Search Results (84)

This study aimed to understand, through the voices of patients, the factors that contribute to inequality and inequity in oral healthcare and their implications for patient safety. A qualitative study was performed using a Grounded Theory approach (GT) through 13 in-depth interviews with a flexible design, recorded and transcribed verbatim for study purposes. Open and axial coding and analysis categories were generated, and a conceptual and explicative framework was established. Ethical approval was obtained. The main findings highlighted how individual, social, and contextual factors significantly influence the materialization of risks and failures in oral healthcare, ultimately affecting patient safety in dental practice. These factors include individual factors, the relationship between professionals and patients, and failures in healthcare service provision. Participants’ discourses showed examples of inequities, such as gender, socioeconomic gradient, educative level, type of healthcare system, discrimination, stigmatization, and othering-otherness, and their effect on dental care and dentistry safety. Health inequities should be tackled in a preventive and proactive manner through the effective integration of intersectoral policies and strategies. This approach would enhance oral health, make patient safety a fundamental pillar of dental care, uphold human dignity, and strengthen trust in the healthcare system. Full article

Background/Objectives: Educational background is an aspect of socio-economic status, that may be associated with higher caries risk. This study aimed to investigate differences in caries prevalence between different school types for older adolescents in Greifswald, Germany. Methods: Cross-sectional data were collected as part of compulsory dental school examinations between 2020 and 2023. Oral health status was assessed according to WHO criteria by six calibrated examiners and reported as mean D₃MFT (D₃: dentin caries, M: missing, F: filled, SD/±: standard deviation). To compare educational backgrounds, the adolescents were divided into two groups according to their age and type of school (11–15 and 16–18 years old). Results: The study included 5816 adolescents (48.7% females) with a mean D₃MFT of 0.65 (Q1–Q3: 0–1); 73.8% were clinically caries-free, having D₃MFT = 0, confirming the polarization in caries experience with 2.5 ± 2.13 SaC index. The logistic regression model showed a significantly increased Odds Ratio for having caries in relation to age, being male, having plaque or gingivitis (p < 0.005). There were significant differences in caries experience and prevalence between school types, where high schools had the lowest D₃MFT values in both age groups (0.39 ± 1.17 and 0.64 ± 1.49, respectively). The highest D₃MFT values were in schools for special educational needs in younger adolescents (1.12 ± 1.9) and in vocational schools in older adolescents (1.63 ± 2.55). Conclusions: In a low-caries-risk population, there were significant differences in caries experience and prevalence among adolescents in different school types. Prevention strategies should aim to reduce the polarization in caries across different educational backgrounds in late adolescence. Full article

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services. Full article

Background: The declaration of COVID-19 as a pandemic by the World Health Organization in 2020 led to the widespread suspension of clinical practices, including dentistry. This study aims to evaluate the impact of these restrictions on oral health and dietary habits. Methods: A retrospective cross-sectional study was conducted at Egas Moniz University Clinic (Lisbon Metropolitan Area), covering from June 2019 to June 2021. A total of 3380 participants were included and categorized into two cohorts: pre- and post-COVID-19 restrictions. Data were collected through a structured questionnaire assessing oral health behaviors and dietary habits. Results: Of 3469 incoming patients, 3380 met the inclusion criteria. Statistically significant post-lockdown changes were observed, including increased smoking prevalence, higher coffee with sugar consumption, reduced use of dental floss and mouthwash, and redistribution in tooth brushing frequency, with fewer individuals brushing 2–3 times daily. Conclusions: COVID-19-related restrictions had a heterogeneous impact on oral health and dietary behaviors. While some individuals reported improved hygiene routines, others showed negative changes, such as increased tobacco use or decreased use of oral hygiene products. These contrasting effects call for targeted public health strategies to reduce inequalities and support vulnerable groups during crises. Full article

