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Global Health: Focus on Oral Care for People of All Ages

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Public Health and Preventive Medicine".

Deadline for manuscript submissions: 30 March 2027 | Viewed by 4080

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Editors

Dr. Anca-Cristina Perpelea

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Guest Editor

Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
Interests: dental public health; oral health improvement; medical legislation; determinants of oral health; prevention; doctor-patient relationship; healthcare management; dental public health intelligence; assessing the evidence on oral health interventions; programs and services

Dr. Ionela Ruxandra Sfeatcu

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Guest Editor

Department of Oral Health and Community Dentistry, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
Interests: community dentistry; health literacy; oral health related quality of life; experiential learning; oral health promotion; risk assessment; health education; treatment needs

Special Issue Information

Dear Colleagues,

We are honored to invite you to contribute to our forthcoming Special Issue “Global Health: Focus on Oral Care for People of All Ages”.

Oral health plays a crucial role in the global health agenda. In 2019, approximately 3.5 billion people worldwide faced oral diseases, with dental cavities being the most prevalent condition among children. The global increase in dental caries represents one of the most significant public health challenges. However, oral diseases are primarily preventable through population-based public health initiatives. Therefore, assessment of oral health status and identification of preventive and curative measures remain essential to any community oral health promotion strategy.

This Special Issue aims to establish a platform for dialogue among dentists, researchers, and other stakeholders committed to improving health outcomes. It provides an opportunity to share the latest research findings, identify the target audience needs, and offer insights into enhancing patients' oral health. Research areas may include (but are not limited to) original articles and reviews that will illuminate the challenges, opportunities, and future advancements in the diverse and evolving field of oral health.

We look forward to receiving your valuable contribution,

Dr. Anca-Cristina Perpelea
Dr. Ionela Ruxandra Sfeatcu
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

dental public health
oral health promotion
community-based programs
medical legislation
determinants of oral health
prevention
dentist-patient relationship
healthcare management
education

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Published Papers (7 papers)

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Research

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15 pages, 791 KB

Open AccessArticle

Barriers, Benefits and Complications of Orthodontic Treatment in Patients with Epidermolysis Bullosa: A Patient-Reported Cross-Sectional Study

by Sebastián Véliz, Gudrun Salamon, Milica Kabic, Sophie Strobl, Pedro Diz-Dios, Colomba Besa-Witto and Susanne Krämer

Healthcare 2026, 14(11), 1584; https://doi.org/10.3390/healthcare14111584 - 4 Jun 2026

Viewed by 176

Abstract

Introduction: Epidermolysis Bullosa (EB) is a rare genetic condition with skin and mucosal fragility. Patients with EB present extra- and intraoral manifestations that can limit their access to dental treatment, including orthodontic treatment. This research aims to determine the barriers, benefits and complications of orthodontic treatment reported by a group of patients living with EB. Materials and Methods: This observational study included n = 101 patients with a genetic diagnosis of EB. After their regular dental consultation, they were interviewed about factors they considered barriers to accessing orthodontic treatment. Those who underwent orthodontic treatment (n = 24) reflected about their perceived benefits and complications from the therapy. Data were analysed with descriptive statistics and multiple Fisher’s exact tests with false discovery rate (FDR) correction. Results: The most prevalent barrier was that most patients with EB had never been evaluated by an orthodontist (74.3%), even if the teams had an orthodontist. Other barriers included distance to the treatment centre (42.6%), poor oral hygiene (27.7%) and poor oral health status (26.7%). Patients with limited mouth opening perceived greater treatment benefit compared to those without this limitation (φ = −0.28, p = 0.0242), while an increasing age was associated with a reduced perception of treatment benefit (Cramér’s V = 0.29, p = 0.0404). Among those who underwent orthodontic treatment, the most prevalent benefits of orthodontic treatment were aesthetic improvement (62.5%), oral hygiene improvement (20.8%) and occlusal stability (12.5%), while the most prevalent complications were wounds and ulcers (75.0%), gingivitis (54.1%), poor oral hygiene (41.6%) and caries (33.3%). Discussion: People living with EB reported different barriers to orthodontic treatment relating to psychosocial and professional aspects, which vary according to the EB type and severity. The involvement of orthodontists in multidisciplinary special care teams and the reduction in access barriers to dental specialities can be facilitated by a more comprehensive understanding of conditions such as EB. Full article

(This article belongs to the Special Issue Global Health: Focus on Oral Care for People of All Ages)

