OBJECTIVE:In 2020, a scoping review mapped the existing Oral Health Birth Cohort Studies (OHBCS). Given the rapid growth and disparate nature of this field, this living scoping review aimed to identify new OHBCS and report their findings. METHODS:A three-step search strategy was adopted. Studies were searched using the databases PubMed, Embase, Web of Science, and Scopus, along with the grey literature with no language restrictions. Two independent reviewers screened the studies. OHBCS included those with baseline data collection during pregnancy or within the first year of the child's life or linked future oral health data to exposures during either of these two life stages. RESULTS:Of the 5374 records, 32 new OHBCS from 16 countries (Northern Ireland and Scotland as part of the UK), comprising 184 studies, were identified. These were categorized as OHBCS with a single oral health publication (n = 17), OHBCS with two or more oral health publications (n = 10), cohorts nested within interventional studies (n = 2) and data linkage cohorts (n = 3). Most of the OHBCS (66%) were established in very high Human Development Index (HDI) countries. OHBCS, with a single publication, included participants from birth to 15, with participation rates ranging from 14.6% to 100.0%. Similarly, those with two or more publications, nested interventions, or data linkage had participation rates ranging from 13.3% to 99.4% by age 6. The most commonly reported primary outcomes were dental caries (n = 18), enamel defect/hypomineralization (n = 9), and oral microbiome (n = 5). CONCLUSION:The review highlights the rapid growth of new OHBCs, particularly in very high-human development countries and identifies emerging approaches in genetics and microbiome research. Efforts should encourage new OHBCS in low- and middle-income countries and support engagement in pooled analyses. Initiatives by GLOBICS (Global Consortium of Oral Health Birth Cohort Studies) may help define critical actions to leverage new and well-established OHBCS.
The global burden of oral diseases and shocking inequalities highlight the failure of current oral health systems and policies. One of the limitations with existing approaches is that they rely almost exclusively on professional perspectives with minimal input from communities, and in particular disadvantaged populations. As a consequence, interventions often fail to achieve sustained improvements and have limited impact in reducing inequalities. Within global health, there is growing recognition of the importance of meaningful community engagement in all aspects of policy, practice and research. The CORE global oral health research programme is being conducted in four middle-income countries (Brazil, India, Colombia and Kenya) and an innovative element is that the planned research will be informed by community engagement with disadvantaged communities. Through a process of co-design, local communities will be actively involved in designing, implementing and evaluating interventions. The planned community engagement activities include community mapping, establishment of community forums, appointment of community link workers and community outreach activities including visual and performing arts events. The aim of this commentary is to critically review the policy context and principles of community engagement, and to reflect on insights gained through the initial engagement activities undertaken as part of the CORE programme.
OBJECTIVES:Oral health is central to holistic wellbeing for Aboriginal and Torres Strait Islander Peoples, yet mainstream promotion approaches often rely on individualistic models that fail to reflect Community realities. Aboriginal Health Workers and Practitioners (AHW/Ps), as trusted Community members and the only nationally registered culturally based health profession, are uniquely positioned to embed oral health within relational models of care. Despite this strength, oral health remains absent from mandatory AHW/P training and continuing professional development. This paper aims to document the co-design of a culturally grounded oral health promotion training with AHW/Ps across Aboriginal Community Controlled Health Organisations (ACCHOs) in South Australia. METHODS:Guided by Indigenous research methodologies, Critical Race Theory and principles of relationality, this project partnered with three ACCHOs in South Australia. The process was governed by an Aboriginal-led Project Governance Committee (PGC) and centred on Yarning sessions, annotated worksheets and iterative feedback loops with AHW/Ps, clinic staff and Community leaders. RESULTS:A total of 34 staff across the three ACCHOs, including AHW/Ps and other clinic team members, contributed to the co-design. Participants prioritised oral health topics relevant to everyday practice. These insights shaped a training package comprising knowledge and practical components, supported by culturally relevant visuals, character-based videos and site-specific referral pathways. CONCLUSION:The co-design process itself was a key outcome, strengthening relationships, trust and Community leadership. Effective oral health promotion must move beyond extractive models toward approaches grounded in Indigenous knowledge, reciprocity and structural change. By centring AHW/Ps, the training supports Community-led health promotion and Aboriginal and Torres Strait Islander self-determination in oral health.
