OBJECTIVES:The "valley of death" between research and practice remains a major challenge. The five-stage Translational Research framework (TR1-TR5) provides a pathway, moving evidence into real-world impact. Traditionally, Randomised Controlled Trials (RCTs) dominate TR stages, yet they are often impractical in public health. Longitudinal observational studies (LOSs), combined with advanced causal statistics, can emulate RCTs. Using the relationship between socioeconomic status (SES) and early childhood caries (ECC) as a case study, where SES is a complex, upstream determinant lacking trial evidence, this study illustrates how LOSs paired with causal statistics, within the TR framework, can generate policy-relevant action, highlighting a promising yet underused strategy. METHODS:This paper first reviewed causal inference gaps identified in a published scoping review of 85 LOSs (TR1), focusing on a subset of 20 studies presented in this paper that examined the relationship between SES and dental caries. The review analysed SES construction, gaps in SES-oral health behaviour-caries pathways, and the use of advanced causal statistics. Findings from TR2 (published) were then summarised to highlight key modifiable mediators linking SES and ECC, followed by TR3-4 (published), which examined interventions targeting these mediators across populations. Finally, this paper presented TR5 for the first time, extending the analysis to estimate population-level impact metrics. RESULTS:TR1 highlighted that most LOSs remained focused on associations rather than causal inference. SES construction was inconsistent and the mechanisms linking SES to dental caries have not been comprehensively examined. TR2 identified free sugar intake (FSI) as a key modifiable mediator. TR3-4 emphasised on reducing FSI to < 10% lowered ECC risk in the general population and suggested < 5% for the high-risk groups. TR5 highlighted that stricter FSI thresholds produced substantial population-level gains. CONCLUSION:The TR framework supported by advanced causal statistics enables translating LOSs into effective public health evidence in the absence of RCTs.

OBJECTIVE:To describe the burden of dentine hypersensitivity (DH) among Australian adults, including its prevalence, distribution, impacts on quality of life, and management patterns. METHODS:A cross-sectional online survey was conducted among Australian adults recruited from two established population-based cohorts: the Tooth for Health (TfH) Study and the Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE). Participants completed a structured questionnaire assessing sociodemographic characteristics, oral health behaviours and indicators, DH symptoms and management, and general and oral health-related quality of life. Quality of life was assessed using the Oral Health Impact Profile (OHIP-14), the Dentine Hypersensitivity Experience Questionnaire (DHEQ), and the EQ-5D-5 L and EQ visual analogue scale. Associations were examined using descriptive analyses and regression models. RESULTS:Among 815 participants, 67.2% reported symptoms consistent with DH. DH prevalence was higher among women than men (71.6% vs 51.1%, p < 0.001) and among participants reporting fair/poor oral health compared with excellent/very good oral health (81.0% vs 54.2%, p < 0.001). DH was associated with indicators of periodontal disease and problem-driven dental attendance. Participants with DH reported worse oral and general health-related quality of life across measures. Coping scores on the DHEQ were worse among those with DH (mean difference -11.93; 95% CI -14.13 to -9.73), representing almost 17% of the scale range. Despite this burden, 74.3% had not sought professional care, and 26.3% reported never having used any treatment; many relied on self-directed strategies, including analgesics and dietary modifications. CONCLUSIONS:In this population-based sample of Australian adults, DH was highly prevalent and was associated with poorer oral and general health-related quality of life. Most participants reporting DH had not sought professional care, and many had never used treatment, indicating a gap between symptom experience and management. CLINICAL SIGNIFICANCE:DH is common yet frequently unmanaged, highlighting the need for greater recognition, education, and evidence-based management in clinical practice.

Tobacco is a global public health issue. Brief interventions can motivate tobacco use cessation. However, Tobacco Use Cessation Counselling (TUCC) is underutilized in dental settings despite being ideal for such interventions. This survey aimed to assess the awareness, associated factors towards TUCC among dental care professionals in Sri Lanka, Brazil, and Queensland (QLD), Australia. This descriptive cross-sectional online survey used a self-administered questionnaire via Qualtrics, conducted from February to August 2023 among dental care professionals. Eligibility criteria included any practicing dental care professionals in the respective countries to account for potential non-response in online surveys. Awareness was assessed using three questions: “Have you ever heard of TUCC?“; “Have you ever heard of the 5A method of counselling?“; and “Have you ever heard of the 5R method of counselling?” Each answer was rated on a 3-point Likert scale: no (score 0), maybe (score 1), and yes (score 2). Participants were categorized into two groups, high and low awareness, based on their total awareness scores ranging from 0 (fully unaware) to 6 (fully aware), with the median score used as the threshold. A total of 480 dental care professionals participated in this online survey across 3 countries. Only 15.6

