Periodontitis is a chronic inflammatory disease that has been consistently linked to a range of chronic conditions, including diabetes, cardiovascular disease, and neurodegenerative disorders. Multimorbidity, defined as the co-occurrence of two or more chronic conditions in an individual, shares complex and multifactorial pathways with periodontitis, with both increasing in prevalence with age. However, the nature of their relationship, whether driven by shared risk factors or causal interactions, remains unclear. Several independent conceptual models have been developed to identify the determinants of periodontitis and multimorbidity. However, no unified frameworks currently exist to understand the interconnections between oral health, particularly periodontitis and chronic conditions. Given that oral health is an integral component of general health, developing an integrated conceptual model is essential to illustrate plausible pathways, guide future research, and support integrated prevention strategies. Therefore, this paper proposes an integrated conceptual framework to illustrate the potential association between periodontitis and multimorbidity, grounded in shared biological mechanisms and informed by the Common Risk Factor Approach and social determinants of health. The model integrates structural, behavioural, and biological factors within a single framework centred on biological pathways. This framework provides a foundation for future research and may support the development of integrated prevention and management strategies.
To compare how official sources specify public oral-health delivery arrangements, territorial extensions, care pathways and reporting across Spain, without inferring actual delivery or access. Comparative documentary analysis of the 17 autonomous communities and the two INGESA-managed cities. Delivery architecture was separated from seven documentary domains. Codes denoted explicit inclusion (E), restricted provision (R), explicit exclusion (X), not identified (N) or insufficiently verifiable evidence (U), relative to the national common baseline. The final evidence set comprised 43 official records: three national and 40 territorial. Twelve territories documented mixed, selective or contracted routes and seven predominantly direct public arrangements. Age-based extensions were explicit in 10 territories and restricted in one. Endodontic provision beyond the national trauma exception was explicit in five and restricted in eight; advanced restorative endpoints were restricted in 11. Orthodontics was restricted in six and explicitly excluded in six; prosthetic provision was restricted in seven and excluded in five. Disability/special-care pathways were explicit in 17 territories. Cervicofacial oncology pathways were explicit in four and restricted in three. Official documents show heterogeneous territorial specification of a common national entitlement, but do not establish utilisation, effective access, quality or outcomes. Delivery architecture was not a proxy for documented clinical scope.
BackgroundCleft lip and palate (CLP) are common congenital craniofacial anomalies associated with substantial health and psychosocial burdens. Although maternal smoking during pregnancy has been linked to CLP, observational studies cannot establish causality because of confounding and reverse causation.MethodsWe performed a two-sample Mendelian randomization (MR) study to investigate the causal effect of maternal smoking on offspring CLP. Genetic variants associated with maternal smoking were used as instrumental variables. Summary statistics were obtained from the UK Biobank (maternal smoking) and the FinnGen consortium (CLP). The primary analysis used the inverse-variance weighted (IVW) method, with MR-Egger and weighted median analyses conducted as sensitivity analyses.ResultsIVW analysis demonstrated a significant causal association between maternal smoking and CLP (b = 5.34, SE = 2.50, p < 0.05). Sensitivity analyses yielded consistent results and showed no evidence of substantial heterogeneity or horizontal pleiotropy, supporting the robustness of the findings.ConclusionsOur findings provide genetic evidence supporting a causal relationship between maternal smoking and CLP. These results reinforce the importance of smoking cessation during pregnancy and support public health strategies aimed at reducing preventable risk factors for CLP. Further studies are warranted to investigate the underlying biological mechanisms and validate these findings in diverse populations.
