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Oral health inequities at a global level persist. This is despite marked advancements in technology, service delivery, training, research and population-level initiatives such as water fluoridation. Although the social determinants of health are frequently cited in the framing, analysis and description of oral health inequities, the explicit role of power is usually omitted. Lukes described power as the capacity of actors to make change, as well as to receive and resist change. An analysis of power thus provides a better understanding of how diverse and conflicting interests of multiple actors can lead to differential oral health norms within communities. An analysis of power also demonstrates the intersectional forms of oral inequities experienced among the socially marginalised; it is not rooted in economic deprivation alone. The training and practice of dentistry itself creates intersectional forms of inequalities through race, gender and class. Dental academic spaces are overwhelmingly White, with the knowledge created thus embedded with Eurocentric values. This needs to be challenged. We aim, in this special issue, to provide an overview of the pluralist and diverse nature of contemporary global society, and to show how attempting to impose singular forms of behaviours, values and knowledge that suppress the cultures of socially marginalised communities enhances oral health inequities. Specifically, this special issue will: (1) present an overview of how power operates generally, using implicit bias examples, with a strong underpinning from the literature; (2) describe what this means for power in dentistry, drawing upon sociological literature with a specific lens on dental organisations; (3) expand understanding of post-colonial theory and how this reinforces power structures in dentistry that further enable the privileged and; (4) examine the power relationship between dentists and patients, using theoretical underpinnings and elaborating on different power paradigms in the Australian vs Asian/Korean context.

To assess the psychometric properties, including face, content, criterion and known-groups validity and reliability, of scales to measure oral health-related self-efficacy and fatalism in a regional Aboriginal adult population in Australia.Four hundred Aboriginal adults (aged 18-82 years, 67% female) completed a self-report questionnaire including items pertaining to oral health-related self-efficacy and fatalism. Structural validity was determined in exploratory factor analysis (EFA) with principal components analysis for each scale. Criterion validity was assessed between the instruments and theoretically related variables. Known-groups validity was investigated by comparing the scores in different population groups according to age, sex, education and employment. Reliability of the scales was assessed through internal consistency.The EFA confirmed a single factor structure for self-efficacy and fatalism scales, with Cronbach's alphas of 0.93 and 0.89 respectively. The two scales were not correlated. Oral health-related self-efficacy was associated with toothbrush ownership and brushing the previous day supporting criterion validity. Oral health-related fatalism was associated with previous extractions and perceived need for extractions also supporting criterion validity. Both measures were associated with social impact of oral health as measured by the OHIP-14, supporting their criterion validity. Mixed findings were observed in terms of known-groups validity.There was initial evidence that measures of oral health-related self-efficacy and fatalism displayed adequate psychometric properties in this Aboriginal community. These constructs could have implications for approaches for improving oral health among Aboriginal people.

Contemporary evidence shows that: (i) racial minorities often bear the greatest burden of oral diseases; (ii) there are notable differences between socially advantaged and disadvantaged racial groups and; (iii) racial inequities in oral health persist over time and across space. In the four papers that follow, we seek to contribute to the discourse around oral health and racial inequities through recognition that racism has a structural basis and is embedded in long-standing social policy in almost every developed (and developing) nation. The papers formed the basis of a symposium entitled 'Racism and oral health inequities' at the 99th General Session of the International Association of Dental Research held July 2021 in Boston, United States. The authors responded to the international Black Lives Matter movement that gained momentum in 2019, responding in many calls to arms for greater exposure to the insidious impacts on racism on all facets of health and wellbeing, and the regulatory regimes in which they operate. The papers provide an overview of the history of racism in oral health inequities at an international level, with a specific focus on the implications of addressing (or not addressing) racism in population oral health at an international level. This includes the role of advocacy and engaging with health policymakers to both minimize racism and to increase comprehension of its residual effects that may lead to misinformed policy.

