OBJECTIVES:This study aimed to develop a framework to guide the provision of basic denture services within public oral health facilities in selected districts of KwaZulu-Natal, South Africa. The study addressed gaps in oral rehabilitation services, particularly the dominance of tooth extractions, limited prosthodontic capacity, and the lack of systematic, evidence-based planning for denture service delivery in underserved communities. METHODS:A multi-stage qualitative synthesis integrating four data sources was undertaken: a 5-year review of district-level oral health service statistics, semi-structured interviews with provincial executives, oral health managers, clinicians, and private providers, and a patient survey on tooth loss and oral health-related quality of life. Findings were triangulated and interpreted using Health Needs Assessment Theory, Public-Private Partnership Theory, the Universal Health Coverage framework, and principles of social justice and quality of life. RESULTS:Analysis revealed persistently high extraction rates, minimal denture provision, rural-urban disparities, and inadequate laboratory and human resources. Stakeholders reported limited financial capacity, infrastructure constraints, and inconsistent understanding of National Health Insurance requirements. Patient responses demonstrated substantial functional and psychosocial impacts of missing teeth and highlighted unmet rehabilitative needs. These insights informed the development of a three-stage framework comprising evidence production, stakeholder engagement, and enactment of program changes. CONCLUSIONS:The resulting framework offers a context-responsive, evidence-informed approach to improving denture services at district level. By integrating needs-based planning, collaborative implementation, and continuous monitoring, the framework supports equitable access to oral rehabilitation and aligns with national priorities for universal health coverage and improved oral health-related quality of life.
PURPOSE:The Canadian Dental Care Plan aims to reduce affordability barriers to oral health care for low- and middle-income families, including children. The selection of covered services is critical to ensure that both immediate needs and long-term oral health outcomes are adequately addressed. This study identified services considered essential for children by pediatric dentists and compared them with those included in the CDCP. METHODS:A cross-sectional survey was electronically distributed by the Canadian Association of Pediatric Dentists/Académie Canadienne de Dentisterie Pédiatrique to certified and retired pediatric dentists in Canada (n = 297). The survey collected demographic, practice, and perspectives on essential services. Data were analyzed using descriptive statistics. RESULTS:The response rate was 35% (n = 104; 78 complete). Most respondents were women, and aged 30-39 years (33%). Participants emphasized the equal importance of primary and permanent teeth and supported comprehensive care. While perspectives generally aligned with CDCP service grids, key gaps were identified in preventive services, including oral hygiene instruction, nutritional counseling, mouth guards, space maintainers, smoking cessation counseling, and primary tooth root canals. CONCLUSIONS:Although the CDCP aligns with many professional priorities, omissions in preventive services limit its comprehensiveness. An upstream approach could support more sustainable oral health care for children and reduce long-term burdens.
Older adults bear a heavy burden of oral disease, but data on their needs in areas like South Texas are limited. Assessing oral health and sociodemographic influences is key to guiding targeted public health efforts. OBJECTIVES:This study assessed oral health needs among non-institutionalized older adults in South Texas. It also examined associations between sociodemographic factors, including access to care and dental insurance-and oral health outcomes. METHODS:A cross-sectional pilot study was conducted with 103 older adults recruited through community outreach events. Participants completed surveys on demographics, oral health behaviors, insurance status, and access to care, and received oral health screenings. Descriptive statistics, logistic regression, and Poisson regression were used to identify factors associated with dental utilization and oral disease outcomes. RESULTS:Participants were primarily aged 75 years or older (44%), female (68%), and Caucasian (42.7%). Nearly one-third (32%) lacked dental insurance, 31.1% had visited a dentist within the past 6 months, and 36.9% reported difficulty accessing needed care. Tooth loss of one to five teeth was reported by 44.7%. Adults aged 75 years or older were significantly less likely to access dental care than those aged 55-64 (OR = 0.15, p = 0.030). Non-Hispanic White participants were more likely than Hispanic participants to have had a recent dental visit (OR = 4.96, p = 0.013). Lack of dental insurance was strongly associated with lower dental visit rates (OR = 0.11, p = 0.001). CONCLUSIONS:This research highlights the need to expand accessible dental services and the scope of practice for the dental workforce.