OBJECTIVES:The WHO Global Strategy and Action Plan on Oral Health 2023-2030 encourages innovative approaches such as shifting tasks from dentists to Mid-level Dental Providers (MLDPs), who work independently to improve access to and equity in oral health. This study aimed to examine stakeholders' perspectives on the challenges and opportunities associated with introducing MLDPs in Iran. METHODS:A qualitative descriptive approach was adopted. Guided by the Consolidated Framework for Implementation Research (CFIR), semi-structured interviews were conducted with 10 stakeholders selected through an informant-based sampling strategy. Interviews were transcribed verbatim and analysed thematically. RESULTS:Stakeholders widely acknowledged the need for MLDPs but disagreed on their scope. Some supported limiting their role to preventive services, while others argued for including essential clinical tasks. Participants recognised that Iran has a legal basis for introducing MLDPs, though some criticized its "career transition" pathway which allowed dental therapists entry into dental programmes. Rural communities and primary health care facilities perceived as receptive to dental therapists, though infrastructure gaps persist. Implementation was considered as dependent on ministry and non-ministry actors. CONCLUSIONS:The findings highlight both opportunities and challenges associated with introducing MLDPs in Iran. The introduction of MLDPs is hindered by professional protectionism and power dynamics that prioritise dentists' interests over public needs, as well as infrastructural weaknesses. Overcoming these barriers will require redistributing decision-making power. This can be advanced through participatory research approaches and public engagement to promote the inclusion of community voices.
BACKGROUND:Periodontitis remains one of the most prevalent chronic diseases worldwide and is strongly socially patterned. However, contemporary disease classifications and guideline-based management largely emphasise individualised, clinically intensive, long-term maintenance approaches. Whether these models are feasible, equitable, or sustainable when applied at the population level has received little attention. METHODS:We synthesised evidence from global and national epidemiological studies, health systems research, clinical practice guidelines, and health policy analyses to examine the implications of current periodontitis classifications and care models for service demand, workforce capacity, equity, and universal health coverage. We developed a conceptual framework linking disease definitions, recommended care intensity, and health system constraints. RESULTS:Current periodontitis classifications and maintenance-oriented care recommendations generate levels of service demand that substantially exceed the capacity of most oral health systems. This creates a feasibility paradox whereby increasingly comprehensive disease definitions and intensive maintenance schedules lead to implicit rationing of care and socially patterned access, disproportionately disadvantaging populations already at highest risk. The prevailing clinical paradigm also places limited emphasis on structural determinants of disease, population prevention, and value-based allocation of resources. CONCLUSIONS:A population-oriented reorientation of periodontal care is needed. We propose a framework that prioritises documented disease progression, risk of harm, and person-centred outcomes; aligns treatment intensity with expected benefit through risk-based and value-oriented approaches; and explicitly incorporates health system capacity together with the structural and commercial determinants of health. Moving beyond maintenance-for-all models toward feasible, equitable, and system-aware strategies is essential to reducing the population burden of periodontitis and advancing universal health coverage.
OBJECTIVE:Access to dental care is often limited by financial, structural and social factors, contributing to persistent oral health inequalities globally. This scoping review systematically maps and synthesizes how financial pressures influence access, service utilization and oral health outcomes, particularly among underserved and vulnerable populations. METHODS:Following PRISMA-ScR guidelines, 73 peer-reviewed studies published between 2004 and 2024 were included. The included studies spanned high-income countries (the USA, Canada, Japan, South Korea and Australia) and low- and middle-income countries (Iran, Tanzania, Uganda, Lesotho and Pakistan). Key outcomes were out-of-pocket expenditures, catastrophic health expenditure, delayed or foregone care, unmet needs, insurance gaps and utilization patterns. RESULTS:Study populations included adults, children, older adults and vulnerable groups such as racial and ethnic minorities and individuals with special needs. Between 17% and 63% of participants reported delaying or foregoing dental care due to cost, reflecting variation across populations and study contexts. Structural barriers, such as transportation limitations, provider shortages and clinic accessibility, further restrict care in low-resource areas. Social and cultural factors, such as discrimination, language barriers and mistrust, also reduced care-seeking among marginalized groups. These findings indicate the need for policies that address both financial and non-financial barriers to dental care. CONCLUSIONS:Reducing financial barriers requires more than expanding coverage alone. Policies should aim to provide comprehensive benefits, affordable essential services, adequate provider availability and strategies that address structural and social barriers to promote equitable oral health outcomes.
