Understanding the factors that support sustained smoking cessation is essential for evaluating the effectiveness of tobacco control measures and improving quit outcomes at the population level. This study investigates successful quitting smoking (SQS), defined as abstinence for at least six months, using two waves of the Global Adult Tobacco Survey (GATS), and explores the factors associated with and contributing to changes in SQS over time. We conducted a secondary analysis of GATS India Wave 1 (2009–2010) and Wave 2 (2016–2017). Adults who smoked either currently or in the past 12 months were included, and SQS was assessed among those who reported quitting and remaining abstinent for six months or more. Chi-squares and z-tests were used to examine the difference in characteristics of included participants between two waves and the change in prevalence of SQS among them. Multivariate logistic regression was used to examine associations between SQS and explanatory or tobacco control-related factors within each wave. Multivariate decomposition analysis was conducted to quantify the contribution of each factor to the change in SQS between waves. While the prevalence of smoking decreased significantly from 17.18

Background Oral diseases represent a significant and growing public health burden in rural India. In Lucknow district, rural communities face a convergence of high disease prevalence, limited infrastructure, financial hardship, and entrenched socio-cultural barriers that collectively restrict access to timely dental care. Objectives This study aimed to assess oral health practices, service utilization, economic burden, and barriers to dental care among rural residents of Lucknow, Uttar Pradesh, and to explore strategies for strengthening oral health systems through community and stakeholder engagement. Methods A convergent mixed-methods design was employed, integrating a cross-sectional quantitative survey (n = 400) with Focus Group Discussions (2 FGDs, n = 12 participants) and clinical examination using the WHO Oral Health Assessment Form (2013). Results Clinical caries prevalence was 81.8% and periodontal disease was found in 55.8% of participants. A total of 60.8% of participants had never visited a dentist. Key barriers included high treatment cost (40.3%), perceived lack of need (19.5%), and transport difficulties (48%). Qualitative findings, mapped onto the 5 A's framework, confirmed structural, financial, socio-cultural, and system-level barriers across all five access dimensions. Conclusions Oral healthcare utilization in rural Lucknow is low, inequitable, and predominantly reactive. Integrated, affordable, community-based interventions are urgently needed, alongside systemic reforms to primary healthcare infrastructure and health insurance coverage.

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.

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:This scoping review aims to assess the current smoking cessation services provided by dental auxiliaries, the populations they serve and the barriers and facilitators they encounter in delivering these services. Additionally, it aims to inform evidence-based recommendations for delivering brief smoking cessation interventions by dental auxiliaries in primary healthcare settings. METHODS:Following the JBI scoping review methodology and the PRISMA-ScR checklist, we searched primary research, reviews and grey literature without restrictions on location, publication date, or language. Searches were conducted across five databases (PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, PsycINFO) and supplemented by an internet search for the grey literature. Two independent reviewers screened records for relevance, extracted data and categorised findings into tables. RESULTS:The initial search yielded 668 references, of which 141 were duplicates and 469 were excluded during the title and abstract screening stage. Fifty-eight studies underwent full-text assessment, and 15 were included in the review. The updated search identified 54 additional records. After the removal of three duplicates, 51 were screened, and all were excluded because they did not meet the inclusion criteria. Findings reveal that dental auxiliaries play an important role in smoking cessation within primary healthcare settings. The included intervention studies reported improvements in quit attempts, smoking reduction, abstinence rates and adherence to smoking cessation guidelines, particularly for interventions based on the 5A's model. Organisational support, training and access to smoking cessation resources facilitated intervention implementation. However, time constraints, inadequate reimbursement and patient-related barriers' attitudes remained the most reported barriers. CONCLUSION:This review highlights the critical role of dental auxiliaries in smoking cessation efforts and provides insights for developing targeted interventions. By addressing identified barriers and facilitators, interventions can be enhanced to support smoking cessation in primary dental care.

