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Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers.Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed-method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review.A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual-family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial-system, provider and individual-family levels and illustrated in the rainbow model of CALD oral health.The review strengthens evidence for multilayered, system-related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.

To evaluate the longitudinal association between yogurt product intake and oral health in a population-based study.This study included 1967 Japanese residents aged 40-79 years who underwent dental examinations in 2012. Among them, 1469 participants were followed up in 2017 for the incidence of tooth loss, which was defined as two or more teeth lost over 5 years. The intake of yogurt products, defined as yogurt and lactic acid beverages, was estimated using a semi-quantitative food frequency questionnaire. The composition of the salivary microbiota was evaluated.The Poisson regression model showed that a higher intake of yogurt products was negatively associated with the incidence of tooth loss (p for trend = .020), adjusted for potential confounding factors. Mediation analysis confirmed that periodontal condition partly mediated the effect of yogurt product intake on tooth loss, while dental caries experience did not. Additionally, we confirmed the association of a high intake of yogurt products with a low percentage of the salivary microbiota pattern, which was associated with poor oral health.These findings suggest that the intake of yogurt products is associated with a lower risk of tooth loss resulting from periodontal disease, probably via modulation of the oral microbiome composition.

OBJECTIVES Dental caries remains a complex childhood condition often requiring preventable hospital admissions. There are limited population-based epidemiological studies that use large and linked data sets to quantify the clinical, socio-demographic and familial risk factors related to hospital admissions for dental caries. The aim of this study was to describe and quantify the rates, socio-demographic, clinical characteristics and familial factors including repeat admissions associated with young children admitted to hospital for dental caries. METHODS This cohort study (n = 33,438) used longitudinally linked hospital admission data among all children aged

Aim and objective This study aims to investigate the association between parity and dental caries among US women. Materials and methods National Health and Nutrition Examination Survey (NHANES 2001-2004) data for parous women aged 20-45 years were used for our analysis (n = 1,914). The association between parity (number of pregnancies resulted in live births) and caries experience [the decayed, missing, and filling teeth (DMFT) index] was analyzed using bivariate and multivariate regression analyses. SAS software version 9.1 was used for the statistical analyses. We used survey procedures (e.g., SURVEYFREQ, SURVEYMEANS, and SURVEYREG) that incorporate information on the appropriate weights to account for NHANES's complex sampling design. Results The bivariate analysis showed a trend of increase in dental caries experience among parous women as the number of live births increased (p = 0.007). After adjusting for confounders, such as age, socioeconomic status (SES), dental care coverage, and utilization, a significant association was still observed between parity level and dental caries experience (p = 0.009). Conclusion Our results suggest that higher parity can be associated with dental caries experience among US women of reproductive age. Clinical significance Clinicians should be aware of this finding to promote better oral health care and education among women with increased parity.

Objective: The aim of this study is to examine the effect of diet drinks on dental erosion among a representative sample of US adults. Methods: Adult dietary and dental data were analyzed from the 2003–2004 cycle of the National Health and Nutrition Examination Survey. Erosion was measured with a modified tooth wear index and was analyzed as a dichotomous variable. Cluster analysis was performed, and the cluster number was based on having a separate diet drink cluster and the R2 values. Survey procedure and sample weights were used. Results: Most of the population (80%) had some form of dental erosive lesions. When compared with the total sample, people with erosion were more likely to be male (52.5%) and older. People with no erosive lesions were younger (42.3%) and non-Hispanic Black (21.2%). Cluster analysis resulted in 4 distinct clusters: high water, high diet drinks, high coffee/tea, and high soda. The respective percentage of individuals in each cluster who had erosion was 78.9%, 85%, 83.9%, and 76.2%, where the “high diet drinks” cluster showed the highest erosion ( P = 0.28). Logistic regression modeling showed that the “high diet drinks” cluster had increased odds of erosion (odds ratio = 1.27; 95% CI = 0.58 to 2.77) when compared with the “high water” cluster, but the relationship was not statistically significant. Conclusion: High diet drinks consumption slightly increased the odds of dental erosion among US adults, although this relationship was not statistically significant. It is thus not yet clear that dentists should recommend diet drinks, as they might be linked to systemic diseases. Further research is needed to explore more about risk factors of erosion. Knowledge Transfer Statement: The findings of this study are suggestive, though not significantly, that diet drinks may increase risk for dental erosion. While further research is needed, it is not clear that dentists should recommend these drinks as healthy substitutes for sugary drinks.