Background: Childsmile is Scotland’s national child oral health improvement programme designed to reduce inequalities in oral health and ensure universal access to NHS dental services by working closely with children and their families. Research has shown that parents with more dental concerns are less likely to bring their children for regular preventive dental check-ups.Therefore, a communication toolkit named ‘Chatterbox’ was created to help families access dental care services. Methods: This study aimed to evaluate the acceptability of Chatterbox from the perspective of parents with young children and from staff who work with them. Thirty parents of young children, volunteers, and staff affiliated with three third-sector family support organisations in Dundee participated in in-depth interviews, focus groups, and observations to assess the objectives of Chatterbox. A framework analysis was conducted to capture the themes, patterns, and findings triangulated using observations and field notes. Results: Chatterbox was found to promote effective communication, identify barriers to dental attendance, provide a platform for reflection, convey the complexities of daily life, and boost parents’ confidence to seek assistance. Conclusions: Chatterbox has the potential to help parents in accessing preventive dental care for their young children when used with trained support workers. Full article

Background: Dental pain is a significant public health issue globally and in Mexico, with substantial negative impacts on affected individuals. Objective: The objective of this study was to evaluate the prevalence of dental pain and its association with clinical, sociodemographic, and socioeconomic risk indicators in schoolchildren aged 6 to 12 years in four cities in Mexico. Material and Methods: A cross-sectional study was conducted on 500 children attending public schools in the cities of Pachuca, Tepatitlán, Toluca, and San Luis Potosí. A questionnaire was applied, and a clinical examination was performed on the schoolchildren. Self-reported dental pain within the 12 months preceding the study, categorized as 0 (no pain) and 1 (pain), was used as the dependent variable. For the statistical analysis, the Stata program was used, where a multivariate binary logistic regression model was applied. Results: The mean age was 8.92 ± 1.99 years; 50% were girls. The prevalence of dental pain was 34.0%. Independent variables associated (p < 0.05) with the experience of dental pain were as follows: age (OR = 0.81), having a car at home (OR = 0.77), a lower socioeconomic position (OR = 2.03), curative or specialized dental care (OR = 8.40), and self-reported dental and/or gingival disease (OR = 5.39). Conclusions: Dental pain is a significant health problem in schoolchildren aged 6 to 12 years in Mexico, with a prevalence of 34% in this study. Sociodemographic and socioeconomic factors, as well as clinical indicators, play an important role in the experience of dental pain. Inequalities in oral health were observed. There is a need for public health interventions to reduce this problem in vulnerable populations. Full article

Background/Objectives: School-based caries prevention can increase access to critical dental services and reduce oral health inequities. However, little is known regarding the incidence of dental caries in children participating in school caries prevention, and caries diagnosis is often interval censored. Methods: In this paper, we used data from a longitudinal, school-based, randomized clinical trial of minimally invasive treatments for dental caries to estimate the per-visit incidence rate and compare the hazard of dental caries in children receiving either silver diamine fluoride or glass ionomer dental sealants. To account for interval censoring, we used semiparametric transformation models for univariate failure time data and imputed caries incidence using G-imputation. Results: There were 3040 children that met inclusion criteria for analysis, 1516 (49.9%) of which were randomly assigned to receive silver diamine fluoride and 1524 (50.1%) were assigned to receive glass ionomer dental sealants and atraumatic restorations. There were no differences in the hazard of caries between treatments (HR = 0.99, 95% CI = 0.72, 1.24), while children with caries at baseline had a significant increase in the hazard of new caries (HR = 2.54, 95% CI = 2.26, 2.83) compared to those that were caries free. The per-visit caries incidence ranged from 4.8 to 11.1 at the individual level and increased with each successive study observation. Conclusions: School-based caries prevention can positively affect caries incidence, and the results can be used to inform future program design and implementation. Full article

