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Introduction: Despite substantial research and provision of dental care, significant morbidity remains for children's oral health. Guided by social practice theory (SPT), this research moves away from the often-ineffective focus on changing individual behavior to rethinking the centrality of the social world in promoting or undermining oral health outcomes. We define social practice as a routinized relational activity linking and integrating certain elements (competence, materials, and meanings) into the performance of a practice that is reproduced across time and space., Objective: To investigate oral health in preschool children in Perth, Western Australia, using social practice theory., Methods: With no definitive methodology for investigating SPT, we chose focused ethnography as a problem-focused, context-specific approach using mainly interviews to investigate participants' experience caring for their children's oral health. The focus of analysis was the practice of oral health care, not individual behavior, where themes identified from participants' transcripts were organized into categories of elements and performance., Results: Eleven parents, all of whom were married or partnered, were interviewed in 2021. Findings identified social practices relevant to oral health within parenting and family relations linked to routine daily activities, including shopping, consumption of food and beverages, and toothbrushing. Oral health literacy was reflected in integrating competence, materials, and meanings into performing oral health care, notably preferences for children to drink water over sugary beverages and information often being sourced from social media and mothers' groups rather than health providers., Conclusion: Focusing on social practices as the unit of analysis offers a more layered understanding of elements in young children's oral health care that can indicate where the problem may lie. Findings provide an opportunity to consider future research and policy directions in children's oral health., Knowledge Transfer Statement: Examining social practices related to young children's oral health care identifies parents/carers' knowledge about, for example, toothbrushing, the resources required, and why toothbrushing is important. Analyzing these separate elements can reveal both enablers and barriers to oral health care. This provides researchers, clinicians and policymakers an opportunity to focus on not changing individual behavior but understanding how social context impacts parents/carers' capacity to make optimum decisions around young children's oral health., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Oral diseases affect a significant proportion of the world's population, yet international comparisons involving oral health outcomes have often been limited due to differences in the way country-level primary data are collected. In response to this, the World Dental Federation (FDI) Oral Health Observatory project was launched with the goal of collecting and producing standardised international data on oral health across countries. The aim of this descriptive cross-sectional study was to examine associations between self-reported general health and a range of factors (sociodemographics, oral health-related behaviours, oral impacts, clinical variables) using these standardised international datasets., Methods: Dentists within FDI member National Dental Associations who chose to take part in the project were selected using a multistage sampling method. The number of dentists in each cluster was set according to the proportion of the national population living in the area, and 50 patients per dentist were systematically approached to take part. Patients and dentists completed 2 separate questionnaires on a mobile app. Ordinal logistic regression (conducted in December 2022) was used to analyse the linked patient and dentist data from 6 countries: China (n = 2242); Colombia (n = 1029); India (n = 999); Italy (n = 711); Japan (n = 1271); and Lebanon (n = 798). Self-reported general health was the dependent variable, with age, sex, education, self-reported oral health-related behaviours, self-reported oral impacts, and clinical variables acting as the independent variables., Results: The results demonstrated a different pattern of associations in the different countries. Better self-reported general health was associated with degree-level education in all 6 countries and with reporting no oral impact and no sensitive teeth in 4 countries. Several country-specific patterns were also found, including the importance of tooth brushing in Colombia, periodontal health in Italy, and differing associations with sugary drinks consumption in India and Japan., Conclusions: These descriptive findings provide a basis for further research and, importantly, for advocacy in identifying patient oral health care needs according to both person-reported and clinical aspects. This can facilitate optimisation of service provision and potentially influence policy and investments., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

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., (Copyright© 2024 Dennis Barber Ltd.)

Background: Poor oral health is common among older adults residing in care homes impacting their diet, quality of life, self-esteem, general health and well-being. The care home setting is complex and many factors may affect the successful implementation of oral care interventions. Exploring these factors and their embedded context is key to understanding how and why interventions may or may not be successfully implemented within their intended setting., Objectives: This methodology paper describes the approach to a theoretically informed process evaluation alongside a pragmatic randomised controlled trial, so as to understand contextual factors, how the intervention was implemented and important elements that may influence the pathways to impact., Materials and Methods: SENIOR is a pragmatic randomised controlled trial designed to improve the oral health of care home residents in the United Kingdom. The trial uses a complex intervention to promote and provide oral care for residents, including education and training for staff., Results: An embedded, theoretically informed process evaluation, drawing on the PAHRIS framework and utilising a qualitative approach, will help to understand the important contextual factors within the care home that influence both the trial processes and the implementation of the intervention., Conclusion: Utilising an implementation framework as the basis for a theoretically informed process evaluation provides an approach that specifically focuses on the contextual factors that may influence and shape the pathways to impact a given complex intervention a priori, while also providing an understanding of how and why an intervention may be effective. This contrasts with the more common post hoc approach that only focuses on implementation after the empirical results have emerged., (© 2023 The Authors. Gerodontology published by Gerodontology Association and John Wiley & Sons Ltd.)