OBJECTIVES:To evaluate health system readiness for UHC for oral health in ageing populations, using a cross-country analysis of eight countries (Japan, India, Colombia, Rwanda, the UK, Nigeria, Australia, Canada). The analysis encompasses health system organisation, financing and service delivery; dental workforce volume and distribution; oral health policies and provisions for older adults; and age-based differences in oral disease burden. METHODS:A narrative review was conducted across eight countries, purposively selected to represent diverse health system financing and governance arrangements using three established health system frameworks, by Böhm et al., Mackintosh et al. and Karan et al. Data were sourced from the WHO Global Oral Health Status Report and supplementary country-specific sources, and findings were organised thematically across four domains. Age-based differences in oral disease burden were quantified using disability-adjusted life years (DALYs) rates per 100 000 population, comparing adults aged ≥ 65 years with those aged < 65 years over the period 2001-2021, with both absolute and relative differences calculated. RESULTS:Considerable variation in readiness towards achieving UHC for oral health in ageing populations was observed. High-income countries nominally included essential dental services under UHC but often with shallow coverage, significant co-payments and limited rehabilitative services, leading to substantial out-of-pocket spending (notably Australia and Canada). Lower-income countries provided minimal public financing for oral health, leaving most dental care to private out of pocket expenditure (as observed in India and Nigeria). Dental workforce shortages and maldistribution were pronounced in low-resource settings (Rwanda and Nigeria recorded dentist-to-population ratios of approximately 1:57000 and 1:35000 respectively). Few countries had specific policies or programmes targeting oral healthcare for older adults (Japan and the UK). In most countries, adults ≥ 65 years had a higher oral disease burden than younger adults, especially in contexts with lower overall disease levels and greater longevity. CONCLUSIONS:Health systems are largely underprepared to deliver adequate coverage for oral health services for ageing populations. Strengthening financial protection, broadening coverage of preventive and restorative dental services, enhancing workforce capacity and embedding oral health in general health and ageing policies are critical to achieving equitable oral health outcomes for older adults.
OBJECTIVES:In the United Kingdom (UK), disabled people face barriers accessing dental care, leading to poor oral health. To understand these barriers, the present study examined how disability is defined and conceptualised in UK oral health policy documents, and explored the implications of these framings for the provision of dental care for disabled people. METHODS:A qualitative documentary analysis was conducted using a seven-phase framework. Oral health policy documents published between 2000 and 2023 were identified through targeted website searches, supplementary web searches and consultation with an expert panel. Twenty-six national and international documents were included. Data were extracted using a structured matrix and analysed using a directed approach informed by the social model of disability. Coding was organised into three themes: disability terminology, underlying models of disability and vision for oral healthcare. RESULTS:Of the 26 documents analysed, 15 provided explicit definitions of disability, predominantly within Special Care Dentistry (SCD) guidance, while general oral health documents rarely defined the term. Most general dental policies adopted a medical model, focusing on individual impairments, whereas SCD and international documents were more likely to incorporate social or biopsychosocial approaches. Consideration of barriers to care, infrastructure requirements and workforce competencies was inconsistent and largely absent from general dentistry documents. A clear, system-wide vision for the provision of inclusive oral healthcare for disabled people was evident in only a small number of documents. CONCLUSIONS:UK oral health policy documents demonstrate inconsistent and often limited conceptualisations of disability, with a predominance of medical model approaches in general dentistry. The lack of clear definitions and absence of barrier-focused frameworks may contribute to ongoing inequalities in access to and outcomes of dental care for disabled people. Greater explicitness in defining disability, alongside the adoption of inclusive, barrier-oriented policy frameworks and increased attention to workforce development and service design, is required to support equitable and accessible oral healthcare.
