Search Results (145)

Early childhood dental caries (ECC) remains one of the most prevalent and preventable chronic diseases affecting young children globally, yet behavioral and contextual determinants of its onset during the first 1000 days of life remain poorly understood and infrequently modeled in Latin American populations. This study presents a novel application of the PRECEDE diagnostic framework to conceptualize Early Childhood Dental Caries during the first 1000 days (1000ECDC) as a behaviorally rooted, socio-ecologically conditioned health problem. Drawing on a formative longitudinal pilot study (n = 10 mother–infant dyads, Caracas, Venezuela) and a complementary narrative literature review, we develop the first PRECEDE-based conceptual model linking maternal prenatal and postnatal behaviors to dental caries risk in a Latin American context. The model identifies dietary and feeding behaviors, oral health care practices, and healthcare service utilization as primary behavioral risk factors, modulated by predisposing factors (low oral health knowledge, limited self-efficacy, cultural norms), enabling factors (socioeconomic constraints, fragmented health systems), and reinforcing factors (social norms, family influence). Exploratory pilot findings indicated that more than 60% of children had advanced dental caries lesions at 24-month follow-up, consistent with regional estimates and underscoring the urgency of early intervention. This model provides practitioners and policymakers with a structured, evidence-informed diagnostic tool to guide the design of early-life oral health promotion programs, with particular relevance for low-resource Latin American settings. Future validation through expert consensus and prospective studies is warranted. Full article

Background/Objectives: Early childhood caries (ECC) is a common, preventable, and socially patterned disease, yet the literature on ECC is vulnerable not only to limitations in evidence generation but also to errors in evidence translation. This conceptual framework paper focuses on evidence translation rather than estimating a new treatment effect. Methods: Literature and framework development were informed by targeted narrative searches of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, with an emphasis on ECC literature from 2010 onward and foundational methodological sources. Sources were purposively retained if they clarified an evidentiary domain, a cross-domain bridge, or a competing interpretation; priority was given to systematic reviews, trials, longitudinal and causal studies, natural experiments, clinical guidance, and implementation evaluations. No pooled effect estimates were produced. Results: Evidence drift is the movement of a finding into a stronger or different claim without adequate bridging evidence. The proposed framework comprises association, mechanism, causation, consequence, disease control, and policy implementation, with commercial and structural determinants operating as a cross-cutting upstream layer. It classifies the inference advanced rather than study design alone and permits primary and secondary domain tags. A four-question test asks whether the research question and conclusion occupy the same domain, what bridge supports the movement, and whether uncertainty is retained. Five trajectories illustrate the framework: vitamin D, dental rehabilitation under general anesthesia, oral microbiome research, silver diamine fluoride (SDF), and sugar taxation. In the SDF case, lesion-arrest evidence is explicitly separated from the still-unproven implementation hypothesis that endpoint-only pathways may create differential standards of care. Conclusions: The original contribution is an integrated vocabulary, decision procedure, and validation agenda for ECC evidence appraisal. The framework generates three prespecified, testable hypotheses: (1) trained raters will classify claims with reproducible inter-rater agreement (kappa ≥ 0.70); (2) claims judged to contain evidence drift will be significantly less likely than domain-concordant claims to include an explicit bridge; and (3) using the structured framework will improve the transparency and proportionality of reviews compared with usual appraisal. Prospective testing of content and construct validity, as well as practical utility, in peer review, guideline development, education, and policy evaluation is required before standardized implementation. Full article