Objectives: To explore and assess what is known about oral health promotion through health-promoting primary schools in developing countries., Methods: A scoping review was conducted using the Arksey & O'Malley framework. Web of Science, PubMed, Scopus and Cochrane Library were searched, followed by the reference lists of the resulting studies. The UN classification of developing countries was used to define the countries included and the search was between 1986 and 2021. Quality assessment was carried out using Joanna Briggs Institute's quality appraisal tools., Results: The search resulted in 33 studies of which almost half were randomized controlled trials. The oral health promotion strategies were oral health education (n = 16) delivered by teachers, parents or peers, or multicomponent involving both toothbrushing (n = 15) and dietary components (n = 2). Most of the included studies were conducted in Asia (n = 25/33)., Conclusions: Findings suggested that comprehensive, multicomponent theory-based oral health promotion showed improvements in oral health outcomes of schoolchildren, particularly if delivered using a whole-school approach. However, further research on feasibility and implementation of oral health promotion through health-promoting primary schools in developing countries should be considered., (© 2023 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Background: The Oral Health Observatory (OHO), launched in 2014 by FDI World Dental Federation, aims to provide a coordinated approach to international oral health data collection. A feasibility project involving 12 countries tested the implementation of the methodology and data collection tools and assessed data quality from 6 countries., Methods: National dental associations (NDAs) recruited dentists following a standardised sampling method. Dentists and patients completed paired questionnaires (N = 7907) about patients' demographics, dental attendance, oral health-related behaviours, oral impacts, and clinical measures using a mobile app. In addition, participating dentists (n = 93) completed an evaluation survey, and NDAs completed a survey and participated in workshops to assess implementation feasibility., Results: Feasibility data are presented from the 12 participating countries. In addition, the 6 countries most advanced with data collection as of July 2020 (China, Colombia, India, Italy, Japan, and Lebanon) were included in the assessment of data quality and qualitative evaluation of implementation feasibility. All NDAs in these 6 countries reported interest in collecting standardised, international data for policy and communication activities and to understand service use and needs. Eighty-two percent of dentists (n = 76) reported a patient response rate of between 80% and 100%. More than 70% (n = 71) of dentists were either satisfied or very satisfied with the patient recruitment and data collection methods. There were variations in patient oral health and behaviours across countries, such as self-reporting twice-daily brushing which ranged from 45% in India to 83% in Colombia., Conclusions: OHO provides a feasible model for collecting international standardised data in dental practices. Reducing time implications, ensuring mobile app reliability, and allowing practitioners to access patient-reported outcomes to inform practice may enhance implementation., Competing Interests: Conflict of interest Steve Mason is employed by Haleon (formally known as  GSK Consumer Healthcare). He reports no other conflicts of interest regarding the work under consideration for publication or relevant financial activities outside the submitted work. Sean Taylor, Sarah R. Baker, Tom Broomhead, Rachael England, Michael Sereny, Georgios Tsakos, and David M. Williams report no conflicts of interest regarding the work under consideration for publication, no relevant financial activities outside the submitted work, and no patents or copyrights., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: The role of primary caregivers in setting the foundation for a child's oral health throughout life is well recognised. Due to the dominant behaviour-based approach, research to date has mainly focused on exploring individual primary caregivers' oral health knowledge and behaviours. A social science approach involving social practice theories moves beyond individual attitudes, behaviour and choices to offer a better understanding of the ways in which collective activity relates to health. This qualitative metasynthesis will involve an interpretive synthesis of data found in published qualitative literature from developed countries. The aim of the metasynthesis is to identify social practices in families from published qualitative research with caregivers on preschool children's oral health., Methods and Analysis: This is a protocol for qualitative metasynthesis. The following databases will be used: MEDLINE, EMBASE, Global Health and Dentistry & Oral Sciences Source (DOSS) using the web-based database search platform Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. The research team has determined search strategies by using relevant key terms. Qualitative studies published in English language on family factors related to preschool children (aged 0-5 years) from developed countries (2022 United Nations classification) will be included. Qualitative data analysis will involve thematic analysis of the reported factors influencing oral health of preschool children, from the perspective of social practice theory. Researchers will use NVivo software for organising and managing the data., Ethics and Dissemination: No ethics approval is required, as this study does not involve human subjects. Findings will be disseminated through professional networks, conference presentations and submission to a peer-reviewed journal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The structural determinants of health include social, economic and political mechanisms which generate social stratification and the socioeconomic positions of individuals within society. Despite their importance, these 'causes of the causes' are still relatively under-studied within oral health research. Yet it is important to assess the effects of these 'upstream' determinants, given that most individuals cannot influence or change them. It is also important to move beyond focusing primarily on downstream determinants and approaches at the individual or household level. This review will offer a brief overview of what is currently known about structural determinants and upstream interventions in relation to oral health. The review starts by briefly summarizing oral health focused studies of structural determinants, including welfare regimes, governance and macroeconomic, social and public policies. Current knowledge on upstream interventions associated with oral health such as community water fluoridation, sugar sweetened beverage taxes and dental payment structures will also be covered. The article will then assess gaps in the research base, including current limitations and barriers-as well as opportunities-in analysing the effects of structural determinants and upstream interventions. The review finishes by suggesting next steps for better understanding and addressing these determinants and interventions-including considerations around theory, data and approaches from other fields such as systems science-with the hope that these can help make contributions to future policy decision making processes., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The aim of this introductory paper is to provide an overview of key methodological developments in social and behavioural research in oral health. In the first section, we provide a brief historical perspective on research in the field. In the second section, we outline key methodological issues and introduce the seven papers in the theme. Conceptual models can contextualize research findings and address the 'why' and 'how' instead of 'what' and 'how many'. Many models exist, albeit they need to be evaluated (and adapted) for use in oral health research and in specific settings. The increasing availability of big data can facilitate this with data linkage. Through data linkage, it is possible to explore and understand in a broader capacity the array of factors that influence oral health outcomes and how oral health can influences other factors. With advances in statistical approaches, it is feasible to consider casual inferences and to quantify these effects. There is a need for not only individual efforts to embrace causal inference research but also systematic and structural changes in the field to yield substantial results. The value of qualitative research in co-producing knowledge with and from human participants in addressing 'the how' and 'the why' factors is also key. There have been calls to employ more sophisticated qualitative methods together with mixed methods approaches as ways of helping to address the complex or Wicked Problems in population oral health. In the final section, we outline possible future methodological directions in social and behavioural oral health research including participatory approaches and the development of core outcome sets. Our overriding goal in the paper is to facilitate a critical debate in relation to methodological issues which can be used to improve understanding and generate knowledge in population oral health and that this, in turn, will help inform oral health policy and practices., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Dental service provision in the care home sector is poor, with little emphasis on prevention. Emerging evidence suggests that the use of Dental Care Professionals (dental therapists and dental nurses) as an alternative to dentists has the potential to improve preventive advice, the provision of care and access to services within care homes. However, robust empirical evidence from definitive trials on how to successfully implement and sustain these interventions within care homes is currently lacking. The aim of the study is to determine whether Dental Care Professionals could reduce plaque levels of dentate older adults (65 + years) residing in care homes., Methods: This protocol describes a two-arm cluster-randomised controlled trial that will be undertaken in care homes across Wales, Northern Ireland and England. In the intervention arm, the dental therapists will visit the care homes every 6 months to assess and then treat eligible residents, where necessary. All treatment will be conducted within their Scope of Practice. Dental nurses will visit the care homes every month for the first 3 months and then three-monthly afterwards to promulgate advice to improve the day-to-day prevention offered to residents by carers. The control arm will be 'treatment as usual'. Eligible care homes (n = 40) will be randomised based on a 1:1 ratio (20 intervention and 20 control), with an average of seven residents recruited in each home resulting in an estimated sample of 280. Assessments will be undertaken at baseline, 6 months and 12 months and will include a dental examination and quality of life questionnaires. Care home staff will collect weekly information on the residents' oral health (e.g. episodes of pain and unscheduled care). The primary outcome will be a binary classification of the mean reduction in Silness-Löe Plaque Index at 6 months. A parallel process evaluation will be undertaken to explore the intervention's acceptability and how it could be embedded in standard practice (described in a separate paper), whilst a cost-effectiveness analysis will examine the potential long-term costs and benefits of the intervention., Discussion: This trial will provide evidence on how to successfully implement and sustain a Dental Care Professional-led intervention within care homes to promote access and prevention., Trial Registration: ISRCTN16332897 . Registered on 3 December 2021., (© 2022. The Author(s).)

Introduction Despite evidence that public pressure can promote sustainability in various domains (for example, retail and travel), no research has considered the public's attitudes towards sustainability in dentistry.Methods A questionnaire was developed to measure attitudes towards sustainable dentistry among adults living in the UK and their willingness to make compromises to reduce the impact of their dental treatment on the environment. In total, 344 adults completed the questionnaire that also measured pro-environmental identity and concern, general willingness to make compromises for the environment, and the tendency to engage in ecological behaviours.Results Participants reported positive attitudes towards sustainable dentistry, and were willing to compromise their time, convenience and durability of their dental treatment, as well as pay more, to reduce the impact of their dental work on the environment. Participants were not willing to compromise their health or the aesthetics of their teeth. There was also evidence that participants' current oral health shaped their attitudes towards sustainable dentistry, such that better oral health was associated with more positive attitudes towards more sustainable dentistry.Conclusions Given that public pressure can be a significant driver of change, these findings provide valuable insight into the kind of compromises that may be accepted by the public in order to improve the sustainability of dental services., (© 2022. The Author(s).)