OBJECTIVES:Oral disorders are an important disability driver in adults aged 70 and older, who often experience greater tooth loss and higher levels of untreated oral disease than younger persons. Despite the importance of regular dental visits, older adults attend dental services less frequently, facing several barriers. This study aimed to evaluate whether a low-threshold dental screening could increase the likelihood that older adults (≥ 65 years) contact a dental professional. METHODS:A total of 194 community-dwelling adults aged ≥ 65 years without a dental check-up in the past 12 months were randomized (1:1) in a two-arm, single-blinded, controlled superiority trial. The intervention group received an oral screening, personalized oral health information, referral letters for a dentist and general practitioner, and a list of nearby dentists. The control group received only general oral hygiene flyers and a list of nearby dentists. The primary outcome was whether participants contacted a dental professional within 4 months following the intervention. Oral hygiene practices (i.e., tooth brushing frequency and use of brushing materials) were evaluated as secondary outcomes. RESULTS:No evidence for an effect of the intervention on contact with a dental professional was found (risk difference = -0.01 (95% CI: -0.12; 0.10)). Within 4 months, 14% of control group participants and 12% of those in the intervention group reported contacting a dental professional, mostly due to urgent issues (e.g., pain or broken teeth), rather than the intervention itself. Among those who did not seek care (n = 133), 79% cited a lack of perceived need. Furthermore, no intervention effect was found regarding oral hygiene practices. CONCLUSION:Motivating older adults to attend preventive professional dental care remains challenging. Greater integration of oral health into primary care, along with early-life promotion of positive oral health behaviours, is essential.
ABSTRACT Objectives To determine whether Dental Therapists and Dental Nurses could reduce plaque levels of dependent older adults residing in care homes and assisted living settings, when compared to ‘treatment as usual’. Methods A two‐arm pragmatic cluster randomised controlled trial over a 6‐month period was undertaken based on an a priori assumption of superiority. Forty‐eight dependent settings across Wales, North‐West England, London and Northern Ireland were recruited. Dependent settings were excluded if they solely focused on end‐of‐life or palliative care or were already participating in an oral health prevention programme. Residents were excluded if they were below 65 years of age or if they were receiving end‐of‐life or palliative care. Dependent settings were randomised using an adaptive algorithm, which generated the randomisation sequence. After allocation, the Chief Investigator, Principal Investigators and the trial statistician were blinded until the trial was completed and the analysis was complete. Due to the nature of the intervention, outcome assessors, those delivering the intervention and the residents were not blinded. Dental Therapists provided routine dental care according to their Scope of Practice. Dental Nurses administered fluoride varnish, oversaw the use of high‐strength fluoride toothpaste, and sought to improve the level of day‐to‐day prevention offered by the formal carers. Current practice formed the control arm. In the United Kingdom, this is often ad hoc and relies on dentists, if available, visiting residents presenting with clinical symptoms. The intervention period lasted for 6 months. The primary outcome measure was the proportion of residents that demonstrated a 50% reduction in the Silness and Löe plaque index. Secondary outcome measures were the number of new carious lesions (coronal and root caries), bleeding on probing, Oral Impacts on Daily Performances, EuroQol five dimensions questionnaire (quality of life measure), oral symptoms, episodes of pain, and episodes of unscheduled care, and the number of onward referrals to dentists. Results Twenty‐four dependent settings were allocated to receive the intervention and 24 continued with ‘treatment as usual’. 41.7% of the settings were in London, 33.3% were in Wales or the Northwest of England, and 25.0% of the settings were in Northern Ireland. One hundred and twenty‐two residents were allocated to the control arm and 142 residents in the intervention arm. The mean age was 85 years and 67.2% were female. Levels of cognitive impairment were high in both arms (mean score 13.7 on the Six Item Cognitive Impairment Test). No statistically significant differences were found in the primary or secondary outcome measures at 6‐months. No differences were apparent in the number of adverse events related to the trial by group. Conclusions A 6‐month intervention using Dental Therapists and Dental Nurses did not produce any measurable improvements in oral health within dependent settings when compared to treatment as usual. High levels of cognitive impairment may have contributed to the lack of any effect seen. Trial Registration The study was registered with ISRCTN: ISRCTN16332897 ( https://doi.org/10.1186/ISRCTN16332897 ) on 3 December 2021 and the protocol was published in 2022 ( https://doi.org/10.1186/s13063‐022‐06487‐3 )
