Oral health inequalities and the COVID-19 pandemic: time for action

Over the last years, the COVID-19 pandemic has introduced a major public health crisis globally that societies have struggled to address irrespective of the approach followed. The different aspects of the crisis and how it has been handled from the point of view of social epidemiology, do not offer a positive reading. One key "message" has been that we are "all in it together". This implies a socially neutral phenomenon, yet there is clear evidence of stark socioeconomic and ethnic inequalities with disproportionate burden of the pandemic among the more deprived groups in the society (Marmot, 2020). And this has taken place in the background of already well-established health inequalities that have further increased over the last decade (Marmot et al., 2020). At the same time, addressing inequalities has been a central piece of government and societal health policy objectives

Treatment needs and skill mix workforce requirements for prosthodontic care: a comparison of estimates using normative and sociodental approaches.

The traditional measure for assessing dental treatment needs and workforce requirements based solely on normative need (NN) has major shortcomings. The sociodental approach (SDA) to assess needs overcomes some of the shortcomings as it combines normative and subjective needs assessments and also incorporates behavioural propensity (Sheiham and Tsakos 2007). The objective of this study was to estimate and compare prosthodontic treatment needs and workforce requirements, using the normative and the sociodental approaches for different skill mix models

Treatment needs and skill mix workforce requirements for prosthodontic care: a comparison of estimates using normative and sociodental approaches.

The traditional measure for assessing dental treatment needs and workforce requirements based solely on normative need (NN) has major shortcomings. The sociodental approach (SDA) to assess needs overcomes some of the shortcomings as it combines normative and subjective needs assessments and also incorporates behavioural propensity (Sheiham and Tsakos 2007). The objective of this study was to estimate and compare prosthodontic treatment needs and workforce requirements, using the normative and the sociodental approaches for different skill mix models

Managing an Ageing Population: Challenging Oral Epidemiology

Global population projections indicate that the proportion of older people is increasing and will continue to do so for the foreseeable future. Many countries are already experiencing the challenges of managing an ageing population, including increased pension contributions from workers, rises to national retirement ages, and spiralling healthcare costs. In oral health terms, in addition to simply an ageing population, epidemiological studies have demonstrated significant changes in the oral health of older adults in recent years. As the numbers of edentulous older adults has declined, there has been a significant increase in the number of partially dentate elderly. Changing attitudes, improved access to dental care and more effective preventative programmes have meant that large numbers of patients are now retaining natural teeth into old age. However, as older patients retain natural teeth for longer, the dental profession is charged with controlling chronic dental diseases in an increasingly challenging oral environment

The Brussels Statement on the Future Needs for Caries Epidemiology and Surveillance in Europe.

Following debate and discussion prompted by a focussed, day long pre-ORCA Symposium in July 2015, the Alliance for a Cavity-Free Future Pan-European Chapter, the Platform for Better Oral Health in Europe, and the European Association of Dental Public Health have agreed this statement on the future needs for caries epidemiology and surveillance in Europe. Each organisation agreed to support the planned publication of the Statement, and will make it available on their Organisation's websites and strive to implement its recommendations

Down syndrome and oral health: mothers' perception on their children's oral health and its impact

BACKGROUND: Individuals with Down syndrome exhibit particular oro-facial characteristics that may increase their risk of oral health problems. However, there is little research on the oral health of children and adults with Down syndrome and the way that oral health may affect Quality of Life (QoL). This study explored mothers' perceptions of the oral health problems experienced by their children with Down syndrome and how these reported problems impacted the lives of the children and their families. METHODS: The study involved 20 in-depth, semi-structured interviews with mothers of children and adolescents aged 12-18 years with Down syndrome attending special care centres in Riyadh, Saudi Arabia. RESULTS: The predominant oral-health related problem reported by mothers was difficulty in speaking. Mothers also reported that tooth decay and toothache were problems that had undesirable effects on different aspects of their children's QoL including: performing daily activities, emotional wellbeing, and social relationships. Poor oral health and functional problems had direct and indirect impacts on the family's QoL as well. CONCLUSION: Mothers perceived an array of QoL impacts from oral conditions, which affected their child with Down syndrome and the wider family

Traumatic dental injuries and socioeconomic position – findings from the Children's Dental Health Survey 2013