This article combines a review of dental studies on race with sociological insights into systemic racism to advance a counter-narrative on the root causes of racial oral health inequities. Taking racism as a form of oppression that cuts across institutional, cultural, and behavioral dimensions of social life, we ask: How pervasive are racial inequities in the occurrence of adverse oral health outcomes? What is the direction and magnitude of racial inequities in oral health? Does the inequitable distribution of negative outcomes persist over time? How can sociological frameworks on systemic racism inform initiatives to effectively reduce racial oral health inequities? The first three questions are addressed by reviewing dental studies conducted in the past few years around the globe. The fourth question is addressed by framing racial oral health inequities around sociological scholarship on racism as a systemic feature of contemporary societies. The paper concludes with a set of practical recommendations on how to eliminate racial oral health inequities, which include engaging with a strong anti-racist narrative and actively dismantling the race discrimination system. Amid the few attempts at moving the field towards improved racial justice, this paper should be followed by research on interventions against racial oral health inequities, including the conditions under which they succeed.

Bias in population oral health research is a form of systematic error that can affect scientific investigations and distort inference (i.e under or over confidence in an estimate). A biased study loses validity in relation to the degree of the bias. While some study designs are more prone to bias, its presence is universal. It is difficult to completely eliminate bias; in the process of attempting to do so, new bias may be introduced or a study may be rendered less generalizable. The goals are to therefore minimize bias and for investigators and readers to comprehend its residual effects, limiting misinterpretation and misuse of data. In the four papers that follow, we seek to contribute to the discourse around random and systematic bias in population oral health research through the lens of case controlled studies, longitudinal studies and genomics re search. The papers formed the basis of a symposium entitled 'Random and Systematic Bias in Population Oral Health Research' at the 98th General Session of the International Association of Dental Research held March 2020 in Washington DC, United States.

In an increasingly globalised world, Trans-National Corporations (TNCs) wield considerable social, economic and political influence, both in the international market economy and within individual countries. The practices of TNCs can have positive or adverse effects on population health through production methods and products, shaping social determinants of health, or influencing the regulatory structures governing their activities. TNCs can contribute to health inequities if the health consequences arising from their practices have disproportionate adverse impacts on vulnerable populations or positive benefits for less vulnerable groups. Despite growing recognition of the implications for health, including oral health, arising from TNC practices, little research has sought to systematically assess the oral health and/or oral health equity impacts of TNCs. In the four papers that follow, we contribute to the discourse around oral health-related inequalities through the lens of power, human agency and TNCs. The papers formed the basis of a symposium entitled 'Transnational Corporations and oral health inequalities' at the 97th General Session of the International Association of Dental Research held June 2019 in Vancouver, British Columbia. The authors responded to the 2014 Lancet-University of Oslo Commission on Global Governance for Health call for greater attention to the health effects of TNC practices and the regulatory regimes in which they operate. The papers overview the role of TNCs in oral health inequalities at an international level, with a specific focus on illuminating their far-reaching influence on our everyday lives, from both epidemiological and sociological perspectives, and the multi-faceted positive or adverse effects on oral health this might have. Key TNC examples are provided by way of the sugar and the tobacco industries, with their impact on dental caries, periodontal diseases and head and neck cancers.