People who use drugs often have poor oral health. It is therefore important to understand what evidence exists to support oral health improvement for them. This review aimed to identify and describe the existing literature on oral health promotion interventions for people who use drugs. The Joanna Briggs Institute scoping review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Scoping Reviews (PRISMA-SrC) guided the review. A search was performed on PubMed, CINAHL, PsycINFO, Scopus, Social Services Abstracts and Web of Science. A grey literature search also took place. The population was people who use drugs. The concept was any health promotion intervention in line with the Ottawa Charter. The context was any healthcare, community or social setting. Data extraction focused on study characteristics, main findings, and health promotion activity. A total of 1061 records were screened. Thirteen records met the inclusion criteria, mainly encompassing text and opinion pieces or qualitative records focused on oral health promotion. The included records described a range of interventions across inpatient, community, and opioid treatment settings. They included subsidised care, integrated screening and referral pathways, tailored oral health education and harm-reduction advice, multidisciplinary collaboration, and supportive, non-judgmental environments. In conclusion this review highlights an evidence gap in relation to how best to approach oral health promotion for this population. Future research should focus on developing interventions using an established intervention development methodology i.e. theory and co-design, followed by research that aims to understand effectiveness.
Co-creation is increasingly promoted to develop sustainable oral health programs. Little is known about how co-creation is applied in adult oral health promotion, including learnings from such programs. This review aims to map the characteristics of co-created, preventive, community-based oral health projects targeting adults and to synthesize learnings, including challenges, possibilities, and successes. A scoping review was conducted in accordance with recommended methodological steps. A bibliometric search across major databases and a grey literature search covering all WHO regions identified eligible projects. Inclusion criteria required projects to concern adult oral health, include co-creation elements, be community-based, focus on prevention, include an intervention, and be conducted within the last 10 years. Data extraction and synthesis focused on project characteristics and learnings. Included projects varied in aims, scope, and intervention types. Many sought to improve access to oral health care for vulnerable groups. Stakeholder involvement was generally narrow and dominated by dental professionals, with limited patient participation. Co-creation activities were often sporadic, typically occurring during implementation rather than across all project stages. Reported challenges included resource limitations, recruitment barriers, and difficulties sustaining collaboration. Opportunities arose from adaptive approaches, multi-sectoral collaboration, and the use of existing networks. Successes were mostly process-oriented, with some projects reporting improved oral health literacy, enhanced service access, and strengthened stakeholder relationships. In conclusion, Co-created oral health promotion projects demonstrate potential but are inconsistently implemented and reported. Future initiatives should prioritize early and sustained stakeholder engagement, structured co-creation processes, and systematic evaluation to strengthen impact and sustainability.
Objective: The trial aimed to study the additive effect of domiciliary professional dental cleaning on root caries lesions (RCLs), oral hygiene outcomes and oral health-related quality of life (OHRQoL) in care-dependent older adults with in-home care that use high fluoride toothpaste, compared with oral care as usual for a year. Basic research design: Parallel-group evaluator-blinded randomized controlled trial. Clinical settings: Participants own home in Sweden. Participants: 194 care-dependent with in-home care aged ≥65 years and ≥1 natural tooth were randomized (1:1) in blocks by computer-generated sequence. 149 were available at baseline (intervention (I) = 80, control (C) = 69). All were provided with toothbrushes and high-fluoride toothpaste (5,000 ppm F) for daily use. Intervention: Domiciliary professional dental cleaning and oral hygiene instructions by dental assistant, every third month. Main outcomes: The primary outcome was RCLs progression. Secondary outcomes were gingival bleeding, oral hygiene, hyposalivation and OHRQoL, registered at baseline and after 1 year by dental hygienists. Results: Due to high attrition (45%), 82 individuals remained (I = 50, C = 32) after 1 year resulting in an underpowered study. The number of subjects assessed with RCLs progression was 11 (22.0%) in I group and 9 (28.1%) in C. With the use of per protocol analysis, no significant differences between groups were seen for any of the outcomes. Conclusions: Domiciliary professional dental cleaning to care-dependent older adults does not seem to have any additive preventing effect on RCLs to daily toothbrushing with high-fluoride toothpaste. This suggests that focus be maintaining good daily oral health routines rather than home-care visits to maintain oral health.