This cross-sectional study assessed the oral and physical factors contributing to improvement of the masticatory performance of community-dwelling older adults in South Korea. We enrolled 84 healthy older adults (38 men, 46 women; age, 71.40 ± 5.15 years) and assessed their skeletal muscle mass index (SMI), functional tooth units (FTUs), and mixing ability index (MAI). Associations between variables were analyzed using Spearman’s correlation coefficient, and the effects of SMI and FTUs on the MAI were evaluated through linear multiple regression. FTUs were positively associated with the MAI in men and women (r = 0.339, p = 0.038 and r = 0.461, p = 0.001, respectively). SMI and FTUs were moderately associated in men (r = 0.459, p = 0.004). MAI showed an approximately 4.4 times increase for each FTU in men (B = 4.442, p = 0.037); however, after the SMI was added, this effect was no longer significant. In women, the MAI increased by about 6.7 times with each FTU (B = 6.685, p = 0.004). FTUs had a significant effect on the MAI only in women with low muscle mass. While there was no significant effect of the SMI on the MAI, its influence should not be overlooked.

Temporomandibular disorders (TMD) have been traditionally associated with psychosocial factors; however, occupational stress as a factor related to TMD has not been adequately assessed in the literature. The aim was to investigate the association between stress at work and TMD on adult paid workers. An electronic search included PubMed, Scopus, Web of Science, Embase, and LILACS databases. Manual searches in the included articles’ reference and gray literature were performed. There were no restrictions regarding language or publication period. The inclusion criteria comprised observational studies with paid workers of any category, of both sexes, above 18 years old, assessing occupational stress/stress or distress and TMD as diagnosis or isolated signs and symptoms. Methodological quality was evaluated using Joanna Briggs tools. We narratively assessed the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. We collected 12 studies. 50% reported a positive association between stress and TMD diagnostic across various job categories. On the other hand, TMJ sounds (a TMD sign) and work stress were associated only in a musicians’ population. However, the shortage of eligible articles and the methodological limitations provided a very low certainty of the evidence; only 4 of the studies used validated tools for both stress and TMD (2 reporting positive association). The association between stress and TMD is inconclusive by the available data. In the future, we expect more robust epidemiologic studies addressing these relevant aspects.

Objectives The Child Dental Benefits Schedule (CDBS) is an Australian Government initiative providing basic dental care to children from low-income households. We sought to investigate levels of utilisation of the CDBS among Aboriginal and non-Aboriginal children to determine whether there is equal access to dental services provided through the schedule. Methods CDBS data were obtained for four financial (July–June) years (from 2013–14 to 2016–17). The data captured all claims made during this period. The data included estimates of usage by Aboriginal status, age group and Dental Benefits groups (administrative categories of related dental procedures). Results The utilisation of CDBS services was lower for Aboriginal children. However, in 2013–14, although the odds of using the schedule were higher for non-Aboriginal children (odds ratio (OR) 0.89; P

Objective The objective of the review is to synthesize existing literature examining the barriers and facilitators to preventive oral health care utilization experienced by culturally and linguistically diverse mothers. Introduction Preventive oral health care in the absence of pain is underutilized in culturally and linguistically diverse groups. Culturally and linguistically diverse mothers experience oral health care utilization barriers compared to their host country counterparts. Much of the current evidence is focused on oral health care knowledge, attitudes, and beliefs of culturally and linguistically diverse groups. To date, it remains unclear as to which barriers or facilitators impact preventive oral health care utilization in culturally and linguistically diverse mothers. Inclusion criteria This review will consider studies that explore oral health care utilization in culturally and linguistically diverse mothers (with children younger than 18 years) who are either born in a different country or who have one parent born in a country that differs culturally and/or linguistically to the host population. Papers that explore barriers and facilitators to oral health care utilization will be included. Quantitative and qualitative studies will be included. Methods A three-step search strategy will be conducted within the following databases: MEDLINE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Central, and Scopus. The search will be supplemented with gray literature and reference searching from collected articles. No date limitation will be applied. Two reviewers will assess papers against the inclusion criteria. A convergent integrated approach using the JBI mixed methods methodology will be followed for critical appraisal, data extraction, and data synthesis and integration.