OBJECTIVES:Globally, dental reforms have gained momentum through enhanced policy dialogues, the rise of digital health, artificial intelligence and outreach initiatives. Yet the burden of oral disease remains disproportionately high among vulnerable populations, particularly in low- and middle-income countries, even as reforms continue to evolve. METHODS:This critical narrative review draws on existing disease burden data, documented reform strategies and an examination of structural gaps in care and prevention delivery. It interprets these through two established frameworks, epistemic humility and implementation realism, to interrogate how reforms are designed. It further proposes epidemiological humility as a new conceptual lens to question how data are interpreted and whose reality remains excluded. RESULTS:The review identifies four recurring patterns: digital innovations that outpace infrastructure and trust, standalone interventions lacking continuity, prevention strategies deployed without curative care and a growing divide between private provision and deteriorating public systems. These gaps not only hinder impact but distort the visibility of oral disease, shaping policies around what is seen rather than what is suffered. CONCLUSIONS:Oral health must be integrated into primary care and embedded in community-based delivery. Reform requires beginning with inclusion, listening before delivering and building systems that centre people's unmet needs.

Introduction Existing frameworks on Commercial Determinants of Health (CDoH) largely focus on macro-level corporate practices and policy environments. Individual-level exposure—mediated through targeted marketing, pricing strategies, product availability and placement—remains underexplored, particularly in low- and middle-income countries. The absence of standardised tools to capture these exposures limits the ability to quantify commercial influences on health and weakens evidence-informed public health responses. There is a critical need for a robust, contextually grounded instrument to measure individual-level exposure to CDoH. Developing and validating an individual-level CDoH measurement tool is therefore essential to strengthen research, surveillance and policy action aimed at mitigating health-harming commercial influences. The availability of this tool will allow policymakers and public health practitioners to identify high-risk populations and monitor the effectiveness of regulatory actions addressing harmful commercial practices.Methods and analysis This study will follow standard guidelines for tool (questionnaire) development. The process will include four sequential phases: item generation, refinement, validity testing and construct validation. A literature review with a systematic search strategy and in-depth interviews with purposively sampled adults will inform domain identification and item generation. An e-Delphi process involving experts in CDoH and public health will refine and confirm items followed by content validity. This will be followed by assessment of face validity for clarity and relevance. Construct validity will be assessed through exploratory and confirmatory factor analyses, using fit indices such as Minimum χ2/df, Goodness of Fit Index, Tucker-Lewis Index, Comparative Fit Index, Root Mean Square Error of Approximation and Standardised Root Mean Square Residual. Reliability will be estimated using Cronbach’s alpha, and convergent and discriminant validity will be examined through correlation analyses.Ethics and dissemination Ethical approval has been obtained from the Institutional Ethics Committee, Amrita Institute of Medical Sciences, Kochi (ECASM-AIMS-2025-267). Results will be disseminated through peer-reviewed publications, conferences and policy briefs, and the validated tool will be made accessible for research and public health applications.

This scoping review aims to systematically identify and theoretically categorise barriers and facilitators affecting access to dental care in LMICs. This scoping review employed the Theoretical Domains Framework (TDF) to synthesise the findings thematically. A comprehensive search of literature published up to May 2025 in MEDLINE (PubMed), Embase, Scopus, and Web of Science, as well as grey literature sources, was conducted to identify relevant articles. Screening was performed using Rayyan, and data were extracted and categorised into the TDF domains. From the 15,140 initial hits, 214 articles were found eligible for final analysis. The maximum number of studies was published in India, Brazil, Nigeria and Iran. Eleven TDF domains were identified, and ‘environmental context and resources’ (n = 452, 41.5%) emerged as the most frequent domain, followed by ‘beliefs about consequences’ (n = 251, 23.1%) and ‘knowledge’ (n = 144, 13.2%). Barriers were more frequently reported than facilitators across all domains. Distinct domain patterns were observed across population subgroups and income categories, with structural barriers dominating in all contexts. Findings from this review underscore the need for integrated, context-sensitive interventions that combine system-level reforms with behaviour change strategies to improve dental care utilisation and reduce inequalities in oral health access across LMICs. There is also a need for more research on this health issue in low-income countries.

INTRODUCTION:This study explores patterns and determinants of attempted quitting of smokeless tobacco (AQSLT) in India and Bangladesh, using data from two waves of the Global Adult Tobacco Survey (GATS). METHODS:A secondary analysis was conducted using nationally representative data from GATS Wave 1 (2009-2010) and Wave 2 (2016-2017) in India and Bangladesh. Adults who reported using SLT currently or within 12 months at the time of each wave were included. Changes in AQSLT prevalence, associated factors, and contribution of independent variables were assessed using descriptive statistics, logistic regression, and multivariate decomposition analysis. RESULTS:While smokeless tobacco (SLT) use declined from Wave 1 to Wave 2 in both countries, changes in AQSLT prevalence were not statistically significant. In India, multivariate decomposition revealed that increases in the proportion of individuals who received quitting advice from a doctor or healthcare professional, noticed health warnings on SLT products, saw SLT warnings in print media, and were exposed to pro-SLT advertisements, had positive endowment effects on AQSLT. Behavioral changes among those exposed to SLT product warnings had the strongest negative composition effect. In Bangladesh, increased exposure to warnings in print media had positive, while decreased exposure to pro-SLT advertisements had a negative endowment effect on AQSLT. No significant composition effects were observed in Bangladesh. CONCLUSIONS:Interventions such as providing advice and health warnings show inconsistent effects on quit behavior. Findings warrant further evaluation of effectiveness of interventions and exploring tested culturally sensitive cessation strategies, that effectively motivate quit attempts among SLT users.