Periodontal disease is highly prevalent among individuals with type 2 diabetes mellitus (T2DM) and shows a bidirectional relationship with glycemic control. The transtheoretical model of behavior change suggests that motivation is associated with the adoption of health habits, and although it is useful for understanding how adherence to self-care fluctuates, and for designing specific interdisciplinary programs related to individuals' motivational stage, its relationship with periodontal health in T2DM remains underexplored. This study aim to analyze the clinical and motivational factors associated with periodontal health in individuals with recently diagnosed T2DM. A retrospective observational study was conducted in 2,999 patients with T2DM diagnosed less than 5 years prior, enrolled in a multidisciplinary care program at a tertiary care hospital in Mexico City. Periodontal parameters and stage of change (baseline and 3 months) were assessed. Generalized ordinal and binary logistic regression models were applied, adjusted for age, sex, and HbA1c. Advancing in the stage of change was significantly associated with better periodontal diagnosis (OR = 1.50; 95% CI: 1.22-1.83), better oral hygiene (OR = 2.42; 95% CI: 2.03-2.88), and reduced bleeding on probing (OR = 1.67; 95% CI: 1.39-2.01). Being a woman, achieving HbA1c targets, and longer follow-up also increased the likelihood of improvement. Advanced motivational stages were associated with better periodontal status and oral hygiene among the study population. The motivational stage may be useful for identifying patients who may benefit from tailored support. Due to the study design and the absence of a control group, these findings should not be interpreted as evidence of causality.
In France, the absence of weekday on-call dental services leaves general dental practitioners (GDPs) as primary providers of urgent dental care. This study examined territorial inequalities in unscheduled and urgent dental care demand and provision and how GDPs adapt their organisation amid unequal workforce distribution. A national cross-sectional online survey was conducted among 945 licensed general dental practitioners. The main outcome measures were the weekly number of emergency consultations and calls per GDP and the answer-to-demand rate. Territorial workforce distribution was assessed using the Localized Potential Accessibility (LPA) index. Multivariable negative binomial regression examined associations with weekly emergency consultations. GDPs reported a median of 7 emergency consultations per week. Emergency demand and organisational patterns varied across workforce density gradients. The lowest and intermediate LPA terciles showed similar emergency pressure, while highly supplied areas showed lower demand and fewer consultations. In under-served areas, practices reported higher daily patient flows and more restrictive acceptance of unknown patients. Distance to the nearest hospital dental service was independently associated with emergency activity. The answer-to-demand rate varied across territorial gradients: over-served areas converted 80% of calls into consultations compared with 60% in under-served and 63% in adequately served areas, suggesting demand rationing in high-pressure territories. Overall, unscheduled and urgent dental care activity appears structured along a territorial continuum shaped by workforce distribution, secondary care accessibility, and practice-level organisational adaptation. Improving access to urgent dental care requires systemic approaches considering territorial configuration of services, referral pathways, and continuity of care rather than workforce numbers alone.
The aim of this study was to determine the association between osteoarthritis and rheumatoid and major dental health outcomes - dental caries, gingivitis, periodontitis and plaque accumulation - in adults and older adults (aged 18 years and above) by way of a systematic review. The review was conducted in accordance with the Cochrane Handbook for Systematic Reviews and reported following PRISMA 2020 guidelines. The search strategy was applied to MEDLINE (via Ovid), EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL and Web of Science, based on predefined inclusion and exclusion criteria. After removing duplicates and screening titles, abstracts and full texts, 36 studies were included. These underwent data extraction and quality assessment using the Newcastle-Ottawa Scale. Frequency distributions were calculated for dental caries, periodontitis, gingivitis and plaque. Findings indicate a consistent trend of poorer oral health among individuals with osteoarthritis and rheumatoid, particularly in relation to periodontitis and plaque accumulation. Significant associations were observed for clinical attachment loss, periodontal pocket depth and plaque-related outcomes, suggesting a link between arthritis and periodontal disease, as well as the detrimental impact of arthritis on oral hygiene maintenance. The results highlight the need for integrated care between medical and dental professionals. Individuals with osteoarthritis and rheumatoid should receive tailored oral health education and preventive interventions to reduce their heightened risk of oral disease. Future research should prioritize longitudinal studies, standardized outcome measures and adjustment for key confounders to clarify the direction and strength of this relationship.