Background The effect of sugared beverages on dental caries has been widely studied in dental literature. A major limitation of these studies was examining the beverages as a single source. To overcome this limitation, a few studies used cluster analysis to group people into similar beverage consumption patterns. These studies did not differentiate between sugared beverages and diet drinks. Therefore the aim of this study is to examine the effect of consuming diet drinks on dental caries among US children by using cluster analysis. Methods In this cross-sectional study, the authors analyzed the dietary data of children aged 3 through 10 years, using 2 24-hour recall interviews in the 2011-2014 National Health and Nutrition Examination Survey data. Cluster analysis has been used to overcome the limitations of examining the beverages as a single source. Clusters were identified based on the R2 statistic and the local peak of pseudo-F statistics. Survey procedure and sample weights were used to account for the complex National Health and Nutrition Examination Survey sampling design. Results Six beverage consumption clusters were identified: high soda, high 100% juice, high juice drinks, high diet drinks, high milk, and high water. Regression analysis showed that the high soda cluster had a tendency to increase caries risk (odds ratio [OR], 1.69, 95% confidence interval [CI], 0.9 to 3.1), while the high diet drinks cluster had neutral effect compared with the high water cluster (OR, 0.94, 95% CI, 0.5 to 1.8). Conclusions The results of this study suggest that diet drinks have no adverse effect on teeth among US children. Additional well-designed longitudinal studies should be conducted to establish the effect of diet drinks on caries when consumed during childhood. Practical Implications Although this study did not show an association between caries and diet drinks, dental practitioners should be cautious about recommending these drinks, as they have been linked to systemic diseases. In addition, the American Academy of Pediatrics and National Academy of Medicine do not recommend that children consume these beverages.

BackgroundDental caries remains a global problem that causes disproportionate suffering in underserved populations. Simple interventions are needed to improve patient experience, clinical and cost-effectiveness, and access to care. The self-assembling peptide P11-4 is a recently developed, non-invasive treatment that regenerates enamel in initial caries lesions.Studies reviewedWe conducted a systematic review and meta-analysis on the effectiveness of the P11-4 products Curodont™ Repair (CR) and Curodont™ Repair Fluoride Plus (CRFP) on initial caries lesions. Primary outcomes were lesion progression after 24 months, caries arrest, and cavitation. Secondary outcomes were changes in merged International Caries Detection and Assessment System (ICDAS) score, Quantitative Light Fluorescence, esthetic appearance, and lesion size.ResultsSix clinical trials comparing CR to controls met the inclusion criteria. Results of this review represent two primary and two secondary outcomes. When compared to parallel groups, CR improved caries arrest (RR: 1.82; 95% CI: 1.32 to 2.50; 45% attributable risk; 95% CI: 24 to 60%) and decreased lesion size by 32% (Hedge’s g: -0.59; CI: -1.03 to -0.15). We observed positive trends for avoiding cavitation (RR: 0.32; CI: 0.10 to 1.06) and lowering merged ICDAS score (RR: 3.68; CI: 0.42 to 32.3). No studies used CRFP or reported adverse esthetic changes.Practical implicationsCR has a treatment effect on caries arrest and decreased lesion size. Two trials contributing to the caries arrest result had non-masked assessors, and all trials had elevated risks of bias. We recommend conducting longer trials. CR is a promising treatment for initial caries lesions.

Background: in this protocol we outline a method of working alongside Aboriginal communities to learn about and facilitate improvement in the oral health habits in Aboriginal adolescents. By facilitating positive oral health in Aboriginal adolescents, we hope to achieve lifelong improvement in oral health and general wellbeing. Methods: this paper outlines a co-design methodology through which researchers and Aboriginal communities will work together to create a custom oral healthcare program aimed at Aboriginal adolescents. Researchers, a youth advisory group, Aboriginal community-controlled health services and three regional NSW communities will together devise an oral health strategy focused on five components: application of topical fluoride, increasing water consumption, improving nutrition, daily toothbrushing, and enhancing social and emotional wellbeing. Capacity building is a key outcome of this program. Discussion: as the gap in health status between Aboriginal and non-Aboriginal people remains wide, it is clear that new approaches and attitudes are needed in Aboriginal public health research. This protocol is representative of this shifting approach; giving power to Aboriginal communities who seek to have sovereignty and self-determination over their healthcare. Trial registration: TRN: ISRCTN15496753 Date of registration: 20 October 2021.