Introduction: HPV vaccination prevents most HPV-related cancers, yet uptake remains low. HPV is linked to an estimated 70% of oropharyngeal cancers (OPCs) in the US and outnumber cases of HPV-related cervical cancers. Not all OPCs can be detected through routine screening, making HPV vaccination a more effective primary prevention strategy. However, bridging primary and oral healthcare faces challenges due to a lack of referral networks between practices. The purpose of this study is to identify key infrastructure elements and policies, as well as HPV prevention strategies, among an academic practice network of dental clinics and partnering community health clinics in a southeastern state. Methods: Researchers held interviews with directors and focus groups with staff at six dental clinics and eight associated community clinics in a southeastern state. Interviews and focus groups at dental and community clinics were analyzed by two study team members using thematic analysis with Nvivo software. Results: A total of 90 participants participated in all focus groups and interviews (N = 14 interviews, 10 focus groups (5–13 participants per focus group). Most participants identified as white (58.9%) and female (70%), with an average age of 38.5 years. Researchers identified nine key study themes: three specific to the dental clinics’ HPV conversations with patients, two related to community clinics’ vaccine provision, and four involving the relationship between the dental and co-located community clinics. Dental clinic staff do not currently discuss HPV with patients. They are open to discussing HPV with patients but anticipate barriers that require preparation to overcome them. Community clinics have demonstrated previous success with HPV vaccination, but patients over the age of 18 face financial barriers to vaccination. Community clinics and dental clinics report that they do not currently have existing referral networks but are open to a referral system between practices if infrastructure is put into place to support it. Conclusions: Our findings indicate that there is interest in, and potential for, increased discussion of HPV with dental patients and collaboration between dental and community clinics for HPV vaccination referral. The results of this investigation can be used to develop intervention strategies to increase HPV vaccination through referrals between dental clinics and nearby community clinics. Ultimately, this work can reduce health inequities in HPV-related cancers, serve as a model for US dental practices, and possibly influence public health policy. Full article

Background: Caries experience in Argentine children is quite high and no national data are present. Aim: This cross-sectional observational survey aimed to assess the oral health status of schoolchildren in Buenos Aires (CABA) using CTNI and to evaluate the ecological association between health inequalities and caries prevalence. Design: Data were collected, via a clustered procedure, during the 2016–2018 school years. Children were examined at school to determine dental status according to the CTNI performed under standardized conditions, using light, dental mirrors, WHO probes and magnification (2.5×). Secondary sources were used to acquire socio-demographic and epidemiological data. A hierarchical cluster analysis was carried out with the municipalities of the CABA as the dependent variable and the socio-demographic factors. Results: The study population consisted of 62,904 schoolchildren, 43,571 of whom were enrolled into the study. Total caries prevalence was 67.78% while severe caries prevalence was 28.29%, which was statistically associated with the year of the survey (p < 0.01). Four territorial conglomerates from a socio-epidemiological standpoint outline homogeneous areas of social risk; cluster 1 had the highest social risk. The prevalence of severe caries (CTNI 7–14) was highest in cluster 1 (44.7–53.2% of the population). Conclusion: The social inequalities between municipalities of the CABA were statistically associated with high inequalities in oral health needs. Full article

This cross-sectional study assessed the magnitude of inequalities in self-rated oral health (SROH) among different socioeconomic groups in Brazil. Secondary data from interviews with a sample of adults (≥18 years) from the national health survey 2013 (n = 64,308) and 2019 (n = 88,531) were analyzed. Positive SROH was considered when participants selected the good or very good options. Socioeconomic indicators were monthly household income and years of education. The magnitude of inequalities among socioeconomic groups was estimated using the Slope (SII) and Relative Index of Inequality (RII). Interaction term assessed changes in SII/RII over time. Estimates were adjusted for sex and age. The prevalence of SROH was 67.50% in 2013 and 69.68% in 2019. Individuals with lower socioeconomic indicators had a lower prevalence of positive SROH. Significant reductions in the magnitude of the education-based RII between 2013 (1.58) and 2019 (1.48) in Brazil, as well as in north (1.70; 1.45) and northeast (1.50; 1.41) regions and reduction in the income-based RII in the north (1.71; 1.51) were observed. Socioeconomic inequalities in SROH persist across different Brazilian regions, although there was a reduction in disparities among education groups in 2019 compared with 2013. The findings of this study suggest that equitable Brazilian oral health policies may have contributed to reducing SROH inequality over time. Full article