OBJECTIVES:To characterise implementation reporting completeness of oral health interventions for culturally and linguistically diverse (CALD) children and caregivers using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). METHODS:Six databases (PubMed, Embase, CINAHL, Scopus, Web of Science, Cochrane Library) were searched for studies published 2010-2025 (PROSPERO CRD42024531750; PRISMA 2020). Eligible studies evaluated oral health interventions for CALD children aged 0-18 years from immigrant, refugee, or asylum-seeking backgrounds. Risk of bias was assessed with RoB 2, MMAT, and ROBINS-I. A 22-item RE-AIM coding tool assessed reporting completeness across five domains, categorised as low (< 60%), moderate (60%-69.9%), or high (≥ 70%). RESULTS:Eleven studies were included (USA n = 9, UK n = 1, Australia n = 1; samples 36-1207). Two of three RCTs were rated High risk (RoB 2), all six non-randomised studies Serious risk (ROBINS-I), and two mixed-methods studies Low and Moderate (MMAT). Reporting completeness was predominantly low (72.7% of studies). Reach (84.1%) and Adoption (86.4%) were well-documented; Effectiveness (32.3%) showed the largest gap. Clinical outcomes (dmft/DMFT) were assessed in 36.4% of studies; cost was not reported in any study. Follow-up of 18 months or longer was limited to 18.2%, and attrition (5.6%-47%) in refugee populations reflected structural mobility rather than intervention failure. CONCLUSIONS:Reporting completeness was substantially incomplete for Effectiveness, cost, and long-term follow-up, though several gaps reflect structural constraints in CALD settings rather than reporting failures alone. Future studies should prospectively embed validated reporting checklists that capture intervention structure and implementation, select outcomes matched to the phase of evidence (proximal in early-phase, clinical in adequately powered trials), and design retention strategies suited to mobile and recently resettled populations.
BACKGROUND:Despite evidence linking oral health to severe COVID-19 outcomes and its potential role in surveillance and service delivery, integration remained absent. This study enquired about: (1) representation of oral health in national COVID-19 taskforces and funding; (2) policy-level barriers to inclusion; (3) lessons from maintaining essential services; and (4) strategies for mobilizing oral health professionals in future emergencies. METHODS:We conducted a scoping review guided by the PRISMA-ScR framework. Systematic searches were performed in PubMed/MEDLINE and Scopus (2000-2025) using tailored search strings combining key terms: oral health, pandemic preparedness, COVID-19, dentistry, health systems and related MeSH terms. Eligible evidence included peer-reviewed studies, reviews, policy documents and commentaries in English. Non-human studies were excluded. Data were charted using the WHO Health System Building Blocks framework. RESULTS:After dual-reviewer screening, 2569-3860 records were screened, yielding 5-8 eligible studies per question (26 studies total). The evidence revealed a consistent narrative of systemic exclusion yet operational resilience. For representation, oral health professionals were almost universally absent from national COVID-19 task forces, with dedicated financial support entirely lacking. Regarding barriers, policy integration was hindered by the framing of oral care as non-essential, its omission from global health security architectures like the International Health Regulations, and limited professional advocacy. In contrast, lessons from service adaptation demonstrated that essential care was maintained through the rapid adoption of triage, teledentistry, robust infection control and effective communication. On workforce mobilization, while consensus existed on the potential for OHPs to expand into roles such as vaccination and surveillance, implementation was obstructed by a lack of pre-emergency training, formal deployment mechanisms and regulatory frameworks with minimal linkage to international instruments. CONCLUSION:The review reflects systemic neglect of oral health, with the literature dominated by descriptions of clinical and operational adaptations rather than formal policy integration. We identify missed opportunities in leveraging OHPs for pandemic response and propose embedding oral health within One Health governance, financing, surveillance and emergency response structures to build more resilient health systems.
