Devon STP, was developed for a targeted supervised toothbrushing programme at early years sites across the most deprived 50% of areas in Devon. Return on investment was estimated using a national resource. Methods are described for identifying eligible sites and defining procurement lots. The NHS dental services commissioner agreed to support this proposal using an innovative approach to commissioning. Results: Three lots, totalling 525 sites, were awarded to two providers. Mobilisation over summer 2019 led to implementation from September 2019. Conclusion: Partnership working and innovative commissioning can enable NHS England to invest in prevention at scale where options to increase dental access are limited. Implementation across a large geographical area creates challenges but facilitates equitable programme delivery. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This article combines a review of dental studies on race with sociological insights into systemic racism to advance a counter-narrative on the root causes of racial oral health inequities. Taking racism as a form of oppression that cuts across institutional, cultural, and behavioral dimensions of social life, we ask: How pervasive are racial inequities in the occurrence of adverse oral health outcomes? What is the direction and magnitude of racial inequities in oral health? Does the inequitable distribution of negative outcomes persist over time? How can sociological frameworks on systemic racism inform initiatives to effectively reduce racial oral health inequities? The first three questions are addressed by reviewing dental studies conducted in the past few years around the globe. The fourth question is addressed by framing racial oral health inequities around sociological scholarship on racism as a systemic feature of contemporary societies. The paper concludes with a set of practical recommendations on how to eliminate racial oral health inequities, which include engaging with a strong anti-racist narrative and actively dismantling the race discrimination system. Amid the few attempts at moving the field towards improved racial justice, this paper should be followed by research on interventions against racial oral health inequities, including the conditions under which they succeed. [ABSTRACT FROM AUTHOR]