This study aimed to investigate the association between the frequency of SSB consumption and the prevalence of oral symptoms in adolescents.We analysed the data collected from the 2017 (13th) Korea Youth Risk Behaviour Web-based Survey (KYRBWS). KYRBS collected beverage consumption data from 64,991 Korean adolescents. Self-reported oral symptoms including sensitivity to food, sharp aches and pains in the teeth, and painful or bleeding gums were also collected. Multivariable logistic regression modelling was used to test the association between the frequency of SSB consumption and oral symptoms groups.It was found that Korean adolescents who consumed SSB at least once a week (94.4%) experienced more subjective oral symptoms (46.5%) even after controlling for confounding variables. In addition, as the frequency of SSB intake in adolescents increased, the subjective oral symptoms increased.The results of this study clearly revealed that the SSB consumption impacted adolescents' subjective oral symptoms. Compared with those who did not consume SSBs, those who consumed SSBs showed increased for developing subjective oral symptoms.

Objective: The purpose of the scoping review is to identify and examine the appropriateness of oral health policies, practices, and guidelines for adult inpatients in hospitals, with specific reference to Australia. Introduction: Oral health is not prioritised in Australian hospital settings and has been largely ignored by the hospital health workforce and policy makers. Poor oral health and hygiene practices of adult hospital inpatients can contribute to hospital acquired infections, and impact on quality of life and wellbeing. A comprehensive understanding of current policies, practices, and guidelines on oral health care for adult hospital inpatients will help improve integrated care, teamwork, and collaboration between hospital staff and oral health professionals. Inclusion criteria: The review will consider studies focussing on oral health related policies, practices or guidelines for adult hospital inpatients in Australia. Both scientific as well as grey literature will be included. This includes scientific articles, reviews, commentaries or opinon articles, dissertations/theses, government and internal hospital reports. Literature over the last 10 years, commencing Jul 2022, will be included in the review. Methods: A scoping review methodology will be followed in the review. Search will be conducted utilising keywords: oral health, dental health, adults, inpatients, hospitals and Australia. The keywords will be developed following the initial selection of articles. MEDLINE, CINAHL, EMBASE, Web of Science, PsycINFO, ProQuest, Proquest disserations and theses global, Cochrane Library, Joanna Briggs Institute EBP, and Google will be included. Grey literature will include hospital reports and policy documents from Australian hospitals. Two reviewers will assess papers against the inclusion criteria, followed by data extraction. Synthesis will be based on a qualitative methods. Data management will be through Covidence. Keywords Oral health policies; adult inpatients; hospitals; Australia

This study aims to investigate the association between parity and dental caries among US women.National Health and Nutrition Examination Survey (NHANES 2001-2004) data for parous women aged 20-45 years were used for our analysis (The bivariate analysis showed a trend of increase in dental caries experience among parous women as the number of live births increased (Our results suggest that higher parity can be associated with dental caries experience among US women of reproductive age.Clinicians should be aware of this finding to promote better oral health care and education among women with increased parity.

Early childhood caries (ECC) is a largely preventable condition that occurs when children develop caries in their primary teeth before the age of six. National trends of ECC indicate that prevalence is decreasing, but disparities between various sociodemographic groups may be increasing, despite intervention efforts. Dynamic mechanisms in caries development are hypothesized to be responsible for the observed population distributions of disease. Agent-based models (ABMs) have been utilized to explore similar hypotheses in many areas of health research. Therefore, we developed an ABM of ECC development mechanisms and examined population outcomes of hypothetical preventive intervention scenarios. We found that risk-based targeting had minimal impact on population averages or disparities and was largely due to the strength of the dynamic mechanisms among those considered to be at high caries risk. Universally increasing intervention access reduced population caries prevalence, but increased disparities between different groups of caries risk profiles. We show that population distributions of ECC can emerge as a result of dynamic mechanisms that have been shown to drive disease development. Understanding the effectiveness of a proposed intervention in relation to the hypothesized mechanism(s) that contributes to the outcome of interest is critical to future efforts to address population disparities in ECC.