BACKGROUND:Dental caries remains one of the most prevalent noncommunicable diseases worldwide despite decades of clinical and behavioural interventions. Persistently high prevalence suggests that current approaches are better organised for ongoing disease management than for preventing new disease occurrence. This commentary examines whether an elimination framework could provide a more coherent and outcome-oriented direction for oral health policy and practice. METHODOLOGY:We apply the Dahlem Framework to assess whether dental caries meets established criteria for disease eradication. We then position caries within the classical continuum of control, elimination, and eradication, drawing on current evidence on caries aetiology, fluoride exposure, dietary environments, primary care integration, surveillance, and the social and commercial determinants of oral health. RESULTS:Dental caries does not meet the criteria for eradication. It has no single causal agent, no interruptible transmission cycle, no immunising intervention, and no global surveillance architecture capable of detecting incidence. Eradication is therefore conceptually impossible. Elimination, however, defined as the stable disappearance of dental caries as a public health problem within a defined population, is biologically plausible and operationally achievable. An elimination frame shifts expectations from managing recurrence to preventing occurrence and reframes caries as a system outcome rather than solely an individual behavioural or clinical problem. CONCLUSION:Caries elimination is not the promise of biological absence, but a realistic and measurable population health objective. Adopting an elimination framework could strengthen policy coherence, surveillance, implementation research, professional education, and accountability, while reorienting oral health systems toward prevention, equity, and sustained population-level impact.
BACKGROUND:There has been an increasing prevalence of childhood overweight and obesity worldwide and locally, with a quarter of Australian children now considered overweight. To address this, the New South Wales government in Australia released guidelines calling for all public dental services to identify children above a healthy weight and refer them to appropriate services. This study was part of a larger study that aimed to codesign and pilot implementation strategies to facilitate the translation of these guidelines into dental staff's practice. METHODS:A pre-post-test design was used to evaluate the strategies across two health districts in NSW. Strategies were codesigned by dental staff and parents of patients and included linguistically appropriate resources; discharge summaries from referral pathways; refresher training; involvement of dental assistants; templates for longitudinal BMI measures and growth assessment flyers for patients. A validated questionnaire measuring intention to engage in the guidelines and self-reported practice was distributed to interested staff before and after the delivery of strategies (2019-2022). Data describing dental staff's' actual practices over this time were also retrieved from patient information management systems. Descriptive and inferential statistics were used to assess the study outcomes and any differences across districts (n = 16). RESULTS:There was no improvement in behavioural determinants of providing a growth assessment as indicated by the overall intention to engage in Children's Healthy Weight guideline (iCHEW) scale scores, however attitude scores had the largest observed improvement (from 30.1 to 35.2) and this was most pronounced in District 2 (27.2-34.3). A significant improvement in adherence to children's healthy weight guidelines was also seen in District 2 (increase of 20.54%, 95% CI 14.09-27.44). In District 1, children had 1.5 times the odds of receiving a growth assessment if they were treated by a dental officer (OR = 1.54; 95% CI 1.00-1.72). Conversely, children in District 2 had significantly lower odds of receiving a growth assessment if they were treated by a dental officer (OR = 0.203; 95% CI 0.12-0.35) or if they were treated at a satellite clinic (OR = 0.572; 95% CI 0.45-0.73). CONCLUSION:Dental staff can play a key role in addressing childhood overweight and obesity, although this can be challenging. The findings suggested some improvements in behavioural determinants and self-reported behaviours following supportive strategies. Further research to confirm these findings using larger sample sizes is recommended.