OBJECTIVES:Oral health problems may function as health-related barriers to school functioning by affecting children's concentration, attendance, and classroom participation, particularly in socioeconomically vulnerable settings. Teachers are strategically positioned to observe these situations and support school-based oral health promotion; however, evidence from vulnerable Latin American communities remains limited. This study examined teachers' oral health awareness, perceptions regarding oral health-related barriers to school functioning, classroom oral health promotion practices, and perceived support needs in a socioeconomically vulnerable school community in Costa Rica. METHODS:A descriptive cross-sectional study was conducted among preschool and primary school teachers from 13 public educational institutions in a socioeconomically vulnerable urban district of Costa Rica (N = 261). Data were collected using a structured self-administered questionnaire assessing oral health awareness, perceived school functioning impacts, classroom oral health promotion practices, and support needs. RESULTS:Teachers reported high oral health awareness scores (mean score = 4.28 ± 0.61). Most participants perceived that oral health problems interfered with students' concentration (82.4%), and 82.0% reported observing situations in which oral health problems appeared to interfere with school functioning. Although 80.1% reported addressing oral health topics during the academic year, implementation was generally infrequent. Willingness to strengthen school-based oral health promotion activities was high (86.6%). CONCLUSIONS:Teachers frequently perceived oral health problems as relevant to students' school functioning; however, implementation of oral health promotion activities remained limited. Strengthening teacher-focused training, institutional support, and school-health collaboration may support more sustainable school-based oral health promotion strategies in vulnerable communities.
OBJECTIVE:To examine the potential role of silver diamine fluoride (SDF) as a public health intervention and propose a practical policy framework for its equitable integration into oral healthcare systems. METHODS:A policy-oriented narrative synthesis of current evidence was undertaken, drawing on systematic reviews, clinical trials, economic evaluations, professional guidance, and implementation literature. Evidence was considered across clinical, workforce, economic, regulatory, and equity domains to identify barriers to SDF uptake and the policy actions required for effective implementation. RESULTS:SDF is an effective, minimally invasive, and comparatively low-cost intervention for arresting active carious lesions. Its simple application, limited equipment requirements, and suitability for community-based delivery make it particularly relevant for children, older adults, people with special healthcare needs, and populations facing financial, geographic, or physical barriers to conventional dental care. However, broader implementation remains constrained by regulatory ambiguity, limited reimbursement and procurement pathways, workforce training gaps, aesthetic concerns, inconsistent consent and follow-up processes, and fragmented governance. A six-pillar framework is proposed, encompassing financing and procurement; regulatory clarity and professional scope; workforce training; patient communication, consent, and program monitoring; research and evaluation; and governance and intersectoral collaboration. CONCLUSIONS:The principal challenge to wider SDF integration is no longer the absence of supporting evidence but persistent policy and health-system barriers. Incorporating SDF into oral health policy, alongside appropriate clinical protocols, referral pathways, financing, workforce preparation, and monitoring, could expand access to minimally invasive care and support more equitable, accessible, and sustainable oral health systems.
OBJECTIVES:Inequitable utilization of regular dental care is known to be a key driver for inequalities in oral health outcomes. The aim of this study was to investigate inequalities in adolescent dental care, at the intersections of sex, race and ethnicity, and sexual identity. METHODS:We analyzed pooled data from the 2021 to 2023 national Youth Risk Behavior Survey, comprising 27,692 participants. A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was performed, defining 20 intersectional strata by sex, race and ethnicity, and sexual identity. Two binary outcomes pertaining to dental service utilization were assessed: (i) not having visited a dentist in past 12 months, and (ii) never having visited a dentist. RESULTS:There was evidence of modest between-stratum heterogeneity with regards to dental visits in the past 12 months, and substantial heterogeneity for never having visited a dentist. The fixed effects of sex, race and ethnicity, and sexual identity explained approximately 93% to 97% of the between-stratum variance. The median odds ratio indicated that, depending on intersectional identity, the odds increased by 35% for not having visited a dentist in the past 12 months and 108% for never having visited a dentist. Discriminatory accuracy was poor for both outcomes. CONCLUSIONS:Inequalities in adolescent dental attendance may be substantial, particularly among Black and sexual minority individuals. Under specific MAIHDA modeling assumptions, we find that the inequalities across intersectional strata appear to be largely additive in nature.