To better understand the determinants of self-rated oral health within an Indigenous population by: 1, examining potential individual-level correlates of socio-demographic, health behaviours, dental care access and oral health literacy-related outcomes with self-rated oral health; and, 2, examining the relative contribution of these domains to self-rated oral health in multivariable modelling.We conducted nested logistic regression analyses on self-reported status of 'fair or poor' versus 'better' oral health using data from a convenience sample of rural dwelling Indigenous Australians (n = 468). Data were collected on background characteristics, health behaviours, access to dental care, oral health literacy-related outcome variables and REALD 30, an oral health literacy scale.Overall 37.0 % of the Indigenous adult population reported fair or poor oral health. In multivariable modelling, risk indicators for fair or poor self-rated oral health that persisted after adjusting for other covariates included being aged 38+ years (OR 2.9, 95%CI 1.9,4.6), holding a Government Health Concession card (OR 2.3, 95%CI 1.1,4.5), avoiding the dentist due to financial constraints (OR 2.3, 95%CI 1.4,3.6), not knowing how to make an emergency dental visit (OR 1.7, 95%CI 1.1,2.7) and poor understanding of the prevention of dental disease (OR 1.7, 95%CI 1.1,2.7).In this vulnerable population, risk indicators contributing to poor self-rated oral health included socio-demographic, dental care access and oral health literacy-related factors. Health behaviours were not significant.

Despite burgeoning evidence regarding the pathways by which experiences of racism influence health outcomes, little attention has been paid to the relationship between racism and oral health-related behaviours in particular. We hypothesised that self-reported racism was associated with tooth brushing, and that this association was mediated by perceived stress and sense of control and moderated by social support.Data from 365 pregnant Aboriginal Australian women were used to evaluate tooth brushing behaviour, sociodemographic factors, psychosocial factors, general health, risk behaviours and racism exposure. Bivariate associations were explored and hierarchical logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) for tooth brushing. Perceived stress and sense of control were examined as mediators of the association between self-reported racism and tooth brushing using binary mediation with bootstrapping.High levels of self-reported racism persisted as a risk indicator for tooth brushing (OR 0.51, 95%CI 0.27,0.98) after controlling for significant covariates. Perceived stress mediated the relationship between self-reported racism and tooth brushing: the direct effect of racism on tooth brushing was attenuated, and the indirect effect on tooth brushing was significant (beta coefficient -0.09; bias-corrected 95%CI -0.166,-0.028; 48.1% of effect mediated). Sense of control was insignificant as a mediator of the relationship between racism and tooth brushing.High levels of self-reported racism were associated with non-optimal tooth brushing behaviours, and perceived stress mediated this association among this sample of pregnant Aboriginal women.. Limitations and implications are discussed.

To describe the reported oral health behaviours and perceptions of Indigenous Australians living in Darwin, Northern Territory and to compare those with estimates for Darwin and Australia derived from the National Survey of Adult Oral Health (NSAOH).A total of 181 Indigenous Australians aged 22 years and over living in Darwin, participating in screening for a wider randomised clinical trial, were included.Information on socio-demographic characteristics, oral health status including oral health behaviours and perceptions was collected using a questionnaire. Differences between the Darwin study (DS) participants and Australians in NSAOH were made based on non-overlapping 95% confidence intervals.Almost 72% of DS participants had last seen a dentist over a year earlier, compared to 47% and 39% of NSAOH Darwin and Australian participants, respectively. A higher proportion of DS participants usually visited a dentist because of a problem than NSAOH Darwin and NSAOH Australian participants. A higher proportion of DS participants had avoided or delayed a dental visit because of cost than NSAOH participants. Over three times as many DS participants rated their oral health as fair/poor compared to NSAOH participants. A higher proportion of DS participants had perceived gum disease and one or more symptoms of gum disease than NSAOH participants. A higher proportion of DS participants experienced toothache, felt uncomfortable about appearance of their mouth and avoided eating because of oral problems than NSAOH participants.A higher proportion of Indigenous Australians living in Darwin presented with non-optimal oral health behaviours and perceptions compared with both the Darwin and Australian general populations.