OBJECTIVES: The aim of this study was to assess whether traumatic dental injuries (TDI) were socially graded among children and adolescents in England, Wales and Northern Ireland, using nationally representative data from the Children's Dental Health Survey (CDHS) 2013. METHODS: This cross-sectional study used data from the Children's Dental Health Survey 2013 which was conducted among a nationally representative sample of schoolchildren in England, Wales and Northern Ireland. Children's family socioeconomic position (SEP) was measured through free school meal eligibility and relative area deprivation using the Indices of Multiple Deprivation. The analytical sample included 6707 schoolchildren aged 8, 12 and 15. Multiple logistic regression was used to model the associations between experience of TDI and the two markers of SEP, after adjusting for sex and age. RESULTS: The overall prevalence of traumatic dental injuries to permanent incisors was 9% (n = 590). There were no statistically significant associations between TDI and either SEP measure. Further subgroup analyses (n = 2650) showed also no significant associations between TDI and additional SEP markers (parental education and social class). The odds of having sustained a traumatic dental injury were higher for boys than for girls and were greater in older age groups. CONCLUSIONS: This study found no significant relationships between the experience of traumatic dental injuries and two markers of family socioeconomic position among children living in England, Wales and Northern Ireland. This implies that rather than specifically targeting the more deprived sectors of society, TDI prevention policies should use upstream public health strategies incorporating a whole-population approach

Oral Health - A Neglected Aspect of Subjective Well-Being in Later Life

OBJECTIVES: This study examined whether oral health is a neglected aspect of subjective well-being (SWB) among older adults. The key research question was whether deterioration in oral health among dentate older adults living in England was associated with decreases in SWB, using measures of eudemonic, evaluative, and affective dimensions of well-being. METHODS: This secondary analysis used data from the third (2006-2007) and fifth (2010-2011) waves of respondents aged 50 and older from the English Longitudinal Study of Ageing (ELSA). We fitted multivariable regression models to examine the effects of changes in oral impacts on daily life and edentulism (complete tooth loss) on SWB (quality of life, life satisfaction, and depressive symptomatology). RESULTS: A worsening in both oral health measures was associated with an increase in depressive symptoms even after adjusting for time-varying confounders including declining health, activities of daily living, and reduced social support. Becoming edentate was also associated with decreases in quality of life and life satisfaction. DISCUSSION: A deterioration in oral health and oral health-related quality of life increases the risk of depressive symptoms among older adults and highlights the importance of oral health as a determinant of subjective well-being in later life

Is periodontitis and its treatment capable of changing the quality of life of a patient?

While clinical indicators, or so-called surrogate outcomes in periodontology, allow us to assess periodontal health and evaluate outcomes of periodontal therapy from a clinician's perspective, they cannot be used to evaluate patients' subjective perceptions of their health status or satisfaction with the received treatment. These can be assessed through patient-based outcomes, such as quality of life. The aim of this paper is to give an overview of the multidimensional concept of oral health-related quality of life (OHRQoL), its measures and association with plaque-induced, inflammatory periodontal diseases. Periodontitis and its clinical consequences, such as tooth loss, have a considerable negative effect on OHRQoL, while periodontal treatment and alleviation of the symptoms can lead to improvement in OHRQoL. Implant rehabilitation of missing teeth also seems to positively influence OHRQo

Cross cultural adaptation and psychometric properties of the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5)

BACKGROUND: The oral health related quality of life (OHRQoL) of children in Bangladesh has not yet been measured, as there is no validated OHRQoL measure for that population. The aim of this study was to cross-culturally adapt the child self-report and parental proxy report versions of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) into Bengali and test their psychometric properties: face validity, construct validity (convergent and discriminant validity) and reliability (internal consistency and test-retest reliability), among 5-9-year-old children and their parents in Bangladesh and assess associations between dental caries/sepsis and OHRQoL in this population. METHODS: The forward-backward translated Bengali SOHO-5 was piloted among 272 children and their parents to test its face validity. The questionnaire was administered to 788 children and their parents to evaluate its psychometric properties. Internal consistency of Bengali SOHO-5 was assessed using Cronbach's alpha, and test-retest reliability was assessed using Kappa. Convergent and discriminant validity were assessed through nonparametric tests. The calculation of effect sizes and standard error of measurement facilitated the assessment of minimally important difference (MID) for SOHO-5. The associations of reporting an oral impact with caries and sepsis were assessed via logistic regression models. RESULTS: Both child self-report and parental proxy report questionnaires showed good face validity. Cronbach's alpha scores were 0.79 and 0.87 for child and parental questionnaire, respectively. A weighted Kappa score of 0.85 demonstrated test-retest reliability of child questionnaire. SOHO-5 scores were significantly associated with subjective oral health outcomes and discriminated clearly between different caries severity and sepsis groups. These differences were considerably higher than the MID. After adjusting for child's age, sex, setting, maternal education and family income, the odds of reporting an oral impact were 2.25 (95% CI 1.98-2.56) and 4.44 (95% CI 3.14-6.28) times higher for each additional tooth with caries and sepsis, respectively. CONCLUSION: This study provided strong evidence supporting the validity and reliability of both versions of Bengali SOHO-5 as OHRQoL measures. Dental caries and sepsis were associated with poor OHRQoL in this population. The Bengali SOHO-5 is expected to be a useful outcome measure for research and clinical purposes in Bengali speaking child populations