Introduction Equitable access to and service provision for oral health in Karnataka, India, remains challenging despite several policy and program initiatives. It was unclear whether the formulation and implementation of the oral health policy were coordinated and involved all stakeholders and institutions. Therefore, this study aimed to explore the gaps and barriers in oral health policy formulation and implementation in Karnataka. Methods This exploratory qualitative study employed a backward mapping approach and policy landscaping from 2000 to 2025. Content analysis was performed on 8 policy documents to identify how oral health was problematised in policies. The resultant policy matrix was subjected to assessing the implementation status of their recommendations and the perceptions of 31 stakeholders, including policymakers, administrators, program implementers, and dental health professionals, through in-depth interviews and focus group discussions. Theories of implementation were employed to guide data collection and analysis. Results Policy document analysis revealed inconsistencies in oral health policy, characterised by recommendations lacking actionable details, clear funding, or integration into broader health frameworks. Stakeholder consultations highlighted systemic neglect, including chronic underfunding, workforce shortages, and limited awareness of oral health policies. Weak accountability structures and the lack of monitoring and evaluation mechanisms further impeded implementation. Administrators, identified as key implementers, were often excluded from policymaking processes, resulting in limited policy ownership and effectiveness. Conclusion Although oral health has gained traction in policy discussions over two decades, implementation remains inconsistent. Oral health policymaking in Karnataka state has been fragmented, lacking a concerted effort involving all stakeholders and the institutions that support policy implementation. Addressing these challenges requires structural changes such as dedicated budgets, increased workforce capacity and stronger monitoring frameworks. These measures are critical to improving oral health services, particularly for marginalised and underserved communities, to achieve the health for all goal.

As the global burden of oral diseases rises, cost-effective solutions are needed to overcome accessibility barriers in oral healthcare. In Indonesia, geographical challenges further limit access to dental services. Teledentistry has emerged as a promising intervention to bridge these gaps by enhancing access to professional guidance and promoting better oral hygiene practices. This paper evaluates a Teledentistry initiative that aims to support progress towards achieving Universal Health Coverage (UHC) for oral health. This mixed-methods study evaluated the effectiveness of Unilever Oral Care’s Teledentistry initiative (the Tanya Pepsodent “Talk to a Dentist” programme) rolled out in Indonesia. The quantitative component compared oral health outcomes between individuals who voluntarily engaged with the Teledentistry service after scanning a QR code printed on Pepsodent product packaging (test group) and those who participated via an online consumer panel and were demographically matched to the test group (control group). The qualitative component involved in-depth interviews with General Dentists to assess the app’s usability and feasibility in providing dental care. Quantitative findings showed that post-test group respondents increased their brushing frequency by an average of 1.06 times per week (i.e., cumulative weekly brushing frequency) and brushing duration by 0.15 min. They also experienced fewer difficulties with chewing and speech, and 62

Background A qualitative research approach is necessary to understand the complexities of social, behavioral, and systemic factors influencing oral health. Despite having a large dental education infrastructure and workforce, a limited number of studies have been published by Indian dental researchers utilizing a qualitative methodology. Objective Map the existing literature to understand the current landscape of qualitative research in oral health in India. Method A comprehensive search of prominent databases, along with handsearching, was conducted to shortlist studies based on a predefined criterion. Eligible studies underwent thematic categorization and bibliometric assessment. Keyword co-occurrence and network analysis were performed using VOSviewer software to identify conceptual linkages and emerging research themes. Results Sixty-four studies met the inclusion criteria. Of these, 56 % were pure qualitative and 43 % were mixed-methods studies, with most published in the last five years. Key focus areas include tobacco cessation, pediatric oral health, and barriers to accessing dental services. Methodologically, the studies relied heavily on interviews and focus group discussions, with limited theoretical integration. Thematic clusters showed dominance of behavior-focused research and regional disparities in study distribution. Conclusion This is the first review to comprehensively chart the evolution of qualitative research in oral health in India. While momentum is growing, significant gaps remain in methodological depth and thematic diversity. Strengthening training, institutional support, and theoretical engagement is essential for advancing qualitative dental research in India.