OBJECTIVES:To examine whether a history of incarceration is associated with self-reported dental care utilization and oral health difficulties among low-income U.S. military veterans. METHODS:Data were from Wave 5 of the National Veteran Homeless and Other Poverty Experiences study (N = 1384). Weighted logistic and multinomial logistic regression models were estimated to examine the association between a history of incarceration and (a) dental care utilization, and (b) oral health difficulties, adjusting for demographic, socioeconomic, military, and health insurance characteristics. RESULTS:In covariate-adjusted models, veterans with a history of incarceration had significantly higher odds of not having a dental visit in the past year compared to those without prior incarceration (adjusted odds ratio [aOR] = 2.393, 95% confidence interval [CI] = 1.357, 4.219, p = 0.003), and reporting a higher relative risk of occasional oral health difficulties in the past 3 months (RRR = 1.856, 95% CI = 1.027, 3.353, p = 0.034) compared to never/hardly ever experiencing difficulties. CONCLUSION:A history of incarceration may represent an important social driver of dental care utilization and oral health difficulties among veterans. Potential programmatic responses through the U.S. Department of Veterans Affairs and the criminal justice system are discussed.
Background Artificial intelligence (AI) is increasingly integrated into public health and dentistry, with a range of applications. While these developments raise questions about efficiency and scalability, uncertainty remains regarding whether AI can substitute for Dental Public Health (DPH) expertise. This paper aims to distinguish between AI-amenable and fundamentally human DPH competencies.Methods An analytical framework was applied to the 10 dental public health (DPH) specialty competencies. Current AI applications reported in the health literature were mapped across competencies including program management, systems evaluation, ethical decision-making, surveillance system design, communication, collaboration and leadership, policy advocacy, evidence appraisal, research, and integration of social determinants of health.Results AI demonstrated strong technical capacity across data-intensive and analytical competencies, including program management, systems evaluation, surveillance design, evidence appraisal, research, and integration of social determinants of health. These domains were classified as augmentable, as AI enhanced data integration, pattern recognition, and operational efficiency when accompanied by appropriate human oversight. In contrast, competencies grounded in ethical decision-making, communication, leadership and collaboration, and policy advocacy were identified as irreplaceable, as they require moral judgment, contextual interpretation, professional accountability, and relational engagement beyond current AI capabilities.Conclusions The findings support the use of AI as a complementary tool in DPH while affirming that the specialists remain indispensable for governance, equity, public accountability, and strategic decision-making in population oral health policy and practice. Competency frameworks, accreditation standards, and workforce development efforts should explicitly define the appropriate role of AI while reinforcing the primacy of human judgment and ethical leadership in population oral health practice.
BACKGROUND:Periodontitis, a prevalent chronic inflammatory disorder, is linked to an increased risk of cardiovascular disease (CVD). However, the impact of social determinants of health (SDoH) on premature CVD mortality in individuals with periodontitis remains poorly understood. METHODS:Data from 8277 US adults aged 30-74 years, collected from NHANES 2009-2014 with mortality follow-up through 2019, were analyzed. Periodontitis was defined according to CDC/AAP criteria, and premature CVD mortality was defined as death from CVD before age 75. A cumulative SDoH score was constructed based on eight indicators. Kaplan-Meier survival curves and log-rank tests compared survival probabilities across groups. Sensitivity analyses utilized Fine and Gray competing risk models. RESULTS:Periodontitis was independently associated with an elevated risk of premature CVD mortality (HR = 2.21; 95% CI = 1.01-4.86), particularly among those with multiple adverse SDoH. A significant dose-response relationship was observed between cumulative SDoH burden and premature CVD mortality in the periodontitis cohort (P for trend = 0.03), but not in those without periodontitis. Food insecurity emerged as the sole individual SDoH independently linked to increased mortality risk. Kaplan-Meier curves revealed significantly lower cumulative survival among adults with periodontitis burdened with high SDoH (p < 0.01). CONCLUSIONS:Periodontitis was associated with an increased risk of premature CVD mortality, especially in the presence of cumulative adverse SDoH, suggesting the need for integrated medical-dental care and broader strategies to address social inequities.