This cross-sectional study investigated the association between experiences of discrimination and oral health self-perception among a probabilistic cluster sample of Brazilian adults who participated in the 2013 National Health Survey. Oral health self-perception was categorized into three groups (very good + good; fair; poor + very poor). Reported experiences of discrimination included attributions based on the respondent’s race/skin color, social class, income, occupation, illness, sexual orientation, religion, sex, and age. Covariates included sociodemographic data, oral health conditions, access to healthcare services, health habits, mental health, and participation in social and/or religious activities. Data were analyzed using ordinal logistic regression for non-proportional odds, considering sample weights and complex samples. Among 60,202 adults, 5.84% perceived their oral health as poor + very poor, with a significantly higher proportion among those experiencing discrimination (9.98%). Adults who experienced discrimination were 1.39 times more likely to report a “poor/very poor/fair” oral health self-perception compared to those who did not experience discrimination. Those who suffered discrimination were 1.28 times more likely to have a “very poor/poor” oral health self-perception than their counterparts who were not affected by discrimination. These findings underscore the importance of considering discrimination experiences as part of the social determinants influencing oral health. Full article

This study aimed to evaluate the long-term impact of children’s dental care programs on children and adolescents to reduce oral health inequalities. It measured and assessed the improvement effects of children’s dental care programs on the oral health of children and adolescents as part of the efforts to decrease oral health disparities in this age group. It included 406 individuals who participated in student and children’s dental care program between 2013 and 2019 at screening facilities in Gwangjin-gu, Seoul. A frequency analysis was conducted for demographic characteristics, and a binary logistic regression analysis was performed to identify factors influencing the prevalence of dental caries as the dependent variable. The data were analyzed using PASW Statistics with the statistical significance level set at α = 0.05. Regarding oral health status based on the frequency of participation in children’s dental care program for children and adolescents, participants with seven or more sessions had lower prevalence rates of dental caries, malocclusion, and periodontal disease than those with only one session. Second, when comparing oral health status in children’s dental care program between primary and adolescent age groups, individuals under continuous oral health care showed a decrease in permanent teeth affected by dental caries, dental caries prevalence, and malocclusion prevalence (excluding primary school age). Third, a binary logistic regression analysis revealed significant influences (p < 0.05) of the developmental stage and frequency of program participation on dental caries prevalence. Children’s dental care programs are essential for alleviating oral health inequalities among children and adolescents and preventing oral diseases. Furthermore, the developmental stage of children and the frequency of program participation are crucial factors in preventing oral conditions, such as dental caries. Full article

Introduction: Cervical cancer develops slowly and may not manifest signs and symptoms at an early stage. It is worth mentioning the factors that can influence the onset of cervical cancer: smoking, early sexual life, multiple sexual partners, use of oral contraceptives, multiparity, low socioeconomic status, among others. An important risk factor for the onset of this disease is HPV infection, a virus associated with most cases of precursor lesions of this type of cancer. It is essential to understand the comprehensiveness of the scope and adherence to the recommended guidelines throughout the national territory. Therefore, health indicators are important management tools that make it possible to evaluate the services offered, measuring the reach of the target population, the supply and access to preventive exams. Objective: To analyze the trend of progress in cervical cancer coverage actions in Brazilian capitals from 2016 to 2021. Method: This is an ecological study with temporal analysis that used secondary data referring to process indicators for cervical cancer control actions in women aged between 25 and 64 years living in Brazilian capitals between 2016 and 2021. Aspects related to the quality of care in the cervical cancer prevention program were evaluated using databases of the Cancer Information System (SISCAN), available in DATASUS. The indicators used to monitor and evaluate cervical cancer control actions were (i) cervical coverage, (ii) reason for cervical surgery, and (iii) proportion of cervical cancer every 3 years. Results: In 2016, 410,000 tests were performed and notified in the SISCAN system in all Brazilian capitals, with emphasis on Curitiba, with 65,715 tests performed, and Porto Velho, with 174. In 2020, there was a reduction in exams compared to the previous year in all capitals, with the exception of Palmas, which went from 7655 exams to 9604. It was observed that all the capitals studied showed an increase in the annual percentage variation of Pap smear coverage, with the exception of Brasília, Manaus, Porto Alegre and Porto Velho, which did not show a statistically significant increase (APC = 3.01, 2.746, 3.987, 3.69, respectively). When analyzing the performance of oncotic cytology exams in the capitals according to the years 2019 and 2020, it was observed that only Manaus registered an increase in the number of procedures performed, reaching a difference of 56.5% from one year to the next. Conclusion: The ecological analysis revealed a worrying drop in the number of tests performed in 2020, reflecting a sharp drop in coverage actions in Brazilian capitals during the pandemic caused by the SARS-CoV-2 virus. The pandemic has exacerbated existing inequalities and highlighted the need for adaptive strategies to maintain essential screening services in times of crisis. Full article

