Introduction: Dental caries in childhood remains a major global public health issue. In response to persistently high caries levels among children, Chile implemented a national programme (Sembrando Sonrisas) including daily supervised toothbrushing and biannual fluoride varnish applications in nurseries. This study aimed to examine the association between these interventions and caries experience in preschool children, and to assess related socioeconomic inequalities. Methods: We analysed aggregated municipality-level data (n = 346) on dental caries outcomes in five-year-olds, coverage of fluoride varnish applications, delivery of toothbrushing materials (toothbrushes and 1000 ppm fluoride toothpaste), exposure to community water fluoridation (CWF), rurality, and socioeconomic deprivation. The primary outcome was the caries experience of children covered by the programme since its national rollout in 2015. Univariate and multivariate weighted linear regression models assessed associations between programme interventions and caries experience, adjusting for deprivation and CWF. Socioeconomic inequalities in caries experience were evaluated using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII). The distribution of programme delivery across socioeconomic deciles was assessed using weighted regression models. Results: Data on 309,360 five-year-olds were included. Complete delivery of toothbrushing materials was associated with lower caries experience (50.1% vs. 55.0%), a 4.9% difference (95% CI: 2.5%, 7.2%) after adjustment. CWF exposure was associated with a 7.5% lower caries experience (95% CI: 4.2%, 10.9%). The combination of both interventions showed the lowest caries levels, with a 13.4% difference compared to areas with neither intervention (95% CI: 7.5%, 19.3%). Fluoride varnish application was not significantly associated with caries experience. Delivery of interventions was equitable across socioeconomic groups. However, caries experience was significantly higher in the most deprived municipalities (SII = 14.7%, 95% CI: 11.7%, 17.7%; RII = 0.283, p < 0.001). Conclusion: Lower caries experience was associated with supervised daily toothbrushing and CWF exposure, but not with fluoride varnish application. Despite equitable programme coverage, substantial socioeconomic inequalities persist. As this ecological study cannot establish causality, further research is needed to evaluate long-term trends and the role of broader determinants in improving child oral health.

BACKGROUND:Child dental caries is highly prevalent worldwide, with significant treatment costs, but its broader societal impact remains underexplored. This cross-sectional study examined associations between child oral health and school absences in Scotland. METHODS:Four population-wide data sets were linked at the individual level, where the outcome was part-day school absence during first primary school year across six academic years (2008/2009-2010/2011, 2012/2013, 2014/2015 and 2016/2017). Oral health was assessed using three metrics: caries experience, urgent need of dental treatment (UNDT) and dental extractions under general anaesthetic (DGA). Gamma-distributed general linear models (identity link) estimated adjusted mean differences, including interaction terms for socioeconomic deprivation (Scottish Index of Multiple Deprivation (SIMD) deciles). Models adjusted for sex, age, academic year and SIMD. RESULTS:Records from 263 597 children (mean age: 5.5 years) showed 33% had caries experience (median 16 part-day absences), 9% had UNDT (median 19) and 2% had DGA (median 20). Children without caries experience had a median of 11 part-day absences. Adjusted models showed mean differences of 5.0 (95% CI 4.9 to 5.2) more absences for children with caries experience versus none; 6.2 (95% CI 5.9 to 6.5) more absences for UNDT versus no UNDT; and 6.5 (95% CI 5.8 to 7.1) more for DGA versus no DGA. Interaction analysis showed a deprivation gradient: children in the 10% most deprived areas had nearly twice the burden of absences related to poor oral health compared with the 10% least deprived. CONCLUSION:Poor oral health was associated with higher absenteeism, with socioeconomic inequalities exacerbating the impact.