Background: The link between oral diseases and school performance and school attendance remains unclear among Middle Eastern children., Aim: To investigate the relationship of oral conditions with schoolchildren's school performance and attendance using the life-course approach., Design: A cross-sectional study was conducted with 466 schoolchildren aged 7-8 years from Kingdom of Bahrain (KoB) and their parents. Questionnaire data on children's current and at-birth environmental characteristics were completed by their parents. Children's oral health measures, including ICDAS (International Caries Detection and Assessment System), PUFA (pulp, ulcer, fistula, abscess), and DDE (developmental defects of enamel) indices, were the exposure variables. School performance and school attendance data obtained from the school register were the outcome variables. The data were analysed using multivariate ordinal logistic regression., Results: The odds of excellent school performance were significantly lower for children with untreated dentinal caries (OR = 0.98; 95% CI: 0.96-0.99). Children with caries-treated teeth showed greater odds of excellent school performance (OR = 1.41; 95% CI: 1.15-1.74). Disease Control and PreventionNone of the dental conditions were significantly associated with children's school attendance. A permissive parental style was associated with poor school attendance (OR = 2.63; 95% CI: 1.08-6.42)., Conclusion: Dental caries was associated with poor school performance but not with school attendance. Treated caries was associated with good school performance., (© 2021 The Authors. International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd.)

This research used proof of concept agent-based models to test various theoretical mechanisms by which neighbourhoods may influence tooth decay in adults. Theoretical pathways were constructed using existing literature and tested in two study areas in Sheffield, UK. The models found a pathway between shops and sugar consumption had the most influence on adult tooth decay scores, revealing that similar mechanisms influence this outcome in different populations. This highlighted the importance of the interactions between neighbourhood features and individual level variables in influencing outcomes in tooth decay. Further work is required to improve the accuracy and reliability of the models., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Aims: To determine psychological factors predicting changes in OHRQoL and clinical status after periodontal treatment., Methods: Cohort of 140 patients with chronic periodontitis receiving non-surgical treatment consisting of scaling, root surface debridement and instruction in plaque control. Participants self-completed questionnaires enquiring about sense of coherence, locus of control, self-esteem and task-specific self-efficacy before treatment, and the Oral Health Impact Profile-14 before treatment, at oral hygiene review and end of study. Relationships among OHRQoL, clinical changes, individual factors (demographic and psychological) and environmental characteristics were analysed using latent growth curve modelling guided by the Wilson and Cleary model., Results: OHRQoL and periodontal status improved after treatment. Being male and having a greater sense of coherence predicted better OHRQoL before treatment. Stronger internal dimension of locus of control predicted a greater rate of improvement in OHRQoL, whereas greater external dimensions predicted a slower rate of improvement. Greater task-specific self-efficacy predicted less gains in probing attachment and reductions in probing depth., Conclusions: Knowledge of psychological factors may be helpful in explaining individual differences in OHRQoL and clinical responses to periodontal treatment, and in identifying where health-promoting interventions may strengthen relevant factors to improve these outcomes., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The implementation of research evidence to promote oral health is critical, given the intransigent and emerging challenges for policymakers at a population level. Despite this, little attention has been paid to implementation research within the evidence-based paradigm. This is important as getting research evidence into clinical practice is not a linear path that consists of simple sequential steps. In this article, we argue that we need to consider a broader range of conceptual and methodological approaches to increase the value of information generated. This should be undertaken either in parallel with empirical and experimental designs, or in some cases, instead of. This is important if we are going to understand the complexity and contextual knowledge of the 'system', within which interventions are implemented. Involving key stakeholders alongside empirical and experimental designs is one helpful approach. Examples of these approaches include Patient and Public Involvement and the development of Core Outcome Sets, where the views of those that will be potentially affected by the research, are included. The use of theoretical frameworks and process evaluations alongside trials are also important, if they are fully integrated into the approach taken to address the research question. A more radical approach is using participatory designs and 'systems thinking'. Participatory approaches include subject matter 'experts by experience'. These include patients, their families, carers, healthcare professionals, services managers, policymakers, commissioners and researchers. Participatory approaches raise important questions about who facilitates the process, when it should happen and how the diverse actors become meaningfully engaged so that their involvement is active, democratic and ongoing. We argue that the issues of control, power and language are central to this and represent a paradigmatic shift to conventional approaches. Systems thinking captures the idea that public health problems commonly involve multiple interdependent and interconnected factors, which interact with each other dynamically. This approach challenges the simplicity of the hierarchy of evidence and linear sequential logic, when it does not account for context. In contrast, systems thinking accepts complexity de novo and emphasizes the need to understand the whole system rather than its individual component parts. We conclude with the idea that participatory and systems thinking help to unpack the diverse agents that are often involved in the generation and translation of evidence into clinical dental practice. It moves our conception of research away from a simple exchange between 'knowledge producers' and 'knowledge users' and raises both methodological and epistemological challenges., (© 2020 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Aims: To determine changes in OHRQoL and clinical status after periodontal treatment and the factors predicting these changes., Methods: Cohort of 140 patients with chronic periodontitis receiving non-surgical treatment. Participant self-completed questionnaires: Sense of Coherence, Locus of Control, Self-esteem and Task-specific Self-efficacy before treatment, and Oral Health Impact Profile at treatment, oral hygiene review and end of study. Relationships between OHRQoL, clinical data, individual and environmental characteristics were analysed with structural equation modelling guided by the Wilson and Cleary model., Results: OHRQoL and the periodontal status improved after treatment. Greater sense of coherence and age, better periodontal status, lower DMFT and being male predicted better OHRQoL after treatment. Better task-specific self-efficacy and self-esteem, but worse plaque score predicted better end periodontal status., Conclusions: OHRQoL and periodontal status improved after periodontal treatment, and this was predicted by individual demographic and psychological factors. These factors may assist with case selection and as possible points for intervention to improve clinical and subjective outcomes of periodontal treatment., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Toothwear may impact on an individual's everyday life, yet there is little research investigating the association between toothwear and oral health related quality of life (OHRQoL). The aim of the present study was to investigate the association between toothwear and OHRQoL in adults in the United Kingdom., Basic Research Design: This study involved secondary analysis of data from 5187 participants with toothwear in the Adult Dental Health Survey conducted in 2009. Toothwear was assessed using Smith and Knight criteria and the Basic Erosive Wear Index and classified as mild, moderate and severe., Main Outcome Measures: Correlation analyses were carried out between OHIP-14 total scores and toothwear type. Regression analyses investigated the association between toothwear and OHRQoL adjusting for demographic variables., Results: There was a significant association between toothwear and OHRQoL, with more severe toothwear associated with greater oral health impact on daily life. The association between erosive toothwear and OHRQoL was significant for moderate and severe severities only. The adjusted linear regression model identified that toothwear accounted for 0.02% of the variance in total OHIP-14 scores. Females, younger individuals and less deprived individuals showed a greater association between toothwear and OHRQoL., Conclusions: In this general population sample, there was a small significant association between toothwear and OHRQoL impacts. However, the association was only significant for more severe categories of toothwear., (Copyright© 2020 Dennis Barber Ltd.)