Background and Objective: Glucagon-like peptide-1 (GLP-1) receptor agonist therapy has intensified the policy debate over whether obesity pharmacotherapy increases short-term healthcare expenditures or reduces downstream medical costs (i.e., non-drug, acute-care expenditures). This study estimated same-year associations between GLP-1 use and medical spending among adults with observed obesity. Methods: Analyses used Medical Expenditure Panel Survey (MEPS) person-year files compiled from 2018 to 2022, with body mass index (BMI)-defined analyses restricted to 2019 and 2021. The primary analytic sample included 7144 person-years, of which 275 represented sustained GLP-1 users. Overlap-weighted Poisson pseudo-maximum likelihood models, utilization regressions, two-part decompositions, and a layered diagnostic framework were applied to assess spending patterns and same-year cost implications. Robustness was evaluated through sensitivity analyses across all-obesity, severe-obesity, and diabetes-excluded subsamples, as well as exploratory molecule-specific specifications. Results: Findings showed no evidence of same-year cost savings, but rather a distinct shift in spending composition. In fully adjusted primary models, GLP-1 use was associated with reduced non-drug medical spending (beta = −0.2494; marginal effect = −$2586 per person-year) and lower acute-care spending (beta = −0.5856; marginal effect = −$2019), while total medical spending was higher (beta = 0.3182; marginal effect = +$6483). Point E values of 1.89 (non-drug) and 2.99 (acute-care) indicated moderate-to-strong resilience to unmeasured confounding. Negative control models using dental spending and visits showed significant positive associations. Since this residual confounding operates in the direction opposite to the negative acute-care association, the headline compositional pattern is unlikely to be an artifact of upward health-seeking bias. Utilization models indicated fewer inpatient discharges (IRR = 0.686) and inpatient nights (IRR = 0.524). Two-part models further suggested that the reduction in acute-care spending was concentrated on the intensive margin among individuals with positive expenditures. Conclusions: The use of GLP-1 is not associated with overall short-term cost savings. This usage is related to a shift in the composition of observed medical spending during the same year. This change is leading to a decline in hospital admissions and acute care costs, in parallel with the rise in pharmaceutical spending. Non-drug and acute-care costs were lower among regular users. However, total spending was at a higher level, consistent with a trend in the budget records from that period in which drug costs were the dominant factor. These associations are consistent with a potential reallocation of healthcare resources from inpatient acute care toward pharmacy and ambulatory services, with corresponding planning implications for payers and possible workforce reallocation of nursing capacity from acute to outpatient settings, contingent on replication in post-2022 data. Full article

Background/Objectives: Romania’s National Health Insurance House (CNAS) reimbursement basket is the principal public financial-protection mechanism, yet whether it reflects the therapeutic services patients actually seek has not been tested against private-market offerings. This study compared the public basket with the private dental service portfolio, using the latter as an indirect, supply-side signal of expressed need rather than a direct measure of demand. Methods: In this cross-sectional study (November 2024–February 2025), the publicly listed portfolios of 420 private dental practices in Bucharest (n = 256), Cluj-Napoca (n = 104), and Iași (n = 60) were analyzed, stratified by size (0–3 vs. >3 employees). Practices were identified from CAEN 8623 records on listafirme.ro; portfolios were extracted from official websites displaying prices. Services were classified as functional or aesthetic by two independent raters (Cohen’s κ = 0.91), with disagreements resolved by consensus. Results: Across all municipalities and strata, approximately 53–68% of private services fell outside the CNAS basket. Critically, about 95–96% of private services were functional rather than aesthetic (4–5%), indicating that the gap reflects functional treatments patients seek and providers offer yet that remain unfunded—not elective demand. No statistically significant geographic differences emerged. Geographic location was not associated with portfolio breadth, whereas in multivariable models larger practices (>3 employees) independently offered approximately 33% more services. Conclusions: Because the analysis reflects advertised portfolio breadth rather than utilization, and a documented Romanian orientation toward reactive over preventive care, these hypothesis-generating findings make private supply a pragmatic, supply-side reference point for evidence-based revision of the CNAS basket, pointing to two directions directly supported by the data—aligning coverage with observed demand and administrative simplification of contracting. To our knowledge, this is the first benchmarking of the CNAS basket against private supply, relevant to other predominantly private European dental systems. Full article

Background/Objectives: Access to dental care is a multilevel challenge shaped by healthcare systems, individual characteristics, and broader social determinants. This study aimed to identify parent-reported barriers to dental care among a sample of children in Saudi Arabia using Levesque’s Conceptual Framework for Access to Healthcare. Methods: A cross-sectional survey was conducted between March and April 2023 among parents of children aged 1–18 years. The 44-item survey assessed sociodemographic, oral health, and dental care utilization, organized using Levesque’s access dimensions. Difficulty accessing needed dental care within the past 12 months served as the main outcome. The chi-square test was used to examine bivariate associations between potential barriers and difficulty accessing needed dental care. Multivariable logistic regression was used to identify factors independently associated with difficulty accessing needed dental care after adjustment for the other variables. Results: This study included 351 parents. The mean age of children was 10.7 ± 4.7 years, and 45.9% were male. One-third of parents reported difficulty accessing needed dental care for their children. The adjusted regression model identified fair/poor oral health (aOR = 13.39, 95% CI: 6.19–28.97), general health condition (aOR = 2.31, 95% CI: 1.11–4.82), and the absence of a nearby dental clinic (aOR = 2.08, 95% CI: 1.11–3.90) as factors independently associated with difficulty accessing dental care. Conclusions: Applying Levesque’s framework highlighted the multidimensional nature of barriers to accessing dental care for the study population. These findings provide preliminary evidence on parent-reported access barriers and may inform larger, representative studies and future policies to improve equitable pediatric oral healthcare in alignment with Saudi Vision 2030. Full article