ABSTRACTObjectivesThis descriptive epidemiological study aims to investigate trends in head and neck cancer (HNC) within the anatomical divisions of laryngeal, oropharyngeal, and oral cavity cancers over the past two decades.DesignRetrospective population‐based observational study.SettingScotland, a constituent country of the United Kingdom, with a population of 5.5 million.ParticipantsNewly diagnosed HNC patients in Scotland registered in the Scottish Cancer Registry from 2001 to 2020.Main Outcome MeasuresTrends in age‐standardised incidence rates from 2001 to 2020 for each HNC subsite, anatomical division, and individual sociodemographic using joinpoint regression analysis and Poisson regression analysis.ResultsOverall, HNC incidence rates have remained stable, with an average annual percentage change (AAPC) of 0.29% (p = 0.34). However, oropharyngeal cancer showed a significant increase in incidence rates with an AAPC of 3.76% (p < 0.001); the tonsils (C09) and the base of the tongue (C01) experienced the greatest increases in AAPC of 4.63% (p = 0.001) and 4.79% (p < 0.001), respectively. Conversely, laryngeal cancer rates declined significantly, with an AAPC of −2.56% (p < 0.001). This decline was primarily influenced by annual reductions of −2.40% (p = 0.09) in cancers affecting the glottis (C32.0). Incidence rates for oral cavity cancer remained mostly stable, with an AAPC of −0.60% (p = 0.08).ConclusionThis analysis highlights that behind a stable HNC incidence rate over the past 20 years, there are differential trends among various anatomical divisions with an overall increasing burden of oropharyngeal cancer and declining rates of laryngeal cancer.

BACKGROUND:Globally, most people with head and neck cancers (HNCs) are diagnosed with advanced-stage disease. HNC diagnostic stage has multifactorial explanations, with the role of health system factors not yet fully investigated. METHODS:HNC centres (n = 18) from the HEADSpAcE Consortium were surveyed via a bespoke health system questionnaire covering a range of factors. Centres were compared using the least square means for the presence/absence of each health system factor to their proportion of advanced-stage HNC. RESULTS:Health system factors associated with lower proportion in advanced-stage diagnosis were formal referral triaging (14%, 95% CI-0.26, -0.03), routine monitoring of time from referral to diagnosis (16%, 95% CI-0.27, -0.05), and fully publicly funded systems (17%, 95% CI-0.29, -0.06). Several health systems factors had no routinely available data. CONCLUSIONS:Through identifying and monitoring health systems factors associated with lower proportions of advanced stage HNC, interventions could be developed, and systems redesigned, to improve early diagnosis.

BACKGROUND:Head and neck cancer (HNC) incidence is on the rise, often diagnosed at late stage and associated with poor prognoses. Risk prediction tools have a potential role in prevention and early detection. METHODS:The IARC-ARCAGE European case-control study was used as the model development dataset. A clinical HNC risk prediction model using behavioral and demographic predictors was developed via multivariable logistic regression analyses. The model was then externally validated in the UK Biobank cohort. Model performance was tested using discrimination and calibration metrics. RESULTS:1926 HNC cases and 2043 controls were used for the development of the model. The development dataset model including sociodemographic, smoking, and alcohol variables had moderate discrimination, with an area under curve (AUC) value of 0.75 (95% CI, 0.74-0.77); the calibration slope (0.75) and tests were suggestive of good calibration. 384 616 UK Biobank participants (with 1177 HNC cases) were available for external validation of the model. Upon external validation, the model had an AUC of 0.62 (95% CI, 0.61-0.64). CONCLUSION:We developed and externally validated a HNC risk prediction model using the ARCAGE and UK Biobank studies, respectively. This model had moderate performance in the development population and acceptable performance in the validation dataset. Demographics and risk behaviors are strong predictors of HNC, and this model may be a helpful tool in primary dental care settings to promote prevention and determine recall intervals for dental examination. Future addition of HPV serology or genetic factors could further enhance individual risk prediction.

Abstract Background Increasing incidence of head and neck cancers (HNCs), driven by rising rates of oropharynx cancer (OPC), has been recorded around the world. This study examined trends in HNC and subsites (oral cavity, oropharynx, and larynx cancers) in Scotland focusing on assessing whether the sociodemographic profile has changed over the past 20 years. Methods Scottish Cancer Registry data (2001–2020) including European Age Standardised Rates of HNC and subsites were analysed in multivariate Poisson regression by age, sex, area-based socioeconomic status, and year of diagnosis (with interaction tests). Results Overall HNC and oral cavity cancer (OCC) incidence remained relatively stable. OPC incidence rates increased by 78%, while larynx cancer incidence declined by 27%. Over time, there were marginal shifts to a slightly older age profile for HNC (p = 0.001) and OCC (p = 0.001), but no changes in OPC (p = 0.86) and larynx cancer (p = 0.29). No shift in the sex profile of HNC was observed except for minor increases in female OCC rates (p = 0.001), and the socioeconomic distribution remained unchanged across all HNC subsites. Conclusions There have been no significant changes in the sociodemographic profile of HNC in Scotland over the last 20 years, despite the changing trends in HNCs with dramatically increasing incidence rates in OPC and reducing larynx cancer. This information can be used to target or stratify HNC prevention and control.