To report on oral-health-related characteristics, beliefs, and behaviours among participants in a randomised control trial of an intervention to prevent early childhood caries (ECC) among Māori children, and to determine whether there were any systematic differences between the intervention and control groups at baseline.Baseline measurements from a randomised control trial (involving 222 pregnant Māori women allocated randomly to either Intervention or Delayed groups) which is currently underway.The rohe (tribal area) of Waikato-Tainui.Self-report information collected on sociodemographic characteristics, pregnancy details, self-reported general and oral health and health-related behaviours, and oral health beliefs.Other than those in the Delayed group being slightly older, on average, there were no significant differences between the two groups. Some 37.0% were expecting their first child. Most reported good health; 43.6% were current smokers, and 26.4% had never smoked. Only 8.2% were current users of alcohol. Almost all were dentate, and 57.7% described their oral health as fair or poor. One in six had had toothache in the previous year; 33.8% reported being uncomfortable about the appearance of their teeth, and 27.7% reported difficulty in eating. Dental service-use was relatively low and symptom-related; 78.9% needed to see a dentist. Overall, most of the sample believed that it was important to avoid sweet foods, visit dentists and to brush the teeth, while about half thought that using fluoride toothpaste and using floss were important. Some 38.2% felt that drinking fluoridated water was important. Oral-health-related fatalism was apparent, with 74.2% believing that most people usually get dental problems, 58.6% believing that most people will need extractions at some stage, and that most children eventually get dental caries.Mothers' important role in nurturing the well-being of the young child includes the protection and maintenance of the growing child's oral health (or ukaipo niho). The findings provide important insights into Māori mothers' oral health knowledge, beliefs and practices.

To compare oral health literacy (OHL) levels between two profoundly disadvantaged groups, Indigenous Australians and American Indians, and to explore differences in socio-demographic, dental service utilisation, self-reported oral health indicators, and oral health-related quality of life (OHRQoL) correlates of OHL among the above.OHL was measured using REALD-30 among convenience samples of 468 Indigenous Australians (aged 17-72 years, 63% female) and 254 female American Indians (aged 18-57 years). Covariates included socio-demography, dental utilisation, self-reported oral health status (OHS), perceived treatment needs and OHRQoL (prevalence, severity and extent of OHIP-14 'impacts'). Descriptive and bivariate methods were used for data presentation and analysis, and between-sample comparisons relied upon empirical contrasts of sample-specific estimates and correlation coefficients.OHL scores were: Indigenous Australians - 15.0 (95% CL=14.2, 15.8) and American Indians--13.7 (95% CL=13.1, 14.4). In both populations, OHL strongly correlated with educational attainment, and was lower among participants with infrequent dental attendance and perceived restorative treatment needs. A significant inverse association between OHL and prevalence of OHRQoL impacts was found among American Indians (rho=-0.23; 95% CL = -0.34, -0.12) but not among Indigenous Australians.Our findings indicate that OHL levels were comparable between the two groups and lower compared to previously reported estimates among diverse populations. Although the patterns of association of OHL with most examined domains of correlates were similar between the two groups, this study found evidence of heterogeneity in the domains of self-reported OHS and OHRQoL.

Evidence suggests that taller individuals have better health than their shorter counterparts. This study aimed to test the hypothesis that shorter participants in wave-3 of the Aboriginal Birth Cohort (ABC) study, a prospective longitudinal investigation of Indigenous Australian individuals born 1987-1990 at an Australian regional hospital, would have more caries and periodontal disease experience than their taller counterparts.Data were collected through oral clinical examinations, anthropometric measures and self-report questionnaires. The outcome variables were participants' caries (mean DMFT) and periodontal disease experience (moderate or severe periodontal disease as defined by the Centre for Disease Control), with height as an explanatory variable. Antecedent anthropometric, socio-demographic, sugar consumption frequency, dental behaviour and substance use variables were used as possible confounders. Linear regression was used in the analysis of caries experience, while adjusted prevalence ratios were used for prevalence of moderate or severe periodontal disease.Higher DMFT was found among participants in the shortest tertile (B=1.02, 95% CI=0.02-2.02) and those who consumed sweets every day or a few days a week (B=1.08, 95% CI=0.11-2.05), while lower DMFT was found among those owning a toothbrush (B=0.80, 95% CI=-0.22-1.82). Periodontal disease was positively associated with the shortest tertile (adjusted PR=1.39, 95% CI=0.96-1.82) and negatively associated with toothbrush ownership (adjusted PR=0.50, 95% CI=0.34-0.66).The hypothesis that shorter participants in wave-3 of the ABC study would have higher levels of caries and periodontal disease was confirmed.