Dental caries, as a common chronic disease with high global prevalence, has undergone a paradigm shift from a traditional treatment-oriented model to a management approach focused on controlling caries risk factors while implementing personalized preventive and therapeutic measures. Confronted with limited medical resources and the additional workload imposed by long-term caries management, the Integrated Dentist–Nurse Collaborative Care Model emerges as a potentially effective pathway to address these challenges. Through task-shifting and collaboration, this model leverages the pivotal role of dental nurses in prevention, assessment, health education, and follow-up management, which may enhance the efficiency of healthcare services. This article elaborates the approaches of implementing the Dentist–Nurse Collaborative Care Model in caries management in China. This includes dental nurse-led health education and assessment conducted before and after treatment, where behavioral guidance is utilized to enhance patients’ self-management capabilities. During the clinical stage, dentists and dental nurses collaborate to advance both caries risk management and caries lesion management, formulating personalized plans based on caries risk assessment and treatment difficulty assessment. In the continuity of care phase, through long-term follow-up and plan adjustments, dentists and dental nurses work together to maintain patients’ oral health, ultimately achieving a fundamental transition from single-episode treatment to comprehensive long-term caries management. Full article

Background/Objectives: This cross-sectional observational study investigated factors associated with emergency room (ER) utilization for dental pain in a rural inland region of Portugal. The main objective was to examine the relationship between access to dental care, sociodemographic characteristics, oral health behaviors, and clinical outcomes with the use of emergency room services for dental problems. Methods: The study sample comprised 423 participants from the districts of Bragança and Vinhais, in Trás-os-Montes, aged 4 to 90 years, who attended their first dental medicine consultation. Participants completed a structured questionnaire addressing sociodemographic characteristics, general health, oral health behaviors, and dental prosthetic use, and underwent oral examination for assessment of the Decayed, Missing, and Filled Teeth (DMFT) index. Associations with reported ER utilization due to toothache were analyzed using Fisher’s exact test and the Mann–Whitney U test. Results: Overall, 28.4% of participants reported having visited the ER due to dental pain, and most cases were managed with medication followed by discharge. ER utilization was significantly associated with behavioral risk factors such as smoking, as well as poorer oral hygiene practices, including less frequent tooth brushing. In addition, participants who sought ER care presented higher DMFT scores, indicating a greater burden of untreated dental decay and tooth loss. Conclusions: These findings suggest that limited preventive dental care and unfavorable oral health behaviors are associated with to avoidable ER visits for dental pain in rural settings. This study reinforces the need to strengthen access to preventive oral health services and to advance the integration of dental care into Portugal’s National Health Service (SNS), particularly in underserved inland regions. Full article

A portable OCT scanner usable for dental applications is designed to be compact (B4 notebook size), lightweight, and capable of DC battery operation, enabling chairside use and mobility in home medical care. TD-OCT faces the challenge of a slower measurement speed compared to SD/SS-OCT. In this study, by utilizing multiple rotating reflectors and combining them with a 3 × 3 fiber coupler, a measurement range of over 10 mm and a measurement speed of 1000 scans per second were achieved. Additionally, the dental intraoral probe was designed to ensure high accessibility, allowing free positioning within the oral cavity, with an ingeniously compact optical system. A cylindrical probe with a diameter of 6 mmϕ and a length of 10 mm was developed to enable tooth measurement. This study demonstrated the capability to evaluate attenuation coefficients derived from material properties, starting with measurements of caries and gums. Full article

Background/Objectives: Dental fear and anxiety (DFA) in children can negatively affect oral health behaviors and dental care utilization. Family-related factors, particularly parental anxiety, parenting styles, and socioeconomic characteristics, may be associated with DFA. This study aimed to investigate the association between family-related factors and DFA among children aged 6–8 years in Jakarta, Indonesia. Methods: A cross-sectional study was conducted among 294 child–parent pairs recruited from 10 primary schools using multistage cluster sampling. Children’s DFA was assessed using the Children’s Fear Survey Schedule–Dental Subscale (CFSS-DS), whereas parental dental anxiety was measured using the Modified Dental Anxiety Scale (MDAS). Sociodemographic and family-related characteristics, including parenting styles, were collected using self-administered questionnaires. Data were analyzed using chi-square tests and multivariable logistic regression. Results: Overall, 34.7% of the children were classified as having DFA. Maternal employment was significantly associated with children’s DFA, with children of formally employed mothers having higher odds of DFA (aOR = 2.01, 95% CI: 1.05–3.85; p = 0.034). Parental dental anxiety was associated with children’s DFA. Children whose fathers and mothers reported high levels of dental anxiety had 4.68-fold (95% CI: 1.64–13.33; p = 0.004) and 2.50-fold (95% CI: 1.10–5.74; p = 0.029) higher odds of experiencing DFA, respectively. Dental drilling and injections were the most frequently reported fear-provoking stimuli. The final regression model explained 13% of the variance in children’s DFA. Conclusions: Parental dental anxiety and maternal employment were significantly associated with DFA among children aged 6–8 years. Family-centered preventive strategies and early identification of at-risk children may help reduce DFA and promote positive dental experiences and oral health outcomes. Full article