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21 pages, 1023 KB

Open AccessArticle

Dental Preventive Policies and Socio-Economic Inequalities in Oral Health: A Panel Data Analysis of EU Countries During and After COVID-19

by Cassandra Lupita, Anca-Cristina Perpelea, Laura-Cristina Rusu, Iulia Muntean, Oana-Ramona Lobonț and Magda-Mihaela Luca

Healthcare 2026, 14(11), 1479; https://doi.org/10.3390/healthcare14111479 - 27 May 2026

Viewed by 248

Abstract

Background/Objectives: Health system socio-economic inequities in dental care are a long-standing problem in Europe. The issue gained increased relevance during the recent pandemic due to service disruption and socio-economic inequities that become even more pronounced under such circumstances. However, while preventive dental programs are considered key elements of public health, little is known about their role in addressing equity in accessing dental care among different countries and over time between them. This research aims at investigating the relationship between preventive dental policy, socio-economic factors, and the inability to get appropriate dental care within EU member states. Methods: A longitudinal panel dataset at the country level, consisting of data collected during 2020 through 2024, was assembled using open sources of statistics from Europe and other international statistical databases. The dependent variable used in the study was the percentage of the population that had unmet dental care need because of cost. Independent variables were the presence or absence of preventive policies related to dentistry, educational attainment, gross domestic product per capita, unemployment rate, number of dentists, and out-of-pocket expenses. Balanced panel datasets and regressions with robust standard errors in random-effects models were estimated. Interaction terms were created to test the moderating effect of education level on the relationship between policies and access to care. Results: Cross-country variations in terms of the prevention policy environment, socio-economic status, and unmet dental care need were found from descriptive analysis. The higher level of out-of-pocket payment was always related to the higher unmet dental care need, while the lower GDP countries displayed poorer access. Using the balanced panel random-effects model, preventive dental policies and the interaction between preventive policies and educational level were insignificant factors predicting the unmet dental care need. On the other hand, higher out-of-pocket payments, education, and dentists per million population had nearly significant positive relationships. In the sensitivity analysis, GDP per capita showed a negative association, whereas dentists per million population remained positively associated with unmet dental care need. Conclusions: The findings suggest that inequalities in access to dental care during and after the COVID-19 period were shaped primarily by financial and structural determinants rather than by the presence of preventive policies alone. While preventive programs remain an important component of long-term oral health strategies, reducing direct household payment burden and strengthening health system capacity may represent more immediate mechanisms for maintaining equitable access to dental services during periods of system disruption. Full article

(This article belongs to the Special Issue Global Health: Focus on Oral Care for People of All Ages)

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21 pages, 960 KB

Open AccessArticle

Dental Caries Is Associated with Multidimensional Poverty: Evidence from Colombia

by Mauricio Alberto Cortes-Cely, Luis Jorge Hernandez-Florez, Angelica Castro-Rios, Monica Pinilla-Roncancio and S. Aida Borges-Yañez

Healthcare 2026, 14(5), 590; https://doi.org/10.3390/healthcare14050590 - 27 Feb 2026

Viewed by 518

Abstract

Objective: The aim of this study was to investigate the association between dental caries and multidimensional poverty in Colombia using data from the National Oral Health Survey (ENSAB IV, Spanish acronym). Methods: A cross-sectional analytical study was conducted using data from 20,534 individuals in six regions of the country. Dental caries was assessed using the ICDAS system, and multidimensional poverty was measured using a proxy Multidimensional Poverty Index (MPI) adapted from the method adjusted for Colombia. Descriptive analyses and bivariate comparisons were carried out, and Poisson regression models adjusted for sociodemographic variables were applied. Results: Households containing at least one member with caries had a higher incidence (59.9%) and intensity (46.7%) of multidimensional poverty compared to those without caries (52.6% and 45.6%, respectively). Significant associations were identified between caries and deprivation in education (low educational attainment: RR = 1.27), child labor (RR = 1.16), unemployment (RR = 1.04), lack of health insurance (RR = 1.09), and inadequate housing conditions (RR = 1.19). The model that analyzed the presence of caries in a household and multidimensional poverty, when controlled for housing conditions, confirmed a positive association between the MPI and the presence of caries (IRR = 1.08; 95% CI: 1.050–1.107; p-value < 0.001). A female head of household and rural residence were also identified as variables associated with the presence of caries in a household. Conclusions: The presence of a household member with dental caries is significantly associated with multidimensional poverty in Colombia. This study highlights the need to consider oral health as a sensitive indicator of structural inequality and proposes its inclusion in social progress metrics. The findings support the design of comprehensive public health strategies that address the social determinants of oral health, especially in vulnerable populations. Full article