In recent years, global commitments have endeavored to reduce the burden of oral diseases. To maintain this momentum, effective advocacy for sustainable oral health is needed to raise public awareness, garner support, and guide policy makers. However, there has been limited use of evidence-based frameworks and approaches to design and measure the impact of oral health advocacy efforts. The 2nd Global Oral Health Forum (GOHF II) was hosted in April 2024 over a 2-day period to reflect on and discuss effective advocacy approaches and strategies for sustainable oral health. Four thematic sessions were organized around advocacy including health policies, health economics, patients, and planetary health. Each session featured eminent transdisciplinary speakers followed by group discussions centered around ideas, experiences, and perspectives from forum participants. The outcome of the forum was a compilation of ten actionable recommendations for moving forward with effective advocacy in oral health. These recommendations are envisioned to help build and strengthen coalitions of like-minded stakeholders in and outside the oral health community to advocate for policies that support sustainable oral health and equitable access to oral health care.

Background Governance is central to health systems, and achieving Universal Health Coverage (UHC) relies on strong, sustainable systems. However, despite UHC's broad health goals, issues like oral health receive inadequate attention, signalling inequity in health systems. In India, oral diseases are rising, yet oral health remains a low political priority, reflecting weak governance and limited state commitment to health equity. This study analysed governance factors within Karnataka's public oral healthcare system through the lens of Siddiqi’s health governance assessment framework. Methods In this exploratory qualitative study, in-depth interviews with twenty stakeholders, including administrators and program implementers, explored enablers and constraints at policy and operational levels. Data analysis was guided by the governance framework developed by Siddiqi and colleagues. Results The findings indicate that challenges persist while Karnataka’s oral health governance benefits from a separate directorate ensuring administrative functionality. These include a lack of strategic vision for oral health, inadequate policy formulation, limited social participation, insufficient budget, workforce shortages, outdated guidelines, and inequitable oral health programs. Power dynamics, particularly with district health officers, further hinder effective governance. The study reveals a siloed approach to oral health with minimal integration into broader health programs. From planning to implementation, weak governance links reflect low political will. Conclusion Although recent attention has been given to oral health in Karnataka, substantial reforms are necessary. These include appointing oral health personnel at primary health centres, increasing budgets, revising the Indian Public Health Standards to prioritise oral health in primary care, empowering the oral health directorate, and establishing accountability and surveillance systems. Strengthening governance in these areas is essential to advance oral health equity and contribute to UHC goals in Karnataka.

Background Governance is central to health systems, and achieving Universal Health Coverage (UHC) relies on strong, sustainable systems. However, despite UHC's broad health goals, issues like oral health receive inadequate attention, signalling inequity in health systems. In India, oral diseases are rising, yet oral health remains a low political priority, reflecting weak governance and limited state commitment to health equity. This study analysed governance factors within Karnataka's public oral healthcare system through the lens of Siddiqi’s health governance assessment framework. Methods In this exploratory qualitative study, in-depth interviews with twenty stakeholders, including administrators and program implementers, explored enablers and constraints at policy and operational levels. Data analysis was guided by the governance framework developed by Siddiqi and colleagues. Results The findings indicate that challenges persist while Karnataka’s oral health governance benefits from a separate directorate ensuring administrative functionality. These include a lack of strategic vision for oral health, inadequate policy formulation, limited social participation, insufficient budget, workforce shortages, outdated guidelines, and inequitable oral health programs. Power dynamics, particularly with district health officers, further hinder effective governance. The study reveals a siloed approach to oral health with minimal integration into broader health programs. From planning to implementation, weak governance links reflect low political will. Conclusion Although recent attention has been given to oral health in Karnataka, substantial reforms are necessary. These include appointing oral health personnel at primary health centres, increasing budgets, revising the Indian Public Health Standards to prioritise oral health in primary care, empowering the oral health directorate, and establishing accountability and surveillance systems. Strengthening governance in these areas is essential to advance oral health equity and contribute to UHC goals in Karnataka.