OBJECTIVES:This study explored how individuals in an online anti-CWF community construct and sustain opposition narratives to inform evidence-based communication and policy engagement. METHODS:A qualitative study was undertaken with adults who self-identified as not supportive of CWF. Fourteen participants from the United Kingdom, Australia, and the United States of America were recruited via the Fluoride Action Network Facebook page, a prominent global hub for anti-fluoridation discourse. Semi-structured interviews were conducted via Zoom between January and July 2025. Data were analyzed using inductive qualitative content analysis. Codes were organized into main, generic, and sub-categories and quantified by endorsement frequency. Reporting followed SRQR and COREQ guidelines. RESULTS:Five main categories were identified: (1) Knowledge, Attitudes, Perceptions, and Policy Views; (2) Information Sources and Trust; (3) Reasons for Opposition; (4) Grassroots and Community Actions; and (5) Alternatives and Conditions for Acceptability. Opposition to CWF was shaped by ethical, health, and institutional concerns rather than by scientific disagreement alone. Eight generic categories captured key reasons for opposition, including perceptions of mass medication without consent, health and social harms, institutional distrust, concerns about industrial waste, ethical objections, skepticism about benefits, preference for individualized alternatives, and experiences of professional dismissal. Anti-fluoride networks and social media were the most trusted sources of information (86%), while trust in mainstream science and health authorities was very low (< 15%). CONCLUSIONS:Opposition to CWF is sustained through network-mediated information ecosystems and reinforced by behavioral economic mechanisms, including loss aversion, autonomy bias, and default framing effects. Effective public health responses must therefore move beyond evidence dissemination to incorporate network-aware communication and behavioral insights-informed strategies that prioritize transparency, public participation, and equitable framing of CWF within broader oral health policy.
OBJECTIVES:To examine how federal appellate courts evaluate constitutional claims concerning custodial dental care and to characterize the clinical and procedural features of these cases. METHODS:Decisions of the U.S. courts of appeals issued between 1980 and 2025 were identified through structured database searches. Cases substantively evaluating dental care were coded for severe pain, infection, abscess (coded separately), functional impairment, delay, custody type, representation status, defendant level, and appellate outcome. Descriptive statistics summarized case characteristics, and logistic regression evaluated associations between selected variables and appellate outcomes. RESULTS:A total of 182 appellate decisions met inclusion criteria, of which 174 evaluated adequacy of care. Severe pain was described in 86% of coded cases and functional impairment in 62%. Infection was documented in 41% of cases, with an abscess specifically identified in 16%. Delay was alleged in 73% of cases. Overall, 35% of decisions resulted in reversal or remand. Among cases with documented delay duration, the median delay was substantially longer in plaintiff-favorable cases, and delays exceeding 90 days were associated with higher odds of reversal or remand. CONCLUSIONS:Appellate review emphasizes documented awareness and response rather than equivalence to community standards. This legal threshold does not ensure timely clinical resolution. Public health evaluation of custodial dental systems should consider disease progression and access to definitive treatment in addition to legal compliance. Improvements are likely to depend on system-level monitoring of access and timeliness of care rather than litigation alone, reflecting the distinction between legal sufficiency and clinical adequacy.