Objectives: This study aimed to explore whether population characteristics were associated with the use of dental services, individual's personal oral health practices, dental caries and oral health-related impacts using the revised Andersen's behavioural model as the theoretical framework., Methods: This cross-sectional study included participants from a Norwegian general population (N = 1840; 20-79 years) included in the Tromstannen-Oral Health in Northern Norway (TOHNN) study. The variables included in the model were social structure (income, education, urbanization), sense of coherence (SOC), enabling resources (difficulties accessing the dentist, declined treatment, dental anxiety), treatment need, use of dental services, toothbrushing frequency, sugary soda drink consumption, decayed teeth and oral health-related impacts (OHIP-14). Structural equation modelling was used to test the direct and indirect effects within Andersen's behavioural model of access and health outcomes., Results: Andersen's behavioural model fit the data well and explained a large part of the variance in use of dental services (58%), oral health-related impacts (48%) and, to a lesser extent, decayed teeth (12%). More social structures and a stronger SOC was associated with more enabling resources, which in turn, was associated with more use of dental services. Social structures were not directly associated with use of dental services or decayed teeth but were predictive of oral health-related impacts. A stronger SOC was associated with more frequent toothbrushing, less soda drink consumptions, fewer decayed teeth and less oral health-related impacts. Self-perceived need did not predict dental attendance but was associated with decayed teeth. A less frequent use of dental services, less frequent toothbrushing and more frequent sugary soda drink consumption were associated with more decayed teeth. Decayed teeth were not associated with oral health-related impacts., Conclusion: The findings suggests that, in addition to focusing on reducing socioeconomic inequalities in relation to oral health in the Norwegian population, it is also important to consider how people perceive their own resources (eg financial, psychological, social) as well as their access to dental care in order to support regular dental attendance and potentially, in turn, enhance oral health., (© 2020 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Introduction: Evidence of the effectiveness of oral health promotion strategies among children from different socioeconomic backgrounds is necessary to support the implementation of public health interventions., Objectives: This study aimed to test the effectiveness of a school-based intervention to enhance the sense of coherence (SOC) and oral health-related quality of life (OHRQoL) of socially vulnerable Brazilian children. Furthermore, we explored the pathways by which the intervention may improve OHRQoL and SOC, assessing the direct and indirect pathways among demographic, clinical, socioeconomic, behavioral, and psychosocial variables., Methods: In this cluster-randomized trial, 5 primary schools in Brazil were randomly allocated into intervention and control groups. The intervention comprised 7 sessions of SOC-based activities over 2 mo, which focused on making the school environment a place to develop children's SOC through involving teachers, school staff, and children. Trained teachers delivered the intervention. OHRQoL and SOC data were collected at baseline, 2 wk after the intervention, and at 3-mo follow-up., Results: Information about oral clinical conditions, socioeconomic status, OHRQoL, and SOC was obtained from 356 children aged 8 to 14 y (165 in the intervention group and 191 in the control group). Children from the SOC-based intervention group reported fewer impacts of their oral health on their daily lives (Child Perceptions Questionnaire mean, 7.22) than those from the control group (9.14). The intervention group also reported greater improvement of SOC at 2 wk (SOC mean, 52.98) and 3 mo (52.75) than the control group (52.21 and 51.65, respectively)., Conclusion: The intervention was effective in improving SOC and OHRQoL among socially vulnerable Brazilian children. Moreover, SOC was a relevant predictor for oral symptom and functional status in this population (Brazilian Clinical Trials Registry RBR-2N9NHJ)., Knowledge Transfer Statement: Clinicians and policy makers can use the results of this study to decide which approach to use when planning public health policy to improve the SOC and OHRQoL of socially vulnerable children. Our findings can assist policy makers in making more appropriate community health decisions in school environments that will improve community empowerment.

Objectives: Provision of oral health care (OHC), including oral hygiene (OH) or oral/dental treatment, to dependent older people (DOP) is frequently insufficient. We aimed to assess barriers and facilitators perceived by different healthcare professionals towards providing OHC to DOP., Materials and Methods: A systematic review was performed. Studies reporting on knowledge, attitudes, and beliefs acting as barriers and facilitators for provision of OHC were included. One database (PubMed) was searched and data extraction independently performed by two reviewers. Thematic analysis was used and identified themes translated to the domains and constructs of the theoretical domains framework (TDF) and aligned with the domains of the behavior change wheel (BCW). Analyses were stratified for the two target behaviors (providing oral hygiene and providing oral/dental treatment) and according to different stakeholders' perspective. For quantitative analysis, frequency effect sizes (FES) were calculated., Results: In total, 1621 articles were identified and 41 (32 quantitative, 7 qualitative, 2 mixed method) studies included. Within these 41 studies, there were 7333 participants (4367 formal caregivers, 67 informal caregivers, 1100 managers of care, 1322 dentists, 340 DOP). Main barriers for providing OH were "lack of knowledge" (FES 65%, COM-B domain: capability, TDF domain: knowledge) and "patients refusing care" (62%, opportunity, environmental context and resources). Main facilitators were "OHC training/education" (41%, capability, skills) and "presence of a dental professional" (21%, opportunity, environmental context and resources). Main barriers for provision of dental treatment were "lack of suitable facilities for treatment/transportation of patients" (76%) and "patients refusing care" (53%) (both: opportunity, environmental context and resources). Main facilitators were "regular visiting dentist" (35%) and "routine assessment/increased awareness by staff" (35%) (both: opportunity, environmental context and resources)., Conclusions: A number of barriers and facilitators for providing different aspects of OHC were identified for different stakeholders., Clinical Relevance: Our findings help provide the evidence to develop implementation strategies for providing high-quality systematic OHC to DOP., Registration: This review was registered at Prospero (CRD42017056078).

A Wicked Problem is a problem that is impossible or difficult to solve partly because of its multi-component nature and its interconnection with other problems (Rittel & Webber, 1973). There are many Wicked Problems in the field of population oral health; tooth decay being one. Tooth decay is a function of biology (destruction of our tooth enamel); a function of our physical environment (availability, advertising and accessibility of sugar sweetened foods and drinks, availability of dental services); a function of our social environment (norms of oral hygiene and sugar consumption vary by socio-economic strata, country, and cultures); a function of us as individuals (dietary habits, visiting the dentist, oral health beliefs, toothbrushing, use of fluoride, dental anxiety, income); and a function of politics (our city, region and national policies on oral health education, tax on sugar sweetened drinks, water fluoridation, dental payment systems)., (Copyright© 2019 Dennis Barber Ltd.)

Objectives: Oral health related quality of life (OHRQoL) has been linked to malocclusion. We aimed (a) to investigate the association between malocclusion and OHRQoL among children, and (b) to examine whether this association varied by socioeconomic status., Methods: Cross-sectional analysis of data for 4,217 children aged 12 & 15 years, who participated in the 2013 Children Dental Health Survey (CDHS); a nationally representative survey of children in England, Wales, and Northern Ireland. Malocclusion was determined using the modified Index of Orthodontic Treatment Need (IOTN). OHRQoL was measured using the Child Oral Impacts on Daily Performance (Child-OIDP). For socioeconomic status, we used the pupils' eligibility for free school meals (FSM) and Index of Multiple Deprivation (IMD). Adjusted marginal effects were estimated controlling for confounding variables. Separate analyses were carried out for the two age groups., Results: Malocclusion was associated with 6% and 15% increases in the probability of reporting negative impact of OHRQoL for 12- and 15-year olds respectively, which was significant for 15-year olds (marginal effect=0.15, 95% CI=0.08-0.22). Malocclusion was associated with the prevalence of oral impacts for 12 year olds (marginal effect=0.1, 95% CI=0.02-0.17) and 15-year olds (marginal effect=0.2, 95% CI 95%=0.13-0.28) not eligible for FSM and for 15-year olds in the most (marginal effect=0.2, 95% CI=0.1-0.29) and least (marginal effect=0.26, 95% CI=0.13-0.4) deprived IMD quintiles., Conclusions: Malocclusion was associated with impacts on OHRQoL for 15-year olds. There was evidence of a relationship between SES, malocclusion and OHRQoL., (Copyright© 2019 Dennis Barber Ltd.)