Background The purpose of this cross-sectional study was to determine if Healthy Eating Index (HEI-2015) scores are associated with coronal caries and the odds of untreated coronal caries in adults 20 years and older. Methods Data on decayed, missing, and filled teeth (DMFT), untreated coronal caries, and HEI-2015 scores were obtained from 7,751 adults who completed a dental examination and two 24-hour dietary recalls in National Health and Nutrition Examination Survey cycles 2011-2012 and 2013-2014. HEI-2015 scores were categorized into quintiles, with HEI-2015 quintile 1 scores indicating the least compliance with 2015-2020 Dietary Guidelines for Americans. The authors used multivariable linear regression to assess associations of HEI-2015 with DMFT and logistic regression for associations with untreated coronal caries. All regression models were controlled for age, sex, race or ethnicity, current cigarette use, family income to poverty threshold ratio, last dental visit, education, and whether participants were ever told they had a heart attack. Results Relative to HEI-2015 quintile 1, the adjusted odds of any untreated coronal caries were quintile 5 (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.46 to 0.80), quintile 4 (OR, 0.66; 95% CI, 0.53 to 0.84), quintile 3 (OR, 0.76; 95% CI, 0.56 to 1.04), and quintile 2 (OR, 0.93; 95% CI, 0.66 to 1.31). Participants who met the recommendations for the total fruits, whole fruits, greens and beans, and added sugars components of the HEI-2015 score were less likely to have untreated coronal caries than those who did not meet the recommendations. Overall, mean coronal DMFT also decreased as HEI-2015 scores increased, but trends were not consistent in all racial or ethnic groups. Conclusions and Practical Implications Greater compliance with the Dietary Guidelines for Americans is associated with lower prevalence and the odds of untreated caries in adults. Dietary counseling for caries prevention by dental professionals should incorporate comprehensive dietary guidelines that are consistent with those intended for enhancing overall health and reducing the risk of developing common systemic diseases.

This letter is a response to commentary by Dr. Smith on 'Examining the association between cancer history in early life and dental care utilization'. We provided additional information and clarification regarding our analysis and results in response to Dr. Smith's questions and comments. Despite the limitations and weaknesses of our study, we still believe that it provides important information and further research questions.

This paper presents the findings of the National Fluoride Varnish Workshop in 2018 along with subsequent actions to scale-up the use of fluoride varnish nationally in Australia. The use of fluoride varnish programs to prevent dental caries in high-risk child populations is an evidence-based population health approach used internationally. Such programs have not been implemented at scale nationally in Australia. A National Fluoride Varnish Consensus Workshop was held in Sydney in November 2018 with an aim of sharing the current work in this area being undertaken by various Australian jurisdictions and seeking consensus on key actions to improve the scale-up nationally. Forty-four people attended the Workshop with oral health representatives from all Australian state and territory health departments, as well as the Australian Dental Association (ADA) at both NSW branch and Federal levels. There was strong support for further scale-up of fluoride varnish programs nationally and to see the wider use of having non-dental professionals apply the varnish. This case study identifies key actions required to ensure scale-up of systematic fluoride varnish programs as part of a strategic population oral health approach to preventing dental caries among high-risk children who may not routinely access dental care.

The prophylactic removal of asymptomatic third molars is a common but controversial procedure often rationalized as necessary to prevent future disease on adjacent teeth. Our objective in this retrospective cohort study of adult men was to examine whether second-molar loss differed by baseline status of the adjacent third molar, taking into account the individual’s overall state of oral hygiene, caries, and periodontitis. We analyzed data from participants of the VA Dental Longitudinal Study who had at least 1 second molar present at baseline and 2 or more triennial dental examinations between 1969 and 2007. We classified second molars by third-molar status in the same quadrant: unerupted, erupted, or absent. Tooth loss and alveolar bone loss were confirmed radiographically. Caries and restorations, calculus, and probing depth were assessed on each tooth. We estimated the hazards of second-molar loss with proportional hazards regression models for correlated data, controlling for age, smoking, education, absence of the first molar, and whole-mouth indices of calculus, caries, and periodontitis. The analysis included 966 men and 3024 second molar/first molar pairs. Follow-up was 22 ± 11 y (median 24, range 3–38 y). At baseline, 163 third molars were unerupted, 990 were erupted, and 1871 were absent. The prevalence of periodontitis on the second molars did not differ by third-molar status. The prevalence of distal caries was highest on the second molars adjacent to the erupted third molars and lowest on the second molars adjacent to the unerupted third molars. Relative to the absent third molars, adjusted hazards of loss of second molars were not significantly increased for those adjacent to erupted (hazard ratio [HR] = 0.96, 95% confidence interval [CI] = 0.79–1.16) or unerupted (HR = 1.25, 95% CI = 0.91–1.73) third molars. We found similar results when using alveolar bone loss as the periodontitis indicator. Our findings suggest that retained third molars are not associated with an increased risk of second-molar loss in adult men.