This study examined the association between life functioning and oral functional problems among Korean adults aged ≥65 years and assessed whether health literacy serves as an explanatory factor in this association. We conducted a cross-sectional analysis using nationally representative data from 1,698 participants in the 2024 Korea National Health and Nutrition Examination Survey. Life functioning was measured using the Life Functioning Scale-10 (LFS-10), with higher scores indicating better functioning. Oral functional problems were assessed using self-reported chewing and speaking difficulty items, with higher scores indicating poorer oral function. Health literacy was measured using the 10-item Health Literacy Index for the Community. Survey-weighted linear regression models were adjusted for sociodemographic characteristics, health behaviors, and comorbidities, and cross-sectional explanatory associations were evaluated using complex-sample hierarchical regression. Participants with low LFS-10 scores reported greater oral functional problems than those with high scores (4.66 vs 3.89). In adjusted models, LFS-10 scores were inversely associated with oral functional problems (B = -0.050; p = 0.006) and positively associated with health literacy (B = 0.159; p < 0.001). After health literacy was added to the model, the coefficient for LFS-10 was modestly attenuated but remained statistically significant (B = -0.043; p = 0.016), while health literacy was inversely associated with oral functional problems (B = -0.050; p = 0.013). The attenuation was approximately 14%, with a small increase in explained variance (ΔR² = 0.009). These findings indicate that lower life functioning is associated with greater oral functional problems and that health literacy modestly explains this association; however, causality cannot be inferred because of the cross-sectional study design.
Objective: To perform the cultural adaptation of the Health Literacy in Dentistry Scale-29 (HeLD-29) for Turkish adults and to evaluate its validity and reliability. Design: The Turkish version of the HeLD-29 was adapted through a forward-backward translation procedure consistent with the original 29-item, seven-subscale structure. The scale was first translated into Turkish by two independent translators and then back-translated into English by two different translators. The final analytical sample included 298 adults aged 19-70 years (117 females, 181 males). To assess temporal stability, 60 randomly selected participants completed the scale again after 7-10 days. Results: Test-retest reliability demonstrated excellent agreement using the Intraclass Correlation Coefficient (ICC = 0.912; p < 0.001). The Spearman rank-order correlation also indicated very strong temporal stability (r = 0.920; p < 0.001). After excluding two outliers, EFA revealed adequate communalities (0.546-0.894) and supported the multidimensional structure, with the final 26-item version explaining 78.07% of the total variance. Internal consistency was high across subscales (α = 0.84-0.93) and for the total scale (α = 0.936), and split-half coefficients further confirmed strong reliability. CFA verified the validity of the multidimensional construct, demonstrating acceptable model fit after minor modifications (RMSEA = 0.063; GFI = 0.900; AGFI = 0.850; CFI = 0.943; χ2 = 606.465; p < 0.001). Conclusion: The Turkish version of the HeLD-29 was demonstrated to be a reliable and valid instrument for assessing oral health literacy in Turkish adults.
This scoping review aims to assess the extent of coverage of school health programs globally, map strategies across settings, and summarize outcomes and reported domains in literature. Guided by Arksey and O'Malley framework, an extensive search was performed across PubMed, Scopus, and Web of Science till February 2026, identifying 13,522 database records and 37 additional source records. After removing 2271 duplicates, 11,288 records were screened, and 84 studies met inclusion criteria. Eligible studies were experimental or observational research evaluating school-based oral health programmes for children involving a minimum of two schools at the district level. Three reviewers independently extracted data, and findings were synthesised using descriptive statistics and thematic analysis guided by the WHO Health Promoting Schools framework. The study identified seven key strategies for strengthening school oral health promotion, including implementing public health policies, delivering oral health services, integrating oral health into broader health programs, fostering collaboration and partnerships, emphasising reinforcement and motivation, ensuring optimal resource allocation, and creating a safe school environment. These strategies varied in extent, reach, and scope, ranging from national to local, from whole-population approaches to targeted population, and from purely educational efforts to comprehensive services. Although various strategies are reported, most focus on educational and behavioural interventions, with limited documentation of system-level approaches, particularly in developed countries.