OBJECTIVES:Approximately 12% of the American population live with a form of diabetes mellitus (DM). People living with DM (PLD) are at a significantly higher risk of developing comorbid conditions, such as periodontal disease (PD). The pathological link between DM and PD is well documented, but the social factors, or social determinants of health (SDH) which may contribute to the link between the diseases are less understood. Our objective is to examine the SDH factors associated with PD among PLD using a national database with the aim of informing intervention strategies for affected subpopulations. METHODS:Utilizing the All of Us national database, we drew a sample of PLD, including those with and without PD, that completed surveys regarding SDH, their overall health, and healthcare utilization. We calculated marginal odds ratios between each variable and PD diagnosis. Analyses were performed using the All of Us Workbench and R 4.3.1. RESULTS:The total cohort consisted of 7971 participants; 342 participants had PD. Significant variables found to increase PLD's risk of PD included male gender, being a current smoker, reporting inability to afford healthcare, and perceived discrimination in healthcare. CONCLUSIONS:Using a large, national cohort, we demonstrate the association between specific SDH and PD among PLD. Our work underscores the importance of considering these variables for intervention strategies and emphasizes the need for preventative oral care programs for PLD.
INTRODUCTION:American Indians and Alaska Natives have lower life expectancies, and poorer oral health compared to other US populations. These negative health outcomes are somewhat preventable with routine care, but provider shortages, proximity to health services, and other factors create barriers. The Community Health Aide Program (CHAP) is a multidisciplinary system of certified mid-level behavioral, medical, and dental providers working alongside licensed providers to increase access to quality care. The objective was to evaluate benefits and challenges of integrating the CHAP model within existing Tribal health systems. METHODS:De-identified data from open-ended responses related to CHAP expansion efforts in three Tribal Nations residing in Oklahoma were qualitatively analyzed using a SWOT analysis framework. Themes were developed deductively under the umbrella of Strengths, Weaknesses, Opportunities, and Threats. Five subthemes commonly affecting existing Tribal healthcare systems were identified. A special emphasis on dental healthcare was highlighted. RESULTS:99 strengths (36.4%), 52 weaknesses (19.1%), 69 opportunities (25.4%), and 52 threats (19.1%) were identified. Subthemes included: Interprofessional and Community Connections and Programs (n = 88); Technology, Physical Infrastructure, and Resource Capacity (n = 80); Workforce Staffing and Efficiency (n = 49); Scope of Administrative Coordination, Budget, and Funding (n = 30); and Cultural Responsiveness (n = 25). Specific to dental healthcare were 59 strengths (n = 20), weaknesses (n = 11), opportunities (n = 21), and threats (n = 7). DISCUSSION:CHAP has historically proven to be a successful healthcare delivery model for underserved populations. More strengths and opportunities than weaknesses and threats regarding the integration and expansion of CHAP to improve medical, behavioral, and dental healthcare access were identified.
OBJECTIVES:The Interim Canada Dental Benefit (CDB) provided financial support for the dental needs of children < 12 years old, from low-income families in Canada. Funds were distributed during two periods, Regular Period 1 (October 2022 through June 2023) and the Regular Period 2 (July 2023 through June 2024). This study evaluated the adjusted rate of child participation across provinces and territories, proportionally for children aged 0-11 who lack dental insurance, from households with a net annual income < $90,000 (Canadian). METHODS:Publicly available data were sourced from the Government of Canada Open Data Portal. Variables of interest were presented as distributions by provinces and territories, age grouping of children, and family net income. Child participation rates were calculated based on Statistics Canada data (2025). RESULTS:A total of 452,460 applications were accepted, with $440.7 million distributed. The adjusted national rate of participation for children without private and public dental insurance from low-income households was 267.3/1000 children in Regular Period 1 and 273.2/1000 in Regular Period 2. The provinces and territories with the highest adjusted rates were Nova Scotia, Saskatchewan, Newfoundland and Labrador, and the Northwest Territories. Families earning less than $30,000 annually made up the largest share of applicants. CONCLUSIONS:Government-funded programs, like the Interim CDB, have the capacity to improve access to dental care for Canadians. The results show clear regional differences, with higher participation often found in regions where public dental programs for children are limited or absent.