Health tourism represents a dynamic sector operating at the intersection of medical services, international patient mobility, and tourism development. Despite its growing prominence, the academic literature frequently conflates health tourism with medical and wellness tourism—a conceptual ambiguity that complicates the establishment of robust, sustainable legal frameworks. Addressing this gap, the present paper conceptualizes health tourism as an overarching framework that encompasses recovery, wellness, and medical sub-sectors. Within this comprehensive paradigm, we explore the contemporary landscape of health tourism in Northern Cyprus through a stakeholder-driven qualitative lens. Utilizing a qualitative case study design, data were gathered via semi-structured interviews with 40 key respondents representing healthcare, travel, public administration, academia, and related professional domains, and subsequently subjected to thematic analysis using NVivo 15 software. The findings reveal that the sector in Northern Cyprus is heavily skewed toward medical tourism, with a concentrated focus on in vitro fertilization (IVF), cosmetic surgery, dental care, and bariatric procedures. Conversely, wellness and rehabilitation tourism remain largely untapped strategic niches. The analysis further indicates that sectoral growth is constrained by structural bottlenecks, including fragmented governance, limited international recognition, transport and accessibility barriers, inadequate accreditation systems, lack of stakeholder synergy, and ethical concerns regarding advertising and patient safety. Moving beyond standard environmental sustainability, this research underscores that long-term destination resilience requires ethical governance, clinical quality controls, patient-rights advocacy, transparent legal frameworks, and community-level economic integration. Ultimately, this study proposes an integrated, stakeholder-centric paradigm tailored to the unique socio-political and structural realities of Northern Cyprus, offering actionable policy recommendations that enrich the discourse on sustainable medical tourism from a small-island perspective. Full article

Objectives: The aims were to compare prevalence of high dental anxiety (DA) in 2000, 2011 and 2023, to compare the age- and sex-specific levels of DA, and to study if total, anticipatory, and treatment-related DA have an independent association with the non-habitual use of oral health care considering age, sex, education, current perceived treatment need, and reported barriers to use of oral health in nationally representative samples of adult Finns (n = 1950). Methods: DA was assessed with a single question (n = 1770) for prevalence and with the Modified Dental Anxiety Scale (MDAS) (n = 1739) for DA levels described as means, medians, standard errors (SE), interquartile ranges, and 95% confidence intervals (CI). Multivariable logistic regression analyses were used to assess the independent effect of total, anticipatory, and treatment-related DA on habitual use of oral health care (regular = habitual, for toothache or other problems = non-habitual) adjusted for age, sex, level of attained education, current perceived treatment need, and barriers to using oral health care (care costs and long queues). Results: Among women, the prevalence of high DA decreased from 2000 to 2011, but the decrease did not continue between 2011 and 2023. Among men, the prevalence of high DA decreased between 2000 and 2023. The mean MDAS (SE) for women was 10.1 (0.1) and for men 8.4 (0.1). Total, anticipatory, and treatment-related dental DA had an independent association with non-habitual use of oral health services. Conclusions: DA as an independent barrier to oral health care can prevent habitual care utilization, potentially leading to poor oral health. Full article

Purpose: Purchased/Referred Care Delivery Area (PRCDA) counties are those where resident American Indian and Alaska Native (AIAN) people are eligible for Indian Health Service care. Due to concerns about racial misclassification, cancer statistics for AIAN people are often restricted to PRCDA counties. Differences in sociodemographic characteristics may exist between PRCDA and non-PRCDA counties, but have not been described; therefore, the potential selection bias associated with the restriction to PRCDA counties remains unknown. Methods: We used data from the University of California, San Francisco Health Atlas to explore ecological differences in county-level demographic, socioeconomic, healthcare access, and health outcomes data between PRCDA and non-PRCDA counties (n = 3152 counties). We tested for statistical differences in mean levels of demographics between PRCDA and non-PRCDA counties using Pooled or Welch t-tests. Results: We observed small, but statistically significant differences between PRCDA and non-PRCDA counties in county-level demographic and socioeconomic characteristics (age, poverty, utility services threat, unemployment, educational attainment, computer access, and median income), neighborhood and environment characteristics (overcrowding, severe mortgage/rent burden), healthcare access and utilization (uninsured, annual checkup, annual dental visit, mammography, binge drinking, smoking, physical inactivity, social isolation), and health outcomes (poor mental health, arthritis, poor self-rated health, high blood pressure, diabetes, high cholesterol, and obesity). Conclusions: These results indicate variability in county-level measures between PRCDA and non-PRCDA counties. While these data do not speak specifically to AIAN peoples’ experiences, they provide critical contextual information to understand how exclusion of AIAN people residing in non-PRCDA counties from cancer statistics may bias risk estimates. Full article