(This article belongs to the Special Issue Global Health: Focus on Oral Care for People of All Ages)

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17 pages, 264 KB

Open AccessArticle

Parental and Caregiver Characteristics and Early Childhood Oral Health: A Cross-Sectional Study

by Rebeca Daniela Marton, Rahela Tabita Moca, Abel Emanuel Moca, Teofana Bota and Mihai Juncar

Healthcare 2026, 14(5), 580; https://doi.org/10.3390/healthcare14050580 - 25 Feb 2026

Viewed by 545

Abstract

Background/Objectives: Early childhood oral health is strongly influenced by parental and caregiver behaviors, yet evidence on the impact of sociodemographic factors remains limited in Eastern European settings. This study evaluated the association between parental and caregiver sociodemographic characteristics (age, educational level, and living environment) and oral health-related behaviors, dental attendance, and caries experience among preschool children in Romania. Methods: A cross-sectional study was conducted among parents or caregivers of children aged 0–6 years (n = 490). Data were collected between September and November 2025 using a structured online questionnaire (24 items). Statistical analyses included Fisher’s exact test, Mann–Whitney U test, Kruskal–Wallis test with post hoc analysis, and Spearman’s correlation (p < 0.05). Results: Higher parental education was consistently associated with favorable oral health behaviors, including earlier initiation of oral hygiene, parent-assisted toothbrushing, use of fluoridated toothpaste, and preventive dental visits (p < 0.01). Children of parents aged 21–30 years were more frequently caries-free (62.7%), whereas caries prevalence was higher among those with parents aged 41–50 years (60.5%) (p < 0.05). Urban residence was associated with twice-daily toothbrushing (49.4% vs. 36.2%) and earlier dental visits compared with rural residence (p < 0.05). Conclusions: Parental education, age, and living environment are significantly associated with early oral health behaviors and caries experience. Preventive programs should prioritize families with lower educational levels and those living in rural areas. Full article

(This article belongs to the Special Issue Global Health: Focus on Oral Care for People of All Ages)

15 pages, 402 KB

Open AccessArticle

Exploring Parental Perceptions and Barriers to Early Orthodontic Treatment in Children: A Mixed-Methods Study

by Guna Shekhar Madiraju

Healthcare 2026, 14(2), 180; https://doi.org/10.3390/healthcare14020180 - 11 Jan 2026

Cited by 1 | Viewed by 896

Abstract

Parents’ awareness, attitudes, and perceptions of barriers to orthodontic care for children significantly influence decisions regarding early orthodontic interventions. This mixed-methods study explored parents’ perceptions of their child’s orthodontic needs and examined their experiences and perceived barriers to accessing early orthodontic treatment (EOT) among children aged 6–12 years. Methods: Quantitative data were collected using a 12-item validated questionnaire, while qualitative insights were obtained through structured interviews and analyzed thematically. Results: Parents’ perception of their child’s orthodontic needs was significantly associated with their attitude toward seeking consultation or treatment (p < 0.001). Among parents who sought consultation, only 38.7% had initiated the required orthodontic treatment. The most frequently reported barriers were high cost (32.1%), long appointment wait times (30.6%), and lack of insurance coverage (22.5%). Thematic analysis revealed four major barriers: financial, structural, cognitive, and psychological. Conclusions: These findings highlight critical challenges to accessing EOT for children, including affordability, long waiting times, limited parental awareness, and inadequate, timely referrals. Addressing these challenges through combined efforts at both the individual and community levels could significantly enhance the uptake of early orthodontic services in children. Full article

(This article belongs to the Special Issue Global Health: Focus on Oral Care for People of All Ages)

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Review

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20 pages, 783 KB

Open AccessReview

Low-Level Laser Therapy for Gingival Inflammation in Children and Adolescents: A Narrative Review Based on In Vitro, In Vivo and Clinical Studies

by Mădălina-Ștefania Stancu, Mihaela Tănase, Aneta Munteanu, Ion-Victor Feraru, Carmen Nicoleta Novac, Anca Andreea Boboc, Petra Șurlin, Liviu Steier and Andreea Cristiana Didilescu

Healthcare 2026, 14(11), 1533; https://doi.org/10.3390/healthcare14111533 - 1 Jun 2026