OBJECTIVES:This retrospective cohort study describes public dental service use among children aged 0-4 years attending public sector oral health services in Metro North and Metro South Hospital and Health Services, Southeast Queensland. This study analyzes age and reason for first dental visits, and whether access pathways, including Lift the Lip (LtL), influence access for key sociodemographic groups. METHODS:We analyzed electronic oral health records for 41,614 children with a first dental visit between January 2014 and December 2022. Age at first visit and reason for attendance were summarized descriptively. Early attendance (≤ 12 and ≤ 24 months) was compared across LtL and non-LtL pathways and risk groups using chi-square tests with risk differences and risk ratios. RESULTS:The mean age at first visit was 37.7 months (SD 17.0). Overall, 11% of children attended by 12 months and 27% by 24 months, and 83% first presented for general care. LtL-referred children were more likely to attend by 12 (27.7% vs. 4.7%) and 24 months (66.7% vs. 12.4%) than non-LtL children. Early attendance remained lower for Indigenous children, those living with greater disadvantage, and Child Dental Benefits Schedule-eligible children, and higher for children from culturally and linguistically diverse backgrounds. Attendance by 12 months increased after 2016, from 5.2% to 12.0%. CONCLUSION:Few children accessed public dental care by the recommended age of first visit. While LtL substantially improved early attendance, equity gaps persisted, highlighting the need to strengthen early-referral pathways and parent/carer awareness of the recommended timing for a first dental visit.
OBJECTIVES:Oral health disparities disproportionately affect low-income populations, with cost a significant barrier to accessing dental care. In Canada, individuals with untreated oral conditions often visit publicly funded medical services, which are not designed to provide dental treatment. The recently launched Canadian Dental Care Plan (CDCP) is intended to expand access to dental services for low-income populations. This commentary argues that reduced medical service use for non-traumatic dental conditions (NTDCs) is a potential benefit that should be monitored to evaluate the impact of the CDCP. METHODS:Canadian studies reporting use and cost estimates of physician visits, emergency department use, and hospital-based care for dental conditions were described. Data sources for routine monitoring of use were identified. RESULTS:In Ontario Canada, use and costs of physician and emergency department visits, and hospital-based care for NTDCs were estimated at over $29M annually during 2003-2015 (population approximately 30 million). These estimates were conservative, with other studies suggesting higher visit volumes and costs depending on case definitions. National hospital and provincial physician billing databases are available for routine monitoring but indicators need to be standardized and data quality assessed. Stratified reporting can monitor equity impacts. CONCLUSIONS:Medical oral health care use is a potential indicator of effectiveness of public dental programs. A decline could signal improved access to dental services while persistent rates may highlight gaps in program reach. Monitoring this indicator is relevant to Canada and other jurisdictions seeking to advance oral health equity through expanded public coverage.
OBJECTIVES:This study examined the effects of dental sealant insurance coverage on trends in pit and fissure sealant (PFS) use, decayed, missing, and filled teeth (DMFT) rates, and filled teeth (FT) rates among Korean adolescents, using data from the Korean Youth Risk Behavior Survey (2005-2024) and the Korean National Health and Nutrition Examination Survey (2007-2015). METHODS:Data from participants aged 12-18 years were analyzed. The proportion of PFS use referred to the proportion of respondents who answered "yes" to the question "Have you received PFS in the past 12 months?" in the survey. DMFT and FT were classified based on oral examination criteria from 2007 to 2015. Statistical analyses were conducted using Joinpoint regression (version 4.8.0.1) and PROC SURVEYLOGISTIC in SAS 9.4 to estimate the annual percent change (APC), odds ratios, and 95% confidence intervals. RESULTS:PFS use increased until 2018 (APC = +1.5%) and declined slightly thereafter until 2024, whereas DMFT and FT rates decreased from 2007 to 2015. Dental sealant insurance coverage was significantly associated with higher PFS use and lower DMFT and FT rates (p < 0.05). CONCLUSIONS:Dental sealant insurance coverage effectively improved oral health and reduced dental caries among Korean adolescents.