There is limited information on self-perceived oral health of homeless populations. This study quantified self-reported oral health among a metropolitan homeless adult population and compared against a representative sample of the metropolitan adult population obtained from the National Survey of Adult Oral Health.A total of 248 homeless participants (age range 17-78 years, 79% male) completed a self-report questionnaire. Data for an age-matched, representative sample of metropolitan-dwelling adults were obtained from Australia's second National Survey of Adult Oral Health. Percentage responses and 95% confidence intervals were calculated, with non-overlapping 95% confidence intervals used to identify statistically significant differences between the two groups.Homeless adults reported poorer oral health than their age-matched general population counterparts. Twice as many homeless adults reported visiting a dentist more than a year ago and that their usual reason for dental attendance was for a dental problem. The proportion of homeless adults with a perceived need for fillings or extractions was also twice that of their age-matched general population counterparts. Three times as many homeless adults rated their oral health as 'fair' or 'poor'.A significantly greater proportion of homeless adults in an Australian metropolitan location reported poorer oral health compared with the general metropolitan adult population.

There is limited information on the impact of poor oral health on Indigenous Australian quality of life. This study aimed to determine the prevalence, extent and severity of, and to calculate risk indicators for, poor oral health-related quality of life among a convenience sample of rural-dwelling Indigenous Australians.Participants (n = 468) completed a questionnaire that included socio-demographic, lifestyle, dental service utilization, dental self-care and oral health-related quality of life (OHIP-14) factors.The prevalence of having experienced one or more of OHIP-14 items 'fairly often' or 'very often' was 34.8%. The extent of OHIP-14 scores was 1.88, while the severity was 15.0. Risk indicators for having experienced one or more of OHIP-14 items 'fairly often' or 'very often' included problem-based dental attendance, avoiding dental care because of cost, difficulty paying a $100 dental bill and non-ownership of a toothbrush. An additional risk indicator for OHIP-14 extent was healthcare card ownership, while additional indicators for OHIP-14 severity were healthcare card ownership and having had 5+ teeth extracted.Risk indicators for poor oral health-related quality of life among this marginalized population included socio-economic factors, dentate status factors, dental service utilization patterns, financial factors and dental self-care factors.

To assess the relative contribution of demographic socioeconomic, physical/lifestyles, dietary, food security and dental factors to self-reported restoration or extraction receipt among New Zealand children.Cross-sectional study of nationally representation data using a two-stage random clustered sampling procedure and complex sampling analysis.Mäori, Pacific and New Zealand European or Other (NZEO) children aged 5-14 years.Of the 3,275 participants 37.4% were Mäori, 32.3% Pacific and 30.3% NZEO. Mäori children had higher odds of having received a restoration than NZEO children after adjusting for age, gender and length of time lived in New Zealand (OR: 1.87) and with addition of household SES (OR: 1.58), lifestyle (OR: 1.92), dietary (OR: 1.64), food security (OR: 1.79) or dental factors (OR: 1.89). By contrast, Pacific children had higher odds of having received an extraction than NZEO children when age, gender and length of time lived in New Zealand were taken into account (OR: 1.69), and with addition of household SES (OR: 1.48), lifestyle (OR: 1.71), dietary (OR: 1.52), food security (OR: 1.21) or other dental factors (OR: 1.93).Mäori children were more likely to have received a restoration, and Pacific children more likely to experience an extraction, than NZEO children after adjusting for behavioural and material factors. Household SES contributed to most of the variance in Mäori child restoration receipt, while food security items explained most of the variance in Pacific child experience of extraction.