BackgroundThere has been little examination of consumer attitudes towards the commercial advertising of healthcare services in Australia and how marketing is used by consumers in their health decision-making. In this research, we examined how consumers reported commercial advertising helped them to understand the health services available to them and the influence that marketing had upon their choices.MethodsA survey instrument using a Likert scale to indicate agreement or disagreement with 21 questions was developed using qualitative interviews before being distributed online within Australia. Sampling of participants was stratified by age, gender and location. The results were subjected to statistical analysis with Spearman Rank Correlation test being used for bivariate analysis.ResultsOne thousand five hundred sixty-four complete surveys were collected. The results revealed certain consumer beliefs, for example; the title of ‘Dr’ was believed to indicate skill and high levels of training (81.0%), with 80.3% agreeing incorrectly that use of the title was strictly regulated. Participants reported to have a higher confidence in their own abilities (71.2%) than the public (52.8%) in assessing health advertising. The level of self-confidence increased with higher education level and decreased by age (p ConclusionsThe data demonstrated that many health consumers felt that while commercial health advertising was helpful, it was also confusing, with many participants also holding mistaken beliefs around other elements of commercial health advertising. While the advertising of healthcare services might have educational effects and be superficially empowering, advertising is primarily intended to sell, not educate. This research demonstrates that there is significant potential for healthcare advertising to mislead. Future developments in regulatory health advertising policy, and the related ethical frameworks developed by professional healthcare associations, need to consider how the consumers of healthcare services might be better protected from misleading and predatory advertising practices.

This qualitative study aimed to explore psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity (PwCSO). Eight focus groups were conducted by one researcher with 40 adult participants at the Adult Healthy Weight Clinic within a hospital-based obesity service. Thematic analysis of focus group transcripts was performed to reveal insights relating to how PwCSO experience dental care and view oral health. A total of 11 participants were male, 29 female, all between the ages of 23 to 74 (mean age of 50). The body mass index of participants ranged from 31.6 to 84.6 kg/m2 . The results highlighted four key themes, including "disempowerment to act to improve oral health", "weight-related stigma and discrimination", "unpredictability of the dental environment" and a "lack of tailored services for PwCSO". A number of subthemes were identified, which reflect the six categories of barriers to access from the disability literature: availability, affordability, acceptability, accommodation, accessibility and appropriateness. These were explored to further appreciate the unique psychosocial considerations for this group. This study concluded that PwCSO face significant barriers to accessing dental services across all six categories highlighted in the disability literature. The study findings provide valuable patient-based information regarding the psychosocial barriers to accessing dental services, which are relevant for all healthcare professionals. The study reflected an increased need for promotion of the dentist's role in obesity management and obesity-related dental training, including familiarization with the biopsychosocial domains of obesity to reduce weight related stigma and discrimination, as an area for further study. The findings also guide the design of Specialized Bariatric Dental Services in the future, with a focus on enablers to access.

The Minamata treaty (2013) enacted a globally binding agreement to phase down amalgam use, which may significantly affect dental care for underserved populations. To comply with the Minamata treaty, strategic approaches need to be implemented to reduce amalgam use while imposing minimal risk on the dental care of the underserved.To establish strategic approaches to reduce amalgam use, the aim of this study is to use a marketing research analysis to determine which patient-related factors influence pediatric dentists' choice of amalgam.A survey containing questions regarding amalgam use, perception about the environmental impact of amalgam waste, and hypothetical clinical scenarios of a child with dental caries with varying levels of caries risk and types of dental insurance was developed and pretested. Emails linked to an electronic survey were sent via Qualtrics to all active American Academy of Pediatric Dentistry members (Of 892 (17.6%) replies, 850 responses were eligible for analysis. Only 385 (45%) respondents indicated using amalgam, and their responses were analyzed in the conjoint model. Respondents' selection of amalgam varied between 8% and 28% across all the clinical scenarios, with most respondents choosing composite or stainless steel crowns. Conjoint analysis revealed that, while both caries risk and type of insurance affected respondents' decision about amalgam use, caries risk was the driving factor in decision-making for using amalgam.These results underscore the importance of prevention and management of risk factors to successfully phase down amalgam use.Our study applied the marketing research tool, choice-based conjoint analysis, to investigate the relative importance of different factors on dentists' decision-making regarding amalgam use. This study should be of great interest to policy makers when developing strategic approaches to comply with the 2013 United Nations Environment Programme (a.k.a. Minamata treaty) policy recommendations for phase-down of dental amalgam.