Oral diseases are among the most common non-communicable diseases and adolescence represents an important time for intervention. The epidemiology of oral health is not well understood in low-resource settings. This study estimates the prevalence and correlates of oral pain and quality of life among adolescents in Tanzania. Baseline, cross-sectional data from a large randomized controlled trial of 1095 adolescents were analyzed. The primary outcome was self-reported oral pain in the past month. Regression models were conducted to assess the relationships between the prevalence of oral pain and sociodemographic characteristics and oral-health related behaviors. A chi-square test was used to explore associations between the experience of oral pain and quality of life measures from the EQ-5D-5 L instrument. The prevalence of oral pain was 13% (95% CI: 11.0, 15.9). No associations were observed between oral pain and most sociodemographic or behavioral factors. One association was found between perceived competence and reported oral pain in both the unadjusted (Prevalence ratio (PR): 1.20 95% CI: 1.04, 1.40) and adjusted models, (PR: 1.26, 95% CI: 1.07, 1.50). Analyses also showed associations with imprecise estimates between oral pain and district, maternal occupation, paternal occupation, and household hunger. A positive association was observed between reported oral pain and anxiety/depression and pain/discomfort measured on the EQ-5D-5 L quality of life instrument. This study contributes to the growing body of literature on the prevalence of oral pain among in-school adolescents. Findings support the need for population-based interventions to support good oral health among all adolescents.
The COVID-19 pandemic disrupted dental services worldwide, requiring rapid adaptation of biosafety measures. In Brazil, emergency protocols were widely implemented across public and private dental care. This nationwide cross-sectional study investigated which biosafety practices adopted during the COVID-19 pandemic were maintained by Brazilian dentists and analysed factors associated with continued respirator use in the post-emergency period. Data were collected between March and October 2023 using non-probabilistic snowball sampling through an online questionnaire based on Brazilian biosafety guidelines and international recommendations. Descriptive statistics, chi-square and Fisher's exact tests, and simple and multiple logistic regression models were used (α=0.05). Among 1,136 dentists, most were female (71.2%), aged 41-50 years (33.6%), and had ≥12 years of professional experience (76.1%). Difficulties obtaining personal protective equipment during the pandemic were reported by 80.2% of participants, mainly involving masks and gloves, with significant associations according to work setting (p<0.05). Respirator use became widespread during the pandemic, with 45.6% reporting use only during the emergency phase and 39.6% continuing its use in the post-emergency period. In the adjusted model, sex and work setting remained associated with maintenance of respirator use (p<0.05). Fatigue (47.7%) and respiratory discomfort (27.3%) were the most frequently reported adverse effects. The pandemic changed dental biosafety practices in Brazil: traditional infection-control measures remained routine, whereas enhanced measures were partly sustained. These findings may inform preparedness planning for future public health emergencies.
This study aims to examine the associations of ethnicity and socioeconomic factors with obvious dental caries and assess longitudinal changes between 5 and 11-years of age. A retrospective longitudinal design was employed, linking individual-level health and education records for children aged 5 and 11-years living in Scotland between 2004 and 2018 (n = 155,737). At age five, Polish and Gypsy/Traveller children had around four times higher odds for developing obvious caries compared to White Scottish peers (OR = 4.37, 95% CI: 3.87-4.94) and (OR = 3.47, 95% CI: 2.52-4.79) respectively. By age 11, African, Chinese, Indian, and White British children showed lower odds of developing obvious caries, while Gypsy/Traveller (OR = 2.70, 95% CI: 1.98-3.70), and Polish (OR = 1.34, 95% CI: 1.18-1.52) children remained at elevated risk compared to White Scottish children. Longitudinal analysis revealed limited overall ethnic differences in new obvious caries development, though African (OR = 0.51, 95% CI: 0.39-0.67) and Chinese (OR = 0.58, 95% CI: 0.38-0.90) children were less likely to develop new obvious caries compared to White Scottish children. Several minority groups, including Polish, Gypsy/Traveller, Pakistani, and Arab children, demonstrated improvements in caries status between ages five and 11 compared to White Scottish children. Obvious caries presence at age five is strongly associated with caries at age 11 (OR = 3.24, 95% CI: 3.16-3.33). Ethnic disparities in obvious dental caries were evident at age 5 and independent of socioeconomic status. By age 11, these inequalities diminished for most groups, with socioeconomic factors emerging as the primary drivers of oral health inequalities, except among Gypsy/Traveller and Polish children.