Systems science methods offer an alternative way to approach problems within Dental Public Health by encouraging the consideration of the wider systems and structures in which oral health problems exist. Through such an approach, and consideration of interacting systems over multiple hierarchical levels, it may be possible to better understand the complexity associated with oral health related outcomes, and to improve theoretical understanding of these relationships. Simulation methods associated with systems science can also be used to help model and capture these real-world problems, and to help test the interactions associated with different elements of a system. The aim of this review is to summarise the concepts behind systems science approaches, and what they can offer the field of Dental Public Health. This will include an overview of the way systems science can approach problems associated with complexity, and the benefits these approaches can have. The main methods associated with the field will then be reviewed, along with examples of their application. This paper will then outline some of the main implications, both conceptual and methodological, that adopting systems science methods may have for Dental Public Health. Finally, the challenges associated with systems science will also be presented. It is hoped that this review will highlight the benefits of systems thinking, and how it can add to our conceptual knowledge of the contexts in which complex health problems are embedded., (Copyright© 2019 Dennis Barber Ltd.)

Statement of Problem: Clinicians are currently unable to quantify the psychosocial, functional, and esthetic effects of prosthetic interventions to replace teeth. Understanding the effects of treatment to replace teeth on oral health-related quality of life (OHRQoL) is important for informed consent. A systematic review of the evidence of OHRQoL improvements with prosthodontic tooth replacement and a comparison of outcomes between treatment modalities is therefore indicated., Purpose: The purpose of this systematic review was to examine the OHRQoL of patients with partial edentulism after different dental prosthetic treatments., Material and Methods: Electronic database and manual searches were conducted to identify cohort studies and clinical trials reporting on the OHRQoL of individuals receiving implant-supported crowns (ISCs), implant-supported fixed dental prostheses (IFDPs), implant-supported removable dental prostheses (IRDPs), tooth-supported fixed dental prostheses (TFDPs), and removable partial dentures (RPDs). Two reviewers independently conducted article selection, data extraction, and quality assessment. Random-effects models were used to compare OHRQoL change scores (standardized mean change, 95% confidence intervals)., Results: Of the 2147 identified studies, 2 randomized controlled trials and 21 cohort studies met the inclusion criteria. Overall, studies were of low or moderate risk of bias. Pooled mean OHRQoL change ≤9 months was 15.3 for TFDP, 11.9 for RPD, and 14.9 for IFDP. Pooled standardized mean change OHRQoL change >9 months was 13.2 for TFDP and 15.8 for IFDP. Direct comparisons ≤9 months between TFDP against IFDP and RPD against IFDP significantly favored IFDP in both cases., Conclusions: TFDP and IFDP had short- and long-term positive effects on OHRQoL. RPDs positively affected OHRQoL in the short term. IFDP showed greater short-term improvement in OHRQoL than RPD and TFDP., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Generating and implementing evidence-based policy is an important aim for many publicly funded health systems. In dentistry, this is based on the assumption that evidence-based health care increases the efficiency and effectiveness of interventions to improve oral health at a population level. This article argues that a linear logic model that links the generation of research evidence with its use is overly simplistic. It also challenges an uncritical interpretation of the evidence-based paradigm and explores approaches to the evaluation of complex interventions and how they can be embedded into policy and practice to improve oral health at a population level., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Much research on children's oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors-the so-called structural determinants of health-play a crucial role. Children's lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children's clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health-related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization's Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries ( N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children's oral health. The structural determinants accounted for between 5% and 21% of the variance in children's oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.

Background: This study aims to cross-culturally adapt the original English-language COHIP-SF 19 to Arabic culture and to test its psychometric properties in a community sample., Methods: The Arabic COHIP-SF 19 was developed and its psychometric properties were examined in a population-based sample of 876 schoolchildren who were aged 12 years of age, in Benghazi, Libya. The Arabic COHIP-SF 19 was tested for its internal consistency, reproducibility, construct validity, factorial validity and floor as well as ceiling effects. A Mann-Whitney U test was used to compare the mean scores of COHIP-SF 19 by participants' caries status and self-reported oral health rating, satisfaction and treatment need., Results: The Arabic COHIP-SF 19 was successfully and smoothly developed. It showed an acceptable level of equivalence to the original version. Overall, the internal consistency and reproducibility were acceptable to excellent, with a Cronbach's alpha of 0.84 and an intra-class correlation coefficient (ICC) of 0.76. All hypotheses predefined to test construct validity were confirmed. That is, children who had active dental caries, and who rated their oral health as poor, were not satisfied with their oral health or indicated the need of treatment had lower COHIP-SF 19 scores (P < 0.05). Floor or ceiling effects were not observed. The exploratory Factorial analysis suggested a 4-component solution and deletion of one item., Conclusion: The Arabic COHIP-SF 19 was successfully developed. The measure demonstrated satisfactory reliability and validity to estimate OHRQoL in a representative sample of 12-year-old schoolchildren.

Background: This study aimed to adapt a measure of trust in physicians to trust in dentists and to assess the reliability and validity of the measure., Methods: Questionnaire data were collected from a simple random sample of 596 Australian adults. The 11-item General Trust in Physicians Scale was modified to apply to dentists., Results: The Dentist Trust Scale (DTS) had good internal consistency (α = 0.92) and exploratory factor analysis revealed a single-factor solution. Lower DTS scores were associated with less trust in the dentist last visited, having previously changed dentists due to unhappiness with the care received, currently having dental pain, usual visiting frequency, dental avoidance, and with past experiences of discomfort, gagging, fainting, embarrassment and personal problems with the dentist., Conclusions: The majority of people appear to exhibit trust in dentists. The DTS shows promising reliability and validity evidence., (© 2017 Australian Dental Association.)

Objective: To examine the factor structure and other psychometric characteristics of the most commonly used child oral-health-related quality-of-life (OHRQoL) measure (the 16-item short-form CPQ 11-14 ) in a large number of children (N = 5804) from different settings and who had a range of caries experience and associated impacts., Methods: Secondary data analyses used subnational epidemiological samples of 11- to 14-year-olds in Australia (N = 372), New Zealand (three samples: 352, 202, 429), Brunei (423), Cambodia (244), Hong Kong (542), Malaysia (439), Thailand (220, 325), England (88, 374), Germany (1055), Mexico (335) and Brazil (404). Confirmatory factor analysis (CFA) was used to examine the factor structure of the CPQ 11-14 across the combined sample and within four regions (Australia/NZ, Asia, UK/Europe and Latin America). Item impact and internal reliability analysis were also conducted., Results: Caries experience varied, with mean DMFT scores ranging from 0.5 in the Malaysian sample to 3.4 in one New Zealand sample. Even more variation was noted in the proportion reporting only fair or poor oral health; this was highest in the Cambodian and Mexican samples and lowest in the German sample and one New Zealand sample. One in 10 reported that their oral health had a marked impact on their life overall. The CFA across all samples revealed two factors with eigenvalues greater than 1. The first involved all items in the oral symptoms and functional limitations subscales; the second involved all emotional well-being and social well-being items. The first was designated the 'symptoms/function' subscale, and the second was designated the 'well-being' subscale. Cronbach's alpha scores were 0.72 and 0.84, respectively. The symptoms/function subscale contained more of the items with greater impact, with the item 'Food stuck in between your teeth' having greatest impact; in the well-being subscale, the 'Felt shy or embarrassed' item had the greatest impact. Repeating the analyses by world region gave similar findings., Conclusion: The CPQ 11-14 performed well cross-sectionally in the largest analysis of the scale in the literature to date, with robust and mostly consistent psychometric characteristics, albeit with two underlying factors (rather than the originally hypothesized four-factor structure). It appears to be a sound, robust measure which should be useful for research, practice and policy., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The current investigation examined the determinants of oral health experiences associated with dentine hypersensitivity using prospective diary methodology., Methods: Staff and students from a large UK university who had self-diagnosed dentine hypersensitivity completed an online daily diary and text survey for 2 weeks recording their mood, oral health-related coping behaviours, coping and pain appraisals, pain experiences and functional limitations. Cross sectional and lagged path analyses were employed to examine relationships., Results: One hundred one participants took part in the diary study. Participants had a mean age of 26.3 years (range = 18-63) and most were female (N = 69). Individuals who used more oral health-related coping behaviours predicted and experienced greater levels of pain on subsequent days. Negative mood also predicted worse pain outcomes. The daily diary method provided a useful avenue for investigating variations in oral health experiences and relationships between variables that can fluctuate daily., Conclusions: Psychological variables such as coping and mood play an important role in the pain experiences of people with dentine hypersensitivity. The study highlights the benefits of using prospective methods to elucidate the experiences of people with oral conditions.