BACKGROUND:Dental caries is the most prevalent disease worldwide, associated with substantial health inequalities. Water fluoridation is a population strategy shown to effectively prevent dental caries; however, its impact on health inequalities remains inconclusive. We investigated the high-dimensional effect heterogeneity of water fluoridation in preventing dental caries among children in Australia. METHODS:Data from the National Child Oral Health Study-a national representative study conducted in 2012-14, linked to the information on lifetime exposure to fluoridated water-were analysed (n = 17 517 children aged 5-14 years). A doubly robust target minimum loss-based estimation was used to estimate the average treatment effect of lifetime exposure to fluoridated water (never exposed versus fully exposed) on the number of tooth surfaces with dental caries. The effect heterogeneity was evaluated by estimating the conditional average treatment effects (CATEs) using the causal forest algorithm, which integrated 47 child demographic, socioeconomic, and parental factors. RESULTS:In total, 58.1% were fully exposed to water fluoridation throughout their lifetime. Water fluoridation was associated with having -0.9 (95% confidence interval: -1.1, -0.8) fewer dental caries incidents. The estimated CATEs were mostly negative and the magnitude substantially varied (median CATE, -0.9; interquartile range, 0.7). Children from lower socioeconomic backgrounds exhibited greater benefits: i.e. the average CATEs ranged from -1.4 for children from a single parent with school-level education and low-income families to -0.8 for children from two parents with tertiary-level education and high-income families. CONCLUSION:Water fluoridation was associated with lower dental caries and exhibited greater benefits for vulnerable subpopulations.

BACKGROUND:Globally, the number of migrants with limited language proficiency and low health literacy has been steadily increasing. In Australia, while most state governments have recognised these individuals as a priority population and provide free or subsidised access to oral healthcare services, their satisfaction levels regarding the received dental care remain uncertain. Studies suggest that patients with communication barriers often report greater dissatisfaction and anxiety in healthcare settings, with cultural insensitivity further worsening their experience. Therefore, feedback on oral healthcare services is crucial for improving service delivery and care quality. OBJECTIVE AND METHODS:This study aims to compare and assess the satisfaction of migrant and Australian-born parents with the oral healthcare received by their children in Australia. Data from the 2012-2014 National Child Oral Health Survey (NCOHS) was utilised, which involved a cross-sectional survey of 24,664 representative school children aged 5-14 years and their parents in Australia. This study used the Child Oral Care Performance Assessment Scale (COPAS), which was originally developed to collect parental observation and assessment of dental care received by their child. In the present study, the COPAS was used as a proxy measure for gauging the parents' satisfaction. Data were analysed using the complex samples' general linear model regression analyses to confirm the association between the factors. RESULTS:In general, the satisfaction scores were significantly lower in migrants than non-migrant parents regarding the oral healthcare provided to their children in efficient, responsive, accessible and capable domains of COPAS. The overall satisfaction score, across all domains, revealed that migrant parents had lower satisfaction levels than non-migrants (B = -1.64; 95% CI, -3.11 to -0.17). Parental language and income were also linked to satisfaction levels, with migrant parents from countries where English is not the primary language having notably lower scores than migrant parents from countries where English is the primary language (B = -4.16; 95% CI, -5.98 to -2.34). Among the other factors studied, parents in lower-income (B = -7.55; 95% CI, -9.14 to -5.95) and middle-income (B = -4.31; 95% CI, -5.45 to -3.17) groups were less satisfied with oral healthcare compared to higher-income parents. Single-adult households also reported lower satisfaction (B = -5.01; 95% CI, -9.67 to -0.35). On the other hand, having fewer children was associated with higher parental satisfaction. CONCLUSIONS:Notable differences in satisfaction levels with oral healthcare of their children were observed between migrant and non-migrant parents. These findings help guide policymakers in developing public health measures to improve satisfaction among migrant parents.