Background/Objectives: Cost-related delays hinder access to dental care in the United States, while the growing use of telehealth has an uncertain impact on population-level access to dental services. The study examined factors associated with cost-related delays in dental care among U.S. adults and whether telemedicine use in the past year was associated with these delays. Methods: This cross-sectional study utilized nationally representative data from the 2023 National Health Interview Survey (NHIS) to examine the association between telehealth use and oral health services utilization in the past 12 months. All analyses were performed using R version 4.5.1 within the RStudio IDE (version 2025.09.0+387). Results: Adults who visited a dental provider within the past 12 months had lower odds of cost-related dental care delay, whereas telemedicine users had higher odds of delay. Higher odds of delayed dental care were observed among women, those aged below 65 years, Hispanics, those with poorer health, and those living in the Midwest, South, and West. Education and family income-to-poverty ratio were not significantly associated with delay in the adjusted analysis. Conclusions: Cost-related delays in dental care remain common and reflect persistent sociodemographic inequities and patterns of healthcare engagement. Telemedicine use alone does not appear to contribute to overcoming barriers to dental care access. Policies that reduce financial barriers and connect telehealth encounters with oral health referral pathways may improve equitable access to dental services. Full article

The present study proposes a narrative synthesis with an original translational approach to analyze the consequence of the global increase in waterborne microbial diseases. The focal point of this research is the relevance of these diseases for infection prevention and control (IPC) in dental settings and for public health. In order to analyze the main issues, the text focuses on studies published between January 2021 and September 2025. Over the past fifteen years, a small number of outbreaks and cases have been reported in dental settings. Nevertheless, the water utilized for dental care is frequently heavily contaminated with microbes, primarily opportunistic ones, which have the potential to cause pandemics of pseudo-infections. These include mainly Legionella, Pseudomonas, and nontuberculous Mycobacterium (NTM), antibiotic-resistant species, and other opportunistic pathogens with relative abundance exceeding 1%. This study focuses on five areas of research: (a) iatrogenic outbreaks and cases, and causes of underestimated waterborne infections; (b) the prevalence, complexity, and relevance of the dental unit water line contamination; (c) factors influencing water contamination in dental settings, (d) issues relating to products used for dental unit water line (DUWL) treatment, (e) main guidelines on water quality and European Union (EU) legislative acts and issues related to water testing. The text highlights the urgent need for greater awareness and preparedness in dental settings, as well as updated guidelines and rules to ensure the safety of patients and healthcare workers. Full article

Oral diseases remain highly prevalent worldwide and require early diagnosis and continuous monitoring to improve clinical outcomes. Conventional diagnostic methods are often invasive, time-consuming, and limited in their capacity for real-time assessment, which has driven the development of biosensor technologies for point-of-care applications. Among these, cell-based biosensors utilize living cells as sensing elements capable of responding to inflammatory mediators, bacterial toxins, metabolic products, and tumor-associated biomarkers. This narrative review summarizes the principles, cell types, detection mechanisms, and applications of cell-based biosensors in oral health. The literature was identified through a structured search of PubMed, Scopus, Web of Science, and Google Scholar using keywords related to cell-based biosensors, oral diagnostics, salivary biomarkers, periodontal disease, oral cancer, and lab-on-chip technologies. Due to the heterogeneity of biosensor designs and detection methods, the selected studies were analyzed qualitatively. Cell-based biosensors have demonstrated applications in periodontal disease detection, cariogenic biofilm monitoring, oral cancer diagnostics, cytotoxicity testing of dental materials, and salivary biomarker analysis. The integration of microfluidic and lab-on-chip systems enables real-time and multiplex detection, supporting the development of chairside diagnostic platforms in dentistry. However, challenges related to standardization, reproducibility, and clinical validation remain and must be addressed to facilitate broader implementation in routine practice Full article