Complex associations exist among socioeconomic status (SES) in early life, beliefs about oral health care (held by individuals and their parents), and oral health-related behaviors. The pathways to poor adult oral health are difficult to model and describe, especially due to a lack of longitudinal data. The study aim was to explore possible pathways of oral health from birth to adulthood (age 38 y). We hypothesized that higher socioeconomic position in childhood would predict favorable oral health beliefs in adolescence and early adulthood, which in turn would predict favorable self-care and dental attendance behaviors; those would lead to lower dental caries experience and better self-reported oral health by age 38 y. A generalized structural equation modeling approach was used to investigate the relationship among oral health-related beliefs, behaviors in early adulthood, and dental health outcomes and quality of life in adulthood (age, 38 y), based on longitudinal data from a population-based birth cohort. The current investigation utilized prospectively collected data on early (up to 15 y) and adult (26 and 32 y) SES, oral health-related beliefs (15, 26, and 32 y), self-care behaviors (15, 28, and 32 y), oral health outcomes (e.g., number of carious and missing tooth surfaces), and oral health-related quality of life (38 y). Early SES and parental oral health-related beliefs were associated with the study members' oral health-related beliefs, which in turn predicted toothbrushing and dental service use. Toothbrushing and dental service use were associated with the number of untreated carious and missing tooth surfaces in adulthood. The number of untreated carious and missing tooth surfaces were associated with oral health-related quality of life. Oral health toward the end of the fourth decade of life is associated with intergenerational factors and various aspects of people's beliefs, SES, dental attendance, and self-care operating since the childhood years., (© International & American Associations for Dental Research 2016.)

Objective: To test the items, identified through qualitative inquiry that might form the basis of a new Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life (OHQoL) of young people with malocclusion., Methods: Piloting with 13 young people reduced the number of items from 37 to 28. Cross-sectional testing involved a convenience sample aged 10-16 years, attending the Orthodontic Department of the Charles Clifford Dental Hospital, Sheffield. The fit and function of the initial MIQ questions were examined using item response theory., Results: 184 participants (113 females; 71 males) completed a questionnaire (response 85%), seven participants were excluded due to missing responses. The mean age of participants was 12·9 years (SD 1·4) and they had a wide range of malocclusions. The majority were White British (67·4%). Data from 47 participants were used to analyse test-retest reliability. Rasch analysis was undertaken, which further reduced the number of items in the questionnaire from 28 to 17. Unidimensionality of the scale was confirmed. The analysis also identified that the original 5-point response scale could be reduced to three points. The new measure demonstrated good criterion validity (r = 0·751; P < 0·001) and construct validity with the two global questions ('Overall bother' ρ = 0·733 and 'Life overall' ρ = 0·701). Internal consistency (Cronbach's alpha = 0·906) and test-retest reliability Intraclass correlation coefficient (ICC = 0·78; 95% CI 0·61-0·88) were also good., Conclusion: Cross-sectional testing has shown the new MIQ to be both valid and reliable. Further evaluation is required to confirm the generalisability as well as the ability of the new measure to detect change over time (responsiveness).

Objectives: This study explored different pathways by which social position and social ties influence adult's oral health over a 13-year period., Methods: A cohort investigation (Pro-Saúde Study) was conducted of non-faculty civil servants at a university in Rio de Janeiro, Brazil (N=1613). Baseline data collected in 1999 included age, social position, social ties, and access to dental care. Psychological factors and smoking were assessed in 2001, whereas tooth loss and self-rated oral health (SROH) were collected in 2012. A hypothesised model exploring different direct and indirect pathways was developed and tested using structural equation modelling., Results: The model was a good fit to the data and accounted for 40% and 27% of the variance in tooth loss and SROH, respectively. A greater social position was linked to more social ties (β=0.31), health insurance (β=0.48), low psychological distress (β=0.07), less smoking (β=-0.21), more regular dental visiting (β=0.30), less tooth loss (β=-0.44) and better SROH (β=-0.25) over time. Social position (β=0.0005) and social ties (β=-0.0015) were linked indirectly with psychological distress, smoking and tooth loss. Social position was linked indirectly with social ties, psychological distress and SROH (β=-0.0071)., Conclusions: Poor social position and weak social ties were important predictors for tooth loss and poor SROH in adults over the 13-year period. Direct and indirect pathways via psychological factors and smoking on the aforementioned relationships were identified, suggesting different areas of intervention to promote adults' oral health., Clinical Significance: Adult's oral health is influenced by social conditions through direct and indirect pathways, including via psychological factors and smoking., (Copyright © 2015. Published by Elsevier Ltd.)

Objectives: To examine the relationships between dental appearance, characteristics of the individual and their environment, and oral health-related quality of life (OHQoL) in young people over time., Methods: A total of 374 young people (122 boys, 252 girls) aged 11-12 years from seven different XX schools were recruited at baseline and 258 (78 boys, 180 girls) followed-up 3 years later, aged 14-15 years (69 per cent response rate). Participants completed a measure of OHQoL (CPQ11-14 ISF-16) and self-esteem (SE, CHQ-CF87). A clinical examination was undertaken, including clinician and self-assessed normative measures of need [Index of Orthodontic Treatment Need (IOTN)] and dental caries. The Index of Multiple Deprivation was used to indicate socio-economic status (SES)., Results: There was a general improvement between baseline and follow-up in the measures of malocclusion, as well as OHQoL. Multiple linear regression indicated that there were significant cross-sectional associations at baseline between OHQoL and SES (rho = -0.11; P = 0.006), SE (rho = -0.50; P < 0.001), and self-assessed IOTN (rho = 0.27; P < 0.001). There were significant longitudinal associations between the change in OHQoL and change in SE (rho = -0.46; P < 0.001) and change in the decayed, missing, or filled surfaces (rho = -0.24; P = 0.001). The mean improvement in the total CPQ11-14 ISF-16 score for those with a history of orthodontic treatment was 3.2 (SD = 6.9; P = 0.009) and 2.4 (SD = 8.8; P < 0.001) for those with no history of treatment. The difference was not statistically significant (P = 0.584)., Conclusions: OHQoL improved in young people over time, whether they gave a history of orthodontic treatment or not. Individual and environmental characteristics influence OHQoL and should be taken into account in future studies., (© The Author 2014. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Recent research has emphasized the relationships between environmental and individual factors that may influence population oral health and lead to health inequalities. However, little is known about the effect of interactions between environmental and individual factors on inequalities in clinical (e.g., decayed teeth) and subjective oral health outcomes (e.g., oral health-related quality of life [OHQoL]). This cohort study aimed to explore the direct and mediated longitudinal interrelationships between key environmental and individual factors on clinical and subjective oral health outcomes in adults. Self-reported measures of OHQoL and individual (sense of coherence [SOC], social support, stress, oral health beliefs, dental behaviors, and subjective socioeconomic status [SES]) and environmental factors (SES and social network) were collected at baseline and 3-mo follow-up, together with a baseline clinical examination of 495 adult employees of an automobile parts manufacturer in India. Lagged structural equation modeling was guided by the adapted Wilson and Cleary/Brunner and Marmot model linking clinical, individual, and environmental variables to quality of life. The study provides tentative evidence that SES may influence levels of resources such as social support and SOC, which mediate stress and in turn may influence subjective oral health outcomes. Accordingly, the present findings and the adapted Wilson and Cleary/Brunner and Marmot model on which they are predicted provide support for the psychosocial pathway being key in the SES-oral health relationship. The pathways through which environmental factors interact with individual factors to impact subjective oral health outcomes identified here may bring opportunities for more targeted oral health promotion strategies., (© International & American Associations for Dental Research 2015.)