Introduction Dental caries among children is a major global health problem and is a particular public health challenge in Saudi Arabia. Dental caries cause pain, infection and negatively impact quality of life. As part of population oral health improvement efforts in Saudi Arabia, this project aims to evaluate the effectiveness of a supervised toothbrushing programme in kindergartens.Methods and analysis This study is a cluster randomised controlled trial. Enrolment began in September 2022, for two academic years (2022–2024) on 20 randomly selected kindergartens in Riyadh. The data collection phase will be completed in September 2024. Ten kindergartens are randomly allocated to supervised toothbrushing and 10 to treatment as usual, which is an annual oral health awareness visit. The primary endpoint will be the worsening of obvious decay experience as measured by decayed (into dentine), missing and filled teeth (d3mft) from baseline to the second year of follow-up. The secondary endpoint will be the increase in the number of teeth affected. A priori subgroups of the region of Riyadh, school type (public, private), child sex and presence/absence of prior decay at baseline, will be analysed. We require 244 evaluable endpoints using a power of 80% to meet the sample size requirement. In addition, questionnaires on behaviours, quality of life, process monitoring and cost analysis are being deployed.Ethics and dissemination Ethics approval for this study was given by the King Fahad Medical City Institutional Review Board in the Saudi Ministry of Health (22-083E/March 2022). The data analysis has been approved by the University of Glasgow Medical Veterinary and Life Sciences Research Ethical Committee (200220194/March 2023). The results of this study will be disseminated through presentations at scientific conferences and in scientific journals.Trial registration number NCT05512156.

In the early 2000s, a Scottish Government Oral Health Action Plan identified the need for a national programme to improve child oral health and reduce inequalities. 'Childsmile' aimed to improve child oral health in Scotland, reduce inequalities in outcomes and access to dental services, and to shift the balance of care from treatment to prevention through targeted and universal components in dental practice, community and educational settings. This paper describes how an embedded, theory-based research and evaluation arm with multi-disciplinary input helps determine priorities and provides important strategic direction. Programme theory is articulated in dedicated, dynamic logic models, and evaluation themes are as follows: population-level data linkage; trials and economic evaluations; investigations drawing from behavioural and implementation science; evidence reviews and updates; and applications of systems science. There is also a growing knowledge sharing network internationally. Collaborative working from all stakeholders is necessary to maintain gains and to address areas that may not be working as well, and never more so with the major disruptions to the programme from the COVID-19 pandemic and response. Conclusions are that evaluation and research are synergistic with a complex, dynamic programme like Childsmile. The evidence obtained allows for appraisal of the relative strengths of component interventions and the reach and impact of Childsmile to feed into national policy.

Introduction This study aimed to quantify the impact of the COVID-19 pandemic on access and inequalities in primary care dental services among children and adults in Scotland. Methods Access was measured as any NHS Scotland primary care dental contacts derived from administrative data from January 2019 to May 2022, linked to the area-based Scottish Index of Multiple Deprivation for children and adults, and related to population denominator estimates from National Record Scotland. Inequalities for pre-pandemic (January 2019-January 2020) and recent (December 2021-February 2022, and March 2022-May 2022) periods for both children and adults were calculated and compared using the slope index of inequality and relative index of inequality. Results Following the first lockdown (March 2020) there was a dramatic fall to near zero dental contacts, followed by a slow recovery to 64.8% of pre-pandemic levels by May 2022. There was initial widening of relative inequalities in dental contacts in early 2022, which, more recently, had begun to return to pre-pandemic levels. Conclusion COVID-19 had a major impact on access to NHS primary dental care, and while inequalities in access are apparent as services recover from lockdown, these inequalities are not a new phenomenon.