Introduction: Determinants of oral health are formed early and influenced by variations in socioeconomic status (SES). It is unclear whether early life SES influences child oral health directly or indirectly through determinants such as intake of free sugars. This study applied the marginal structural modelling approach to household income at birth and free sugar intake to investigate pathways those determinants influence child oral health. METHODS:We used data collected in SMILE, a population-based birth cohort study of Australian mother/newborn dyads, who have been followed-up prospectively since birth with questionnaires and clinical assessment. Area- and individual-level factors collected at childbirth were background confounders. Household income at childbirth (low/medium/high) and free sugar intake at age 2 years (low/medium/high) were used as primary exposure and mediator to investigate pathways through which SES at childbirth influences oral health. By applying the causal inference approach and using marginal structural modelling, we estimated the controlled direct effect of household income and the direct effect and mediating effect of intake of free sugars on dental caries experience. We developed a causal directed acyclic graph to guide the analysis. The baseline confounders were balanced using a stabilised inverse probabilities of treatment weight, mimicking randomisation. RESULTS:Low household income at childbirth was associated with 1.65 (95% confidence intervals [CI]: 1.01, 3.02) times higher accumulated dental caries experience by age 5 years than in children born to high-income households. High intake of free sugars had strong direct effects on both the prevalence (1.55 [95% CI: 1.03, 2.32]) and cumulative experience (2.64 [95% CI: 1.36, 5.15]) of dental caries by age 5 years. Proportions of effects of income were mediated by intake of free sugars. CONCLUSION:Socioeconomic variations at birth and immediate determinants such as intake of sugars, directly and indirectly, influence oral health. Timely and appropriate addressing of those variations may limit inequity in oral health. .

This study aimed to investigate the association between the different information sources on infant oral hygiene accessed by mothers and infant oral hygiene practices in South Australia. Information on the oral hygiene practices used in 6-month-old infants—gum/tooth cleaning in the past 3 months, frequency of brushing, and the usage of fluoridated toothpaste—were acquired from the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE) cohort survey. Descriptive statistics and multivariable logistic regression modelling were used to analyse the relationship between the information sources and infant oral hygiene practices. The majority of mothers (60.4%) reported not having cleaned their 6-month-old’s gums/teeth in the past 3 months. One-third of mothers with 6-month-olds did not seek information on infant oral hygiene. Mothers who sought advice from dentists were more likely to have cleaned their infant’s gums/teeth in the past 3 months, and those with infants whose teeth had erupted were also more likely to clean their infants’ teeth twice or more daily. We can conclude that mothers who sought information on infant oral hygiene from more than one source adopted generally better oral hygiene practices for their infants, with a dentist’s advice notably increasing the likelihood of mothers following the guidelines for cleaning their infants’ teeth.

Background: Older adults in residential aged care facilities (RACFs) experience disproportionate levels of poor oral health relative to other groups in the general population, affecting their physical and mental wellbeing. The Oral Health Assessment Tool (OHAT) is a validated and widely used dental assessment tool; however, recent systematic reviews have identified shortcomings with respect to its measurement properties. Objective: The objective of this protocol is to provide a detailed overview of a multidisciplinary qualitative study that aims to (a) co-design and develop a modified OHAT for RACFs and (b) inform the development of an OHAT training package and implementation strategies. Methods: This study will utilize a co-design methodology with aged care residents, caregivers, staff members, and health professionals. The co-design workshops will: (1) investigate the barriers to and enablers of optimal oral healthcare in RACFs; and (2) co-design a modified version of the Oral Health Assessment Tool and a referral to treatment pathway that is appropriate for use in RACFs. The co-design workshops will facilitate group discussion and involve interactive activities using, for example, mind mapping and Sticky Notes. Qualitative data (transcripts and artefacts from co-design activities) will be analyzed in NVivo using an inductive codebook thematic analysis, specifically a template analysis. Conclusion: The findings of this study will inform a modified OHAT (M-OHAT), as well as future study phases regarding training and implementation strategies. It is expected that the M-OHAT will have enhanced usability and relevance to RACFs, facilitating the identification of poor oral health and timely referral to dental treatment.

Oral mucosa lesions are the third most prevalent oral pathology, following caries and periodontal diseases. Teledentistry offers an effective way to manage patients with these lesions. The accuracy of remote diagnoses and consultations relies heavily on the quality of the information and photos sent to remote specialists. This study aims to evaluate the usability and reliability of a teledentistry tool for the remote diagnosis of oral lesions. The cross-sectional study included both usability evaluation and reliability assessment. The teledentistry platform, "OralMedTeledent", facilitated synchronous and asynchronous interactions, allowing for patient consultations, remote follow-ups, and doctor-to-doctor consultations. Usability was evaluated by 5 experts using the Nielsen heuristic checklist. Reliability was assessed from August 2022 to September 2023 with 109 patients, using Cohen's kappa coefficient to measure agreement between examiners and the gold standard in diagnosing oral lesions. The findings revealed 66 usability issues, most of which were related to helping users recognize, diagnose, and recover from errors, as well as issues with help and documentation. Among these, 11 issues were of minor severity. The reliability test, conducted with 109 participants (57.8