Objectives: Prisoners have worse oral health and greater unmet dental treatment needs than the general population. However, little is known about the impact of the mouth, or attitudes such as dental indifference and consequent patterns of dental service use in this disadvantaged group. The aim was to determine whether dental indifference was associated with the oral health-related quality of life (OHQoL) of prisoners using Andersen's behavioural model of service utilization as the theoretical framework., Methods: The sample was male prisoners aged 20-35 years attending three prisons in the north of England. Participants took part in interviews and oral examinations. The variables were selected to populate Andersen's model including: predisposing characteristics (socioeconomic status), enabling resources (dental indifference and dental attendance patterns before prison), perceived need (perceived treatment need, satisfaction with appearance of teeth, global rating of oral health), evaluated need (number of decayed teeth), health behaviours (use of dental services while in prison) and health outcomes (OHQoL). Structural equation modelling was used to estimate direct and indirect pathways between variables., Results: Of the 700 men approached, 659 completed the interview and clinical examination. Worse OHQoL was associated with less dental indifference (i.e. greater interest in oral health), previous regular use of dental services, perceived need for treatment and use of prison dental services. The number of decayed teeth and predisposing factors such as qualifications and employment did not predict OHQoL., Conclusions: Dental indifference was related to the OHQoL of prisoners in addition to previous regular use of dental services, a perceived need for treatment and use of dental services while in prison. Dental services in prisons might incorporate methods to address dental indifference in their attempts to improve oral health. The findings also have general implications for the assessment of population oral health needs., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To identify clinical and psychosocial predictors of oral-health-related quality of life (OHQoL) in Thai children over time., Methods: OHQoL data were collected from 510 students aged 10–14 years at baseline and 3, 6 and 9-month follow-up using the Child Perceptions Questionnaire (CPQ11-14), and sense of coherence (SOC), dental coping beliefs (DCB) and socioeconomic status (maternal educational attainment, paternal educational attainment and parental income), together with clinical variables (untreated caries, gingival health, malocclusion, dental opacities), were collected at baseline. The data were analysed with structural equation modelling (SEM) guided by the Wilson and Cleary model (J Am Med Assoc 1995;273:59)., Results: Mean DMFT was 1.97 (SD=1.81). Most students had healthy gingivae (54.3%) and 68.9% scored IOTN 1–4. The SEM model fitted the data well [CMIN/DF=2.574, SRMR=0.0561, CFI=0.974 and RMSEA=0.059 (90% CIs=0.039–0.079)]. Higher SOC, DCB and socioeconomic status (SES) at baseline consistently predicted better OHQoL at all three time points. Untreated caries at baseline predicted worse OHQoL at 6-month follow-up only. Malocclusion and dental opacities were unrelated to OHQoL at any time point., Conclusions: Individual factors, particularly SOC, were important influences on OHQoL, suggesting that interventions designed to promote SOC may present an opportunity to enhance children's experience of oral health in their daily lives. Clinical factors were not consistently related to OHQoL. This could be attributed to weak relationships between the two, the low level of disease and/or the sensitivity and discriminant validity of the CPQ11-14.

The objective of this study was to examine, using structural equation modelling, the relationships among clinical characteristics (such as caries experience and malocclusion), oral health-related quality of life (OHRQoL), and psychological characteristics (mental health, self-esteem, somatisation, and social perception of body image) in adolescents in New Zealand. Adolescents were examined for malocclusion using the Dental Aesthetic Index (DAI) and for dental caries. Among the 353 (58.8%) 12- and 13-yr-old adolescents who took part in this cross-sectional study, the overall mean ± SD decayed, missing, or filled surfaces (DMFS) value was 1.6 ± 3.0, with slightly more than 50% of being caries-free; the mean ± SD DAI was 31.5 ± 7.6, with one-quarter of subjects having a 'handicapping' malocclusion. The structural equation modelling analysis showed that the structural model was a good fit to the data. As hypothesized, the DAI score significantly predicted OHRQoL. There was no direct relationship between caries experience (DMFS) and OHRQoL, but there was an indirect effect of DMFS on OHRQoL mediated through psychological characteristics. The amount of OHRQoL variance accounted for in the model was substantial, at 62%. It appears that investigating OHRQoL in adolescents is not straightforward; while malocclusion directly affects OHRQoL, the influence of dental caries experience is less direct., (© 2013 Eur J Oral Sci.)

Sense of coherence (SOC) has been related to oral health behaviors and oral-health-related quality of life (OHRQoL) in observational studies. This cluster-randomized trial aimed to test the effect of an intervention to enhance SOC on OHRQoL in children. Twelve primary schools were randomly allocated to intervention and control groups. The intervention was comprised of 7 sessions over 2 mos, focusing on child participation and empowerment. The first 4 sessions were classroom activities, and the last 3 involved working on healthy school projects. Trained teachers who received a one-day course delivered the intervention. Socio-demographic and clinical data, together with self-reported measures of OHRQoL, SOC, and oral health beliefs, were obtained from 261 total 10- to 12-year-olds (133 in the intervention and 128 in the control groups). Data were collected at baseline, 2 wks after the intervention, and at three-month follow-up. Mixed-effects models indicated that the intervention increased SOC and improved OHRQoL, together with oral health beliefs and gingival health. The findings offer experimental evidence that OHRQoL can be influenced by SOC. SOC may also provide an avenue for oral health promotion (Australian New Zealand Clinical Trials Registry ACTRN12612000547842).

Purpose: Dental conditions have the potential to impact negatively on children's oral health-related quality of life (OHRQoL). However, little attempt has been made to investigate how psychosocial variables and significant life events affect children's OHRQoL. This research aimed to explore how children's dental status, coping, and self-esteem influenced OHRQoL during transition to secondary school., Methods: All patients were undergoing treatment at a UK Dental Hospital. Self-report questionnaires obtained psychosocial data on self-esteem, coping styles and OHRQoL and were completed by children 3 months prior to secondary school entry and 3 months following educational transition. Data were extracted from the clinical records of the paediatric patients who agreed to participate in the research., Results: A total of 92 children aged between 10 and 11 years participated at baseline (43% response rate) and 71 of these children participated in the follow-up investigation (77% response rate). Multiple lagged regression analyses revealed that clinical variables and children's self-perception of their physical appearance were significant predictors of OHRQoL following transition to secondary school., Conclusions: Children who were satisfied with their physical appearance reported fewer impacts on their OHRQoL. The mechanisms through which this domain of self-esteem impacts on OHRQoL warrants further investigation.