The persistence of geographic inequities in vaccination coverage often evidences the presence of zero-dose and missed communities and their vulnerabilities to vaccine-preventable diseases. These inequities were exacerbated in many places during the coronavirus disease 2019 (COVID-19) pandemic, due to severe disruptions to vaccination services. Understanding changes in zero-dose prevalence and its associated risk factors in the context of the COVID-19 pandemic is, therefore, critical to designing effective strategies to reach vulnerable populations. Using data from nationally representative household surveys conducted before the COVID-19 pandemic, in 2018, and during the pandemic, in 2021, in Nigeria, we fitted Bayesian geostatistical models to map the distribution of three vaccination coverage indicators: receipt of the first dose of diphtheria-tetanus-pertussis-containing vaccine (DTP1), the first dose of measles-containing vaccine (MCV1), and any of the four basic vaccines (bacilli Calmette-Guerin (BCG), oral polio vaccine (OPV0), DTP1, and MCV1), and the corresponding zero-dose estimates independently at a 1 × 1 km resolution and the district level during both time periods. We also explored changes in the factors associated with non-vaccination at the national and regional levels using multilevel logistic regression models. Our results revealed no increases in zero-dose prevalence due to the pandemic at the national level, although considerable increases were observed in a few districts. We found substantial subnational heterogeneities in vaccination coverage and zero-dose prevalence both before and during the pandemic, showing broadly similar patterns in both time periods. Areas with relatively higher zero-dose prevalence occurred mostly in the north and a few places in the south in both time periods. We also found consistent areas of low coverage and high zero-dose prevalence using all three zero-dose indicators, revealing the areas in greatest need. At the national level, risk factors related to socioeconomic/demographic status (e.g., maternal education), maternal access to and utilization of health services, and remoteness were strongly associated with the odds of being zero dose in both time periods, while those related to communication were mostly relevant before the pandemic. These associations were also supported at the regional level, but we additionally identified risk factors specific to zero-dose children in each region; for example, communication and cross-border migration in the northwest. Our findings can help guide tailored strategies to reduce zero-dose prevalence and boost coverage levels in Nigeria. Full article

Indigenous populations around the world experience a disproportionate burden of oral diseases and health conditions. These inequalities are likely due to a complex web of socioeconomic, cultural, and health determinants. The Baka pygmies of southern Cameroon find themselves in this context of an indigenous population with health inequities. The purpose of this study was to describe the oral health status, diet, hygiene habits, and access to health services of the Baka pygmy children, from which different care needs will emerge in order to develop health strategies. A descriptive cross-sectional study was conducted in 22 Baka pygmy camps randomly selected. The study population consisted of children aged 5–6 years and 11–12 years chosen by a consecutive sampling technique. The examination was performed using a data sheet based on World Health Organization (WHO) criteria and recommendations which consisted of an oral health questionnaire for children and an oral health assessment form for children. A total of 120 children participated in the study. Extraoral examination of the study population revealed the presence of noma (1%) in the age range of 5–6 years. A total of 2713 teeth were examined, and the DMFT/dft index of the sample was 0.71 with a predominant caries component. The periodontal status showed 87% bleeding on probing. Seven percent of the sample presented a need for immediate urgent treatment due to pain and/or infection. Eighty-seven percent of the sample reported never having been examined by a dentist. The examination and oral care they received was only from nongovernmental organizations (NGOs). The conclusion of this descriptive study is that the precarious oral health situation of pygmy children combined with the absence of care services in general for the Baka pygmies generate a situation of great vulnerability. Full article