Purpose While silver diamine fluoride has been used extensively for caries arrest and desensitising, silver fluoride (AgF) at neutral pH may also have value as a minimally invasive dental caries treatment. This study explored the effectiveness of two AgF products (AgF/KI and AgF/SnF2) when used in adult patients with special needs (SN) who had high caries risk and salivary gland hypofunction. Methods This split-mouth clinical study, over two appointments 3-months apart, compared the impact of a single application of AgF/KI (Riva Star Aqua, SDI) and AgF/SnF2 (Creighton Dental CSDS, Whiteley) on matched carious lesions in the same arch, by clinical visual-tactile (cVT) assessment of caries status and laser fluorescence (LF, DIAGNOdent) evaluation of bacterial load in the lesions, using repeated measures analysis. Results Twelve participants were recruited in the study. A total of 56 teeth (28 pairs) were included. Both AgF products gave a significant decrease in caries activity as measured by cVT (P < 0.0001) and LF (P = 0.0027). There were no statistically significant differences between the two AgF treatments, with response rates for improvements in active lesions of 92% in the AgF/KI arm, and 96% in the AgF/SnF2 arm. There was no effect of tooth type, lesion type, arch type, plaque metabolism and plaque area at the site level on outcomes, nor was there a clustering effect of sites in a patient level analysis. Overall, LF was superior to cVT for detecting lesions that still progressed despite treatment (P = 0.0027). Conclusion A single application of AgF/KI or AgF/SnF2 has high predictability (over 90%) for achieving arrest in active caries lesions in adult patients with SN and high caries risk. Clinical assessment should use visual-tactile examination combined with LF readings to detect lesions that are still progressing and that require additional treatments. Future studies should compare these AgF modalities with SDF and explore factors such as time between applications and the need for repeated applications. Trial registration The study was registered with the Australian Clinical Trials Registry (ACTRN12621001139864p) on 23/08/2021.

BACKGROUND:Discoloration of carious lesions after application of silver diamine fluoride lowers patient acceptance and limits its wider use for caries arrest. OBJECTIVE:To assess lesion and tooth color changes from 2 novel silver fluoride (AgF) products and its relationship to caries activity (clinical visuo-tactile scores) and bacterial load (using laser fluorescence with the DIAGNOdent). METHODS:A split-mouth design was followed, with matched smooth surface carious lesions in the same arch in adults with special needs randomized for 1-min treatments with AgF/potassium iodide (KI) (Riva Star Aqua, SDI) and AgF/stannous fluoride (SnF2) (Caries Status Disclosing Solution; Whiteley). Standardized images taken at baseline, immediately postoperatively, and at 3-mo review were subjected to digital image analysis to calculate delta-E and to track changes in luminosity of carious lesions. RESULTS:Twelve participants were recruited in the study. A total of 56 teeth (28 pairs) were included. Significantly greater changes were seen in treated lesions than in the adjacent noncarious natural tooth structure, both immediately after treatment and at the 3-mo review (P < 0.0001). Color change and caries activity were not affected by tooth type, tooth location, plaque status, salivary status, or special needs condition. AgF/SnF2 caused transitory darkening immediately on application, while AgF/KI caused the immediate formation of yellow deposits (silver iodide). Both products caused significant darkening of treated lesions at 3 mo (P = 0.0009; P = 0.0361), with no differences between them (P = 0.506). Responding lesions showed larger and more perceptible color changes immediately after either AgF application (P = 0.002; P = 0.024). CONCLUSIONS:Both AgF products were highly effective for caries arrest in this patient population. Despite minor differences in the appearance of treated lesions at the time of application, both products lead to similar darkening of treated sites at 3 mo. KNOWLEDGE TRANSFER STATEMENT:This study shows the usefulness of silver fluoride used in conjunction with potassium iodide or stannous fluoride for achieving caries arrest in smooth surface lesions in adults with special needs. Patients need to be informed that long-term staining of the lesion occurs with both, similar to silver diamine fluoride.