OBJECTIVES:To evaluate the association between prematurity and dental caries occurrence at four years of age and to assess whether variables related to dental development, tooth eruption, and oral healthcare mediate this association. METHODS:A longitudinal study was conducted using data from the 2015 Pelotas (RS) Birth Cohort. The outcome was dental caries at four years, classified using ICDAS. Gestational age at birth was estimated by ultrasonography examination in 3 407 (79.7%) cases, with 3 242 (75.8%) performed during the 1st or 2nd trimester. Mediating variables included enamel defects, number of teeth at 12 months, oral hygiene practices, sugar consumption, and maternal guidance. The variables were selected using a directed acyclic graph (DAG). Associations were estimated using Poisson regression models, and mediation was assessed through structural equation modelling (SEM). Analyses were performed using STATA 18.0. RESULTS:Children born before 34 weeks had a 40% lower incidence of caries at four years compared to those born after 39 weeks, and those born between 37 and 38 weeks had a 20% lower incidence. The number of teeth mediated this relationship, indicating that lower gestational age was associated with fewer teeth at 12 months and a lower occurrence of caries. CONCLUSION:The findings highlight the importance of early dental monitoring and suggest preventive programs starting with the eruption of the first tooth, given its relevance in the occurrence of caries.
OBJECTIVES:To systematically evaluate the economic burden of preventable dental-related emergency department visits (PDEDV) and preventable dental-related hospital admissions (PDHA), identify reasons for these presentations, and synthesise recommendations to reduce avoidable utilisation. METHODS:This systematic review followed the PRISMA 2020 guidelines. A comprehensive multiple database search was conducted in PubMed, Embase, Cochrane Library, EBSCOHOST, and Web of Science for studies reporting direct and/or indirect costs of PDEDV and PDHA in any age group, published in English from 2000 to March 2026. Three calibrated reviewers screened and critically appraised the identified studies. Data including patient characteristics, estimated charges/costs, reasons for PDEDV and PDHA, and recommendations to minimise the avoidable burden were extracted. Charges/costs were inflation-adjusted and standardised to 2024 US dollars. RESULTS:Of the 2600 total studies identified, 25 met the inclusion criteria. The majority were conducted in the United States and focused on direct medical costs. Uninsured individuals, public health insurance enrolees and residents of low-income areas were more likely to experience PDEDV. Mean charges per any PDEDV ranged from $409.73 to $2740.76. Mean charges per any PDHA ranged from $5234.46 to $62 298.25, while mean hospital costs ranged from $350.42 to $22 375.53. Dental caries was the commonest cause for PDEDV. Odontogenic infections were the costliest to manage, with mean charges of $2740.76 per PDEDV and $62 298.25 per PDHA. PDEDV and PDHA were primarily driven by financial barriers, socio-demographic disparities, limited access to routine dental care, and health workforce constraints. Proposed strategies focused on improving affordability and access to preventive dental care, enhancing oral health literacy, strengthening integration between medical and dental services, and expanding the dental workforce. CONCLUSIONS:PDEDV and PDHA, particularly those due to dental caries and odontogenic infections, impose a significant economic burden on healthcare systems, highlighting the need to reduce financial and access barriers to routine dental care for high-risk groups and priority conditions.
OBJECTIVES:Routine dental attendance is associated with better health outcomes, yet those from disadvantaged backgrounds are more likely to seek problem-driven, episodic care. The RETURN intervention, a brief behavioural intervention delivered by dental nurses in urgent care, was designed to support urgent care users to take up planned dental care. This study evaluates the cost-effectiveness of the RETURN intervention. METHODS:A cost-utility analysis was conducted alongside a randomised controlled trial. Resource use and health outcomes, measured in Quality-Adjusted Life Years (QALYs) derived from the EQ-5D-5L questionnaire, were evaluated at 12 and 18 months. The primary analysis used a cost-effectiveness threshold of £20 000 per QALY. Multiple imputation was used to account for missing data. Objectives also included providing an estimated incremental cost per improved Oral health impact profile (OHIP-14) point. RESULTS:The intervention was found to be cost-effective with high confidence. At 12 months, intervention incremental cost was £18.83 with incremental Quality-Adjusted Life Year (QALY) gain of 0.014, and an incremental net health benefit (NHB) of 0.013 QALYs. The probability of cost-effectiveness was 90.5%. At 18 months, the incremental cost was £15.11 for a QALY gain of 0.009, and incremental NHB of 0.008 (probability of cost-effectiveness 70.9%). The findings were supported by complete case analysis, which showed probabilities of cost-effectiveness of 99.7% at 12 months and 98.5% at 18 months. Sub-group analysis gave the strongest evidence of cost-effectiveness in the most deprived populations. CONCLUSIONS:The RETURN intervention is highly likely to be a cost-effective use of National Health Service resources. Its impact appears particularly strong among those living in the most deprived areas, suggesting the potential to reduce inequalities in access to routine dental care. TRIAL REGISTRATION:The RETURN trial was registered at isrctn.com (ISRCTN84666712).