Dental caries is one of the most prevalent diseases worldwide and represents a significant challenge for public health, especially in childhood. The Global Burden of Disease Study 2015 estimated that 7.8% of children suffer from untreated caries in deciduous teeth. Despite dental health improvements in the past decades, dental caries continues to be a global health problem particularlyly among disadvantaged groups, both in industrialized and in developing countries. Chile is facing up to the dental caries challenge in childhood by developing new public health programmes that aim to improve child oral health and reduce oral health inequalities. The last available cross-sectional national epidemiological study in 6-year-old children, published in 2007 and commissioned by the Chilean Ministry of Health, indicated that 70% of children had a history of dental caries. It also revealed marked inequalities by socioeconomic level and by geographical location, raising the need to improve oral health in childhood and reduce inequities in the distribution of the disease. The findings also highlighted the need for action towards a preventive approach, with upstream and downstream interventions and a strengthening of primary dental care, with actions Key Features

Introduction: An economic evaluation (EE) was conducted alongside a randomized controlled trial (the Protecting Teeth @ 3 Study [PT@3]), exploring the additional preventive value of fluoride varnish (FV) application at 6-monthly intervals in nursery schools compared to treatment as usual (TAU) in the same nurseries. TAU represented a multicomponent national child oral health improvement intervention, the Childsmile program, apart from nursery FV. Methods: The EE was a within-trial cost-utility analysis (CUA) comparing the FV and TAU groups. The CUA was conducted from a National Health Service perspective and followed relevant methods guidance. Within-trial costs included intervention costs and health care resource use costs. Health outcomes were expressed in quality-adjusted life years (QALYs) accrued over the 2-y follow-up period. The Child Health Utility 9 Dimensions questionnaire was used to obtain utility scores. National reference costs were used, a discount rate of 1.5% for public health interventions was adopted, multiple imputation methods for missing data were employed, sensitivity analyses were conducted, and incremental cost-utility ratios were calculated. Results: Data from 534 participants from the 2014–2015 PT@3 intake were used in the EE analyses, n = 265 (50%) in the FV arm and n = 269 (50%) in the TAU arm. Mean incremental cost per child in the FV arm was £68.37 (P = 0.382; 95% confidence interval [CI], –£18.04 to £143.82). Mean incremental QALY was −0.004 (P = 0.636; 95% CI, −0.016 to 0.007). The probability that the FV intervention was cost-effective at the UK £20,000 threshold was 11.3%. Conclusion: The results indicate that applying FV in nurseries in addition to TAU (all other components of Childsmile, apart from nursery FV) would not be deemed cost-effective given current UK thresholds. In view of previously proven clinical effectiveness and economic worthiness of the universal nursery toothbrushing component of Childsmile, continuation of the additional, targeted nursery FV component in its pre–COVID-19 form should be reviewed given its low probability of cost-effectiveness. Knowledge Transfer Statement: The results of this study can be used by child oral health policy makers and dental public health professionals. They can form part of the evidence to inform the Scottish, UK, and international guidance on community-based child oral health promotion programs.

Background Composite measures of multiple deprivation are composed of multiple domains e.g., income, education, health. There is a concern that using deprivation-dependent health outcomes as indicators in the health domain of these measures to predict health inequalities will lead to biased results due to endogeneity. The objective of this study was to assess the effects of this potential endogeneity bias. Methods The Scottish Index of Multiple Deprivation (SIMD) was used as an exemplar composite measure of multiple deprivation as it includes health-related indicator variables in the calculation of area deprivation scores. Area deprivation scores were calculated at the Data Zone level which divides Scotland into approximately 7,000 geographic units. Data Zones were assigned to deprivation deciles calculated independently using the original SIMD, SIMD with the health domain excluded, and the income domain in isolation. Health inequalities were assessed using population-wide mortality data for two time periods (2010—2012 and 2017—2019) and self-rated health data from the 2011 Scottish census as dependent variables. Health inequalities were assessed separately for males and females using age-standardised rates, as well as both the slope and relative indices of inequality. Results There were no significant differences in slope or relative indices of inequality when comparing 912 pairs of values calculated using SIMD with either the health-excluded version or the income domain in isolation. Similarly, only two of 160 pairwise comparisons of age-standardised rates between SIMD and the two alternative methods were significantly different: mortality in females in decile 9 was 943 (95% CI: 904, 983) using SIMD versus 854 (95%CI: 816, 893) using the income domain; self-rated bad health in males in decile 6 was 45.8 (95%CI: 45.0, 46.7) using SIMD versus 47.6 (95%CI: 46.8, 48.6) using the income domain. Mortality and health outcomes were consistently poorer in more deprived areas. This pattern of inequalities held for all three methods used to calculate deprivation deciles. Conclusion Endogeneity due to the inclusion of health indicators in composite measures of multiple deprivation did not have any substantial effect on estimates of age-standardised mortality and health outcome rates or the measurement of health inequalities. Further work is needed to confirm this result is generalisable to composite measures of multiple deprivation other than the Scottish Index of Multiple of Deprivation and to other health outcomes. Researchers should continue to be thoughtful in their selection of deprivation measure but should be reassured that endogeneity bias of this type will not substantially affect results.