OBJECTIVES:Oral health is an important part of general health and well-being and shares risk factors, such as poor diet, with obesity. The published literature assessing the association between obesity and oral health in early childhood is sparse and inconsistent. The objective of this study was to investigate associations between overweight/obesity (measured by body mass index) and dental outcomes (caries, plaque index and gingival index) both cross-sectionally and longitudinally, taking account of potential confounding factors, based on data collected at age 2 and age 5 within the Australian Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) birth cohort study. METHODS:This study used data from 1174 SMILE participants. Associations between overweight/obesity and dental outcomes were assessed using generalized linear regression models for the modified Poisson family with log link to estimate prevalence ratios. Cross-sectional and longitudinal models were fitted, after minimal and full adjustment for potential confounders. RESULTS:Approximately 12% of the participants were overweight/obese at 2 years and 9% at 5 years. Between 2 and 5 years, the prevalence of caries increased from approximately 4% to 24%, at least mild plaque accumulation increased from 37% to 90% and at least mild inflammation from 27% to 68%. There were no associations between overweight/obesity and the prevalence of dental caries; prevalence ratios (PR) [95% confidence interval (CI)] after adjustment for age and sex were 0.9 (0.3, 2.4) cross-sectionally at 2 years, 1.0 (0.6, 1.5) cross-sectionally at 5 years, and 1.0 (0.6, 1.5) for overweight/obesity at 2 years and caries at 5 years. Prevalence ratios were all around the value of 1 for the other dental outcomes and also after adjustment for additional confounders. CONCLUSIONS:There were no associations between overweight/obesity and dental caries, plaque index or gingival index in this cohort of preschool children. However, associations may emerge as the children become older, and it will be possible to extend analyses to include data collected at age 7 in the near future.

Objectives: This systematic review aimed to review the safety and effectiveness of professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries (LMICs). Methods: Randomized controlled trials conducted in LMICs, in which professionally applied fluorides were compared with placebo/no treatment/health education only or usual care with a minimum one-year follow-up period, were included. Any topically applied fluoride agents such as sodium fluoride (NaF), acidulated phosphate fluoride, silver diamine fluoride (SDF), and nano silver fluoride (NSF) were included. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched in May 2022. Meta-analysis was conducted using a random effect model. Results: This review included 33 studies for qualitative synthesis, encompassing 16,375 children aged between 1.5 and 14 years. Nevertheless, the meta-analysis focused on only 17 studies, involving 4067 children. Fourteen papers assessed potential adverse events, none of which was reported as major adverse events. SDF and NSF were identified as effective in arresting caries on primary teeth (p < 0.05) compared with a placebo or no treatment. Fluoride varnish and gel were identified as effective in reducing new caries development on primary teeth (p < 0.05) but not on permanent teeth (p > 0.05). The certainty of the generated evidence obtained is low. Conclusion: The review provides valuable insights into the use of professionally applied fluorides in LMICs and contributes to recommendations for their use. However, the limited rigorous evidence suggests the need for further research to strengthen these findings and draw more robust conclusions.

AbstractReducing free sugars intake is important for the prevention of dental caries and obesity in children. The study aimed to determine the amount and sources of free sugars known to contribute to dental caries, and identify sociodemographic determinants of intake by children aged 5 years in Australia. Cross‐sectional analysis of dietary data from a cohort study, collected using a customized food frequency questionnaire were used to calculate free sugars intake as grams/day and percentage contribution to Estimated Energy Requirement (EER). The percent contribution of food sources to free sugars intake was derived. Sociodemographic determinants of achieving intakes within WHO thresholds (i.e., <5% and <10% Energy were explored with multinomial logistic regression. Complete data were available for 641 children (347 boys, 294 girls). Median (IQR) free sugars intake (g/day) was 31.6 (21.3–47.6) in boys and 28.1 (19.6–47.9) in girls. The median (IQR) percentage contribution to EER was 7.9 (5.4–12.7); 21% and 42% of children had intakes <5% EER and between 5% and <10%, respectively. The main sources of free sugars were: (1) Cakes, Biscuits and Cereal Bars; (2) Sweetened Milk Products (predominantly yoghurts) and (3) Desserts. Maternal university education, single‐parent household, and maternal place of birth being Australia or New Zealand were associated with free sugars intake <5% EER. In conclusion, less than a quarter of 5‐year‐old children in the SMILE cohort achieved the WHO recommendations to limit free sugars to <5% EER. Strategies to lower free sugars intake could target priority populations such migrants, populations with lower levels of education or health literacy and identify areas for intervention in the wider food environments that children are exposed to.