The objective of the study is to assess the relationship between functional limitation and use of dental services among older American adults; and whether this relationship is independent from socioeconomic factors. We used data pertaining to older American adults aged 60 years and over from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). Functional limitation was indicated by difficulties in hearing, seeing, concentrating or remembering, walking or climbing stairs, dressing or bathing, and doing errands alone. Use of dental service was indicated by one or more dental visit within the past year. Logistic regression was conducted to assess the association between any limitation and use of dental service adjusting for income, education, health insurance, smoking, tooth extraction, age, sex and ethnicity. The analysis included 142,095 participants. Dental visit within past year, and functional limitations were reported by 67.4% and 39.7% of the participants, respectively. Functional limitation was negatively associated with dental visit in the previous year with Odds Ratios 0.69 (95% Confidence Intervals: 0.65, 0.74) in the fully adjusted model. Functional limitation could be a potential and additional barrier to use of dental services among older Americans. Public health strategies should consider alternative care models for those with functional limitations.
Objective: There is evidence to show that young children with educational additional support needs (ASN) have poorer oral health and less access to primary care dental services than their peers however, less is known about the oral health and dental service access of young people with ASN as they embark on secondary education. This study investigates the rates of tooth extraction under general anaesthesia and primary care dental attendance in young people with educational ASN attending secondary school in Scotland. Methods: A multi-cohort study of 214,142 young people followed up from age 12 to 16 years in Scotland using data linkage of three routine databases: Pupil Census; Scottish Morbidity Records; and Management Information and Dental Accounting System. Rates of tooth extraction under general anaesthetic in hospital and access to primary care dental services were compared among young people with ASN to those with no recorded ASN. Results: Tooth extraction under general anaesthesia was higher among young people with autism (Adjusted Risk Ratio (aRR) = 2.48; 95% Confidence Interval (CI) = 1.85 to 3.25) and with intellectual disabilities (aRR = 1.76; 95% CI = 1.43 to 2.16) compared to those with no ASN. Regular attendance at primary dental care was less likely for young people with any ASN, particularly among those with intellectual disabilities and social-related ASN. Conclusions: Young people with ASN experience greater inequalities in oral health and dental care, which would also include preventive interventions, than their peers without ASN. Early intervention through national oral health improvement programmes such as Childsmile may help reduce these inequalities.
To analyze factors associated with tooth loss in 12-year-old adolescents, data were collected from 615 adolescents attending public schools in the five most densely populated cities in the state of Mato Grosso do Sul, Brazil. Tooth loss was assessed using the M component of the DMFT index. Information was also obtained on access to fluoridated water, consumption of unhealthy foods, and sedentary behaviour. Guided by the social determinants of health framework, multilevel logistic regression analyses were conducted to test associations. The prevalence of tooth loss among adolescents was 5%. In the adjusted models, sedentary behaviour was significantly associated with tooth loss [odds ratio (OR) = 1.77; 95% CI: 1.28-2.45], while access to fluoridated water was a protective factor [OR = 0.40; 95% CI: 0.16-0.99]. Household income below the poverty line and moderate to high consumption of unhealthy foods showed higher odds of tooth loss, but the confidence intervals included the null value in the adjusted model. Sedentary behaviour was significantly associated with tooth loss in 12-year-old adolescents, whereas access to fluoridated water was protective. Sedentary behaviour should be interpreted as a marker of broader lifestyle and social vulnerabilities rather than as a direct causal factor.