Introduction Care-experienced children have poorer health, developmental, and quality of life outcomes across the lifespan compared to children who are not in care. These inequities begin to manifest in the early years. The purpose of the proposed scoping review is to collate and synthesise studies of the physical health of young care-experienced children. The results of the review will help map the distribution of health outcomes, identify potential targets for intervention, and assess gaps in the literature relating to this group. Methods and analysis We will carry out a scoping review of the literature to identify studies of physical health outcomes in care-experienced children. Systematic literature searches will be carried out on the MEDLINE, CINAHL and Web of Science Core Collection databases for items indexed on or before 31 August 2022. Studies will be included where the participants are aged 3months or greater and less than 6 years. Data elements extracted from included studies will include study objectives, health outcomes, participant demographics, care setting characteristics and bibliographic information. The results of the review will be synthesised and reported using a critical narrative approach. Comparisons between care and non-care populations will be reported if sufficient studies are identified. Ethics and dissemination Data will be extracted from publicly available sources, so no additional ethical approval is required. Results will be published in a peer-reviewed journal article. Furthermore, they will be shared in summary reports and presented to local authorities, care organisations and other relevant stakeholders that can influence healthcare policy and procedure relating to young children in care.

Introduction People who present with more advanced stage head and neck cancer (HNC) are associated with poorer outcomes and survival. The burden and trends of advanced stage HNC are not fully known at the population level. The UK national cancer registries routinely collect data on HNC diagnoses. Aims To describe trends in stage of diagnosis of HNCs across the UK before the COVID-19 pandemic. Methods Aggregated HNC incidence data were requested from the national cancer registries of the four UK countries for the ten most recent years of available data by subsite and American Joint Commission on Cancer stage at diagnosis classification. Additionally, data for Scotland were available by age group, sex and area-based socioeconomic deprivation category. Results Across the UK, rates of advanced stage HNC had increased, with 59% of patients having advanced disease at diagnosis from 2016-2018. England had a lower proportion of advanced disease (58%) than Scotland, Wales or Northern Ireland (65-69%) where stage data were available. The completeness of stage data had improved over recent years (87% by 2018). Conclusion Prior to the COVID-19 pandemic, diagnoses of HNC at an advanced stage comprised the majority of HNCs in the UK, representing the major challenge for the cancer healthcare system.

Abstract Background Cancer risk assessment models are used to support prevention and early detection. However, few models have been developed for head and neck cancer (HNC). Methods A rapid review of Embase and MEDLINE identified n = 3045 articles. Following dual screening, n = 14 studies were included. Quality appraisal using the PROBAST (risk of bias) instrument was conducted, and a narrative synthesis was performed to identify the best performing models in terms of risk factors and designs. Results Six of the 14 models were assessed as “high” quality. Of these, three had high predictive performance achieving area under curve values over 0.8 (0.87–0.89). The common features of these models were their inclusion of predictors carefully tailored to the target population/anatomical subsite and development with external validation. Conclusions Some existing models do possess the potential to identify and stratify those at risk of HNC but there is scope for improvement.

Background: Explanations for socioeconomic inequalities in survival of head and neck cancer (HNC) patients have had limited attention and are not well understood. Methods: The UK Head and Neck 5000 prospective clinical cohort study was analyzed. Survival relating to measures of socioeconomic status was explored including area-based and individual factors. Three-year overall survival was determined using the Kaplan-Meier method. All-cause mortality was investigated via adjusted Cox Proportional Hazard models. Results: A total of 3440 people were included. Three-year overall survival was 76.3% (95% CI 74.9, 77.7). Inequality in survival by deprivation category, highest education level, and financial concerns was explained by age, sex, health, and behavioral factors. None of the potential explanatory factors fully explained the inequality associated with annual household income or the proportion of income of benefits. Conclusion: These results support the interventions to address the financial issues within the wider care and support provided to HNC patients.