OBJECTIVES:To develop a Core Outcome Set suitable for adults and children for use in studies of Dental Behaviour Support (DBS) techniques, including non-pharmacological DBS, sedation and General Anaesthesia research. METHODS:Two systematic reviews generated a preliminary list of candidate outcomes that were shared with Key Stakeholders (KSG) and Public Patient Involvement (PPI) groups, who shortlisted outcomes for further exploration. Patients, carers, clinicians, and researchers were invited to participate in a Delphi panel. A modified e-Delphi was used to generate prioritisation and consensus across outcomes. A subsequent series of consensus meetings with panellists, patient groups and professional stakeholder groups determined the final outcomes within the COS. RESULTS:Twenty-three candidate outcomes were rated by 88 panellists in Round 1. The attrition rate between Rounds 1 and 3 was 21.6%. Thirty-four to 32 panellists attended the consensus meetings. The BeSiDe core outcome set for Dental Behaviour Support consisted of nine outcomes: acceptability, adverse effect, anxiety, behavioural response, cost, pain, therapeutic alliance, time and treatment completion. An additional subset of three core outcomes for use in pharmacological DBS studies was agreed upon: recovery, sedation effect and physiological monitoring. Each outcome was presented with a plain-language label and description to support consistent interpretation across stakeholders. CONCLUSIONS:A core outcome set to be used across all DBS studies was produced covering both adults and children, with supplementary additional outcomes available to use in studies exploring only pharmacological DBS approaches. The list is for use in research, though there is obvious transferability to clinical practice. TRIAL REGISTRATION:COMET Initiative database (Study ID: 2101), registered September 2022.
OBJECTIVE:To investigate whether the association between exclusive breastfeeding and malocclusions in primary dentition is modified by pacifier use duration and intensity. METHODS:Data from a birth cohort study conducted in southern Brazil were used (n = 3591). Poisson regression with robust error variance was used to assess the association between exclusive breastfeeding and malocclusion. The exposure to exclusive breastfeeding was collected through information about breastfeeding duration at 3 and 12 months follow ups. Malocclusion outcomes were assessed at 48 months of follow up using criteria of the World Health Organization. Effect measure modification (EMM) analysis was adopted to verify the association between exclusive breastfeeding and malocclusions, which vary according to pacifier use duration and intensity. EMM was assessed by means of the relative excess risk due to interaction (RERI), which corresponds to the additional risk that would be expected if the combination of exclusive breastfeeding and pacifier use intensity and duration was fully additive. RESULTS:Children who were not exclusively breastfed for 6 months and who used a pacifier throughout the first 4 years showed a prevalence of 7.82 higher than malocclusion (95% CI 4.70-12.92). Even among children who were exclusively breastfed, pacifier use during this period was also associated with a higher prevalence of malocclusion (PR 5.98; 95% CI 3.50-10.21). When occurrence of malocclusion by pacifier use intensity at 48 months was analysed, children full-time users and those children who were not exclusively breastfed presented a malocclusion prevalence of 4.87 (95% CI 3.43-6.93), and those children who were full-time users and who were exclusively breastfed showed a prevalence of 3.96 higher for malocclusion (95% CI 32.66-5.90). Positive RERI for both duration and intensity of pacifier use were observed, suggesting that the joint effect of breastfeeding and pacifier use on malocclusion is larger than the sum of their individual values. CONCLUSION:Pacifiers use duration and intensity in the first 4 years of life modify the protective effect of exclusive breastfeeding for the first 6 months of life on the malocclusion prevalence at 48 months of life. These findings reinforce the deleterious effects of pacifier use on occlusal development, even with the practice of exclusive breastfeeding.