Background: A variety of inherited and acquired conditions affect the dentition. The aim of this research was to investigate the oral health-related quality of life (OHRQoL) of children in relation to the status of their permanent incisors, at a significant transitional stage in their childhood., Method: Two hundred and sixteen patients of the Charles Clifford Dental Hospital, Sheffield, aged between 10 and 11 years, were sent an OHRQoL questionnaire (CPQ₁₁₋₁₄) three months before secondary school entry. Participants were categorised, according to clinical status, as having a visible dental difference (abnormal incisor aesthetics and/or orthodontic malocclusion) or no visible difference. Follow-up questionnaires were issued three months after secondary school entry to obtain repeat psychosocial data. Analysis of variance tests investigated the impact of clinical variables, self-reported satisfaction with dental appearance and gender on OHRQoL during educational transition., Results: Ninety-two children participated in the baseline study and 71 of these children completed the follow-up questionnaire (43% and 77% response rates, respectively). Visible dental differences and dissatisfaction with dental appearance were associated with worse OHRQoL at baseline and follow-up., Conclusions: Dental conditions which result in visible incisor differences are associated with higher levels of dissatisfaction with appearance and have potential to negatively impact on children's OHRQoL.

Few studies have examined, comprehensively and prospectively, determinants of oral-health-related quality of life. The aim of this study was to examine the relationships between psychosocial factors and oral health status, health perceptions, and quality of life. Measures of symptom and functional status, health perceptions, quality of life, oral health beliefs, and psychological (sense of coherence, self-esteem, health locus of control) and social factors (parents' income and education) were collected from 439 12- and 13-year-olds at baseline and six-month follow-up, together with a clinical examination at baseline. Structural equation modeling indicated that increased levels of caries and more symptoms predicted more functional limitations, and, cross-sectionally, greater functional impact was associated with worse health perceptions, which were linked to lower quality of life. Sense of coherence was the most important psychosocial predictor. These factors are important in understanding how oral health affects young people's daily lives.

Objectives: Andersen's revised behavioural model provides a framework for understanding the factors which influence utilization of health services and key health outcomes. To date, there have been few studies that have explicitly tested the model in relation to oral health. The aim of this study was to test the model and to examine the direct and mediated pathways between social, attitudinal and behavioural factors and perceived oral health outcomes., Methods: The model was tested in a general population sample with data from the UK adult dental health survey (N = 3815) using the two-stage process of structural equation modelling., Results: Structural equation modelling indicated support in line with the hypotheses within the model; enabling resources (oral health education advice, type of dental service, finding NHS treatment expensive, dental anxiety) predicted need (number of decayed or unsound teeth and perceived treatment need); enabling resources and need predicted personal health practices and use of services (frequency of toothbrushing, recent dental attendance, attendance orientation) which, in turn, predicted perceived oral health outcomes (oral health quality of life). Both enabling resources and need also predicted perceived oral health outcomes. The impact of predisposing factors (social class, qualifications, income) on need, personal health practices and use of services, and oral health outcomes was indirect; that is, mediated by intervening factors. In the final model, 26%, 37%, 49% and 21% of the variance was accounted for in enabling resources, treatment need, personal health practices and use of services and perceived oral health outcomes respectively., Conclusion: The results provide support for Andersen's behavioural model as applied to perceived oral health. Further conceptual development of the model is discussed.

Objectives: The aim of the study was to test prospectively Wilson and Cleary's (1) conceptual model of the direct and mediated pathways between symptom burden, functional status and health perceptions in relation to the oral health of housebound elderly edentulous people., Methods: The data were collected as part of a community based randomized control trial of a domiciliary denture service for older people. Measures of self-reported symptoms, functional status and global oral and general health perceptions were collected from 133 participants prior to treatment and at 3-month follow-up., Results: The results indicated support for the dominant direct and indirect pathways within the model; worse patient reported symptoms predicted a lower functional status; worse daily functioning predicted lower global oral health perceptions. In addition, the impact of symptom status on oral health perceptions was mediated by patient reported functioning. The treatment (domiciliary denture service) significantly improved functional status and global oral health perceptions. All relationships were significant prospectively that is, from baseline, prior to the intervention, to 3-month follow-up, with the exception of between symptoms functioning., Conclusion: The results support Wilson and Cleary's conceptual model of patient outcomes as applied to elderly edentulous people. They highlight the importance of assessing a range of patient-orientated variables in order to help gain a greater understanding of how oral health impacts on individuals' daily lives and well-being. Further conceptual development of the model is discussed, particularly the role of individual difference factors.

Locker's (1988) multidimensional model of oral health provides a scientific model for the understanding of oral disease and its consequences. To date, there have been no studies that have explicitly tested the model with empirical evidence. This study aimed to: first, test the model in a general population sample using data from the UK adult dental health survey (N = 5268); and, second, to cross-validate these results in two different and diverse samples--edentulous elders (N = 133) and a clinical sample of xerostomia patients (N = 85). Structural equation modeling indicated support for the model as applied to each of the samples. All of the direct pathways hypothesized by the model were significant, in addition to several indirect or mediated pathways between key variables. Further conceptual development of the model is discussed, particularly the role of individual difference factors, and theoretical and methodological issues in oral-health-related quality-of-life research are highlighted.

Objectives: The aim of the study was to systematically test Wilson and Cleary's [Wilson IB, Cleary PD. JAMA 1995; 273: 59-65] conceptual model of the direct and mediated pathways between clinical and non-clinical variables in relation to the oral health-related quality of life (OHRQoL) of patients with xerostomia., Methods: We collected measures of clinical variables, self-reported symptoms, OHRQoL, global oral health perceptions and subjective well-being from 85 patients attending outpatient clinics., Results: Structural equation modelling indicated support for the dominant direct pathways between the main levels of the model; more severe clinical signs predicted worse patient reported symptoms; worse symptom perception was associated with a lower functional status as measured by OHRQoL; and lower OHRQoL predicted worse global oral health perceptions. There was no relationship between the final two levels of the model; global oral health perceptions and subjective well-being. Subjective well-being was associated instead with earlier non-adjacent levels; biological variables, symptoms and functional status. These pathways were both direct (salivary flow-well-being, functioning-well-being) and indirect (clinical signs-well being, symptom status-well-being). There were also indirect pathways; most notably, the impact of clinical variables on OHRQoL was mediated by patient reported symptom status., Conclusions: The results support Wilson and Cleary's conceptual model of patient outcomes as applied to a chronic oral health condition and highlight the complexity of (inter)relationships between key clinical and non-clinical variables. Further conceptual development of the model is discussed, particularly the role of individual difference factors, and theoretical and methodological issues in OHRQoL research are highlighted.

Objectives: The study compared the validity of the short form of the Oral Health Impact Profile (OHIP) and Oral Impacts on Daily Performance (OIDP) as measures of oral health-related quality of life in patients with xerostomia in the UK., Methods: A cross-sectional comparison of OHIP14 and OIDP with measures of clinical indicators, xerostomia symptom status, speech function, global oral health ratings and psychological well-being, in 85 patients attending outpatient clinics., Results: Both OHIP14 and OIDP had excellent internal reliability, and good criterion and construct validity when used in this population of xerostomia patients. In regression analyses, salivary gland condition and xerostomia symptom status significantly predicted oral health-related quality of life (OHRQoL), accounting for 29% and 14% of the variance in OHIP and OIDP scores respectively. In turn, OHRQoL predicted global ratings of oral health (26% of variance) and psychological well-being (depression) scores (15%). Sex, ethnicity and age were associated with clinical presentation and patient-reported symptoms. Clinical presentation, OHRQoL (as measured by the OIDP) and speech function were related to duration of symptoms., Conclusion: Both OHIP14 and OIDP have good psychometric properties and appear useful measures of OHRQoL in xerostomia. Overall, the OHIP14 performed better than did OIDP. For both measures, the additive scoring method may be more relevant for this population that the number of impacts.