Hidden hot springs likely impact rural water supplies in Malawi's Rift Valley with excess dissolved fluoride leading to localised endemic severe dental fluorosis. Predicting their occurrence is a challenge; Malawi's groundwater data archive is sporadic and incomplete which prevents the application of standard modelling techniques. A creative alternative method to predict hidden hot spring locations was developed using a synthesis of proxy indicators (geological, geochemical, dental) and is shown to be at least 75% effective. An exciting collaboration between geoscientists and dentists allowed corroboration of severe dental fluorosis with hydrogeological vulnerability. Thirteen hidden hot springs were identified based on synthesised proxy indicators. A vulnerability prediction map for the region was developed and is the first of its kind in Malawi. It allows improved groundwater fluoride prediction in Malawi's rift basin which hosts the majority of hot springs. Moreover, it allows dentists to recognise geological control over community oral health. Collaborative efforts have proven mutually beneficial, allowing both disciplines to conduct targeted research to improve community wellbeing and health and inform policy development in their respective areas. This work contributes globally in developing nations where incomplete groundwater data and vulnerability to groundwater contamination from hydrothermal fluoride exist in tandem.

Background: In many high-income countries cancer mortality rates have declined, however, socioeconomic inequalities in cancer mortality have widened over time with those in the most deprived areas bearing the greatest burden. Less is known about the contribution of specific cancers to inequalities in total cancer mortality. Methods: Using high-quality routinely collected population and mortality records we examine long-term trends in cancer mortality rates in Scotland by age group, sex, and area deprivation. We use the decomposed slope and relative indices of inequality to identify the specific cancers that contribute most to absolute and relative inequalities, respectively, in total cancer mortality. Results: Cancer mortality rates fell by 24 % for males and 10 % for females over the last 35 years; declining across all age groups except females aged 75+ where rates rose by 14 %. Lung cancer remains the most common cause of cancer death. Mortality rates of lung cancer have more than halved for males since 1981, while rates among females have almost doubled over the same period. Conclusion: Current relative inequalities in total cancer mortality are dominated by inequalities in lung cancer mortality, but with contributions from other cancer sites including liver, and head and neck (males); and breast (females), stomach and cervical (younger females). An understanding of which cancer sites contribute most to inequalities in total cancer mortality is crucial for improving cancer health and care, and for reducing preventable cancer deaths.

Background The association between socioeconomic disadvantage (low education and/or income) and head and neck cancer is well established, with smoking and alcohol consumption explaining up to three-quarters of the risk. We aimed to investigate the nature of and explanations for head and neck cancer risk associated with occupational socioeconomic prestige (a perceptual measure of psychosocial status), occupational socioeconomic position and manual-work experience, and to assess the potential explanatory role of occupational exposures. Methods Pooled analysis included 5818 patients with head and neck cancer (and 7326 control participants) from five studies in Europe and South America. Lifetime job histories were coded to: (1) occupational social prestige—Treiman’s Standard International Occupational Prestige Scale (SIOPS); (2) occupational socioeconomic position—International Socio-Economic Index (ISEI); and (3) manual/non-manual jobs. Results For the longest held job, adjusting for smoking, alcohol and nature of occupation, increased head and neck cancer risk estimates were observed for low SIOPS OR=1.88 (95% CI: 1.64 to 2.17), low ISEI OR=1.74 (95% CI: 1.51 to 1.99) and manual occupations OR=1.49 (95% CI: 1.35 to 1.64). Following mutual adjustment by socioeconomic exposures, risk associated with low SIOPS remained OR=1.59 (95% CI: 1.30 to 1.94). Conclusions These findings indicate that low occupational socioeconomic prestige, position and manual work are associated with head and neck cancer, and such risks are only partly explained by smoking, alcohol and occupational exposures. Perceptual occupational psychosocial status (SIOPS) appears to be the strongest socioeconomic factor, relative to socioeconomic position and manual/non-manual work.