Viewed by 320

Abstract

Background/Objectives: Gingivitis is one of the most prevalent inflammatory conditions in pediatric populations and represents a significant oral health burden worldwide. In addition to conventional approaches, emerging adjunctive therapies such as low-level laser therapy (LLLT), also known as photobiomodulation, have gained increasing attention. This review aims to evaluate current evidence regarding the clinical relevance and potential healthcare implications of LLLT in the management of gingival inflammation in children and adolescents. Methods: A structured narrative literature review was conducted, including experimental, animal, and clinical studies published between 2005 and 2025. Study selection and screening were performed independently by two reviewers. Methodological characteristics of the included pediatric clinical studies were qualitatively assessed, focusing on randomization, blinding, follow-up reporting, and adverse event monitoring. Results: Experimental studies demonstrate that LLLT enhances gingival cell proliferation and modulates inflammatory responses, while antimicrobial effects remain inconsistent. Animal studies indicate reductions in gingival inflammation and alveolar bone loss when LLLT is used adjunctively with conventional therapy. Clinical studies in pediatric populations report improvements in gingival indices and periodontal treatment needs, with no adverse effects observed. Conclusions: LLLT appears to be a safe, non-invasive adjunctive therapy with potential to improve oral health outcomes in pediatric populations. Its clinical applicability and high patient acceptability support its potential integration into broader oral healthcare strategies. However, further well-designed clinical trials with standardized protocols and long-term follow-up are required. Full article

(This article belongs to the Special Issue Global Health: Focus on Oral Care for People of All Ages)

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41 pages, 3082 KB

Open AccessReview

Periodontitis and Rheumatoid Arthritis: Shared Pathophysiology, Bidirectional Association, and Therapeutic Implications—A Narrative Review

by Neda Najafimakhsoos, Emanuela Pashollari, Nazzarena Malavolta, Francesca Zangari and Claudio Cesari

Healthcare 2026, 14(10), 1411; https://doi.org/10.3390/healthcare14101411 - 20 May 2026

Viewed by 528

Abstract

Periodontitis (PD) and rheumatoid arthritis (RA) are chronic inflammatory disorders that impose substantial individual and societal burdens worldwide. PD is characterized by progressive destruction of the periodontal ligament and alveolar bone, leading to tooth loss, impaired oral function, and sustained systemic inflammatory burden. RA, affecting approximately 0.5–1% of the population, is a chronic autoimmune disease marked by persistent synovial inflammation, progressive joint destruction, disability, and reduced quality of life. Increasing evidence indicates that these conditions are biologically and clinically interconnected. Both diseases share key pathogenic pathways, including microbial dysbiosis, immune dysregulation, chronic inflammation, genetic susceptibility, and aberrant autoantibody responses. Particular attention has focused on keystone periodontal pathogens such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, which may promote protein citrullination and the formation of anti-citrullinated protein antibodies (ACPA), thereby providing a plausible mechanistic bridge between periodontal infection and systemic autoimmunity. Shared genetic risk factors, including HLA-DRB1 susceptibility alleles, further support a common host predisposition. Clinical, epidemiological, and translational studies increasingly support a bidirectional association. Individuals with PD appear to have a higher risk of RA development, whereas patients with RA demonstrate greater prevalence, severity, and progression of periodontal disease. Interventional studies suggest that nonsurgical periodontal therapy may reduce local periodontal inflammation, circulating inflammatory biomarkers, and RA disease activity indices, while effective pharmacological control of RA may also improve periodontal outcomes. This narrative review critically evaluates the PD–RA relationship across four interconnected domains: (i) epidemiological and clinical associations between PD and RA, (ii) key mechanisms underlying RA pathogenesis, (iii) shared biological pathways linking both diseases, and (iv) the extent to which treatment of one condition influences the other. Particular emphasis is placed on major sources of heterogeneity and confounding—including smoking, metabolic comorbidities, disease stage, therapeutic exposure, and variable diagnostic definitions—that may explain inconsistencies across the literature. By integrating current mechanistic and clinical evidence, this review provides a structured synthesis that extends beyond a descriptive overview of association studies. A clearer understanding of the periodontal–rheumatologic axis may facilitate risk stratification, identify novel therapeutic targets, and support integrated multidisciplinary care. Targeting both oral and systemic inflammation may improve outcomes in patients with coexisting PD and RA and may potentially reduce the risk or severity of one condition in individuals already affected by the other. Full article

(This article belongs to the Special Issue Global Health: Focus on Oral Care for People of All Ages)

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