BACKGROUND Dental caries is the most common multifactorial oral disease; it affects 60% to 90% of the global population. Dental caries is highly preventable through prevention behaviors aimed at improving oral hygiene, adequate fluoride usage, and dietary intake. Mobile apps have the potential to support patients with dental caries; however, little is known about the availability, target audience, quality, and features of these apps. OBJECTIVE This review aims to systematically examine dental caries prevention apps; to describe their content, availability, target audience, and features; and to assess their quality. METHODS We systematically identified and evaluated apps in a process paralleling a systematic review. This included a search strategy using search terms; an eligibility assessment using inclusion and exclusion criteria focused on accessibility and dental caries self-management behaviors, including oral hygiene, dietary intake, and fluoride usage; data extraction on app characteristics, including app store metrics; prevention behavior categorization; feature identification and description; a quality appraisal of all apps using the validated Mobile App Rating Scale (MARS) assessment tool; and data comparison and analysis. RESULTS Using our search strategy, we retrieved 562 apps from the Google Play Store and iTunes available in Australia. Of these, 7.1% (40/562) of the apps fit our eligibility criteria, of which 55% (22/40) targeted adults, 93% (37/40) were free to download, and 65% (26/40) were recently updated. Oral hygiene was the most common dental caries prevention behavior domain, addressed in 93% (37/40) of the apps, while dietary intake was addressed in 45% (18/40) of the apps and fluoride usage was addressed in 42% (17/40) of the apps. Overall, 50% (20/40) of the apps addressed only 1 behavior, and 38% (15/40) of the apps addressed all 3 behaviors. The mean MARS score was 2.9 (SD 0.7; range 1.8-4.4), with 45% (18/40) of the apps categorized as high quality, with a rating above 3.0 out of 5.0. We identified 21 distinctive features across all dental caries prevention behaviors; however, the top 5 most common features focused on oral hygiene. The highest-ranking app was the Brush DJ app, with an overall MARS score of 4.4 and with the highest number of features (n=13). We did not find any apps that adequately addressed dental caries prevention behaviors in very young children. CONCLUSIONS Apps addressing dental caries prevention commonly focus on oral hygiene and target young adults; however, many are not of high quality. These apps use a range of features to support consumer engagement, and some of these features may be helpful for specific patient populations. However, it remains unclear how effective these apps are in improving dental caries outcomes, and further evaluation is required before they are widely recommended. CLINICALTRIAL

Background Dental caries is the most common multifactorial oral disease; it affects 60% to 90% of the global population. Dental caries is highly preventable through prevention behaviors aimed at improving oral hygiene, adequate fluoride usage, and dietary intake. Mobile apps have the potential to support patients with dental caries; however, little is known about the availability, target audience, quality, and features of these apps. Objective This review aims to systematically examine dental caries prevention apps; to describe their content, availability, target audience, and features; and to assess their quality. Methods We systematically identified and evaluated apps in a process paralleling a systematic review. This included a search strategy using search terms; an eligibility assessment using inclusion and exclusion criteria focused on accessibility and dental caries self-management behaviors, including oral hygiene, dietary intake, and fluoride usage; data extraction on app characteristics, including app store metrics; prevention behavior categorization; feature identification and description; a quality appraisal of all apps using the validated Mobile App Rating Scale (MARS) assessment tool; and data comparison and analysis. Results Using our search strategy, we retrieved 562 apps from the Google Play Store and iTunes available in Australia. Of these, 7.1% (40/562) of the apps fit our eligibility criteria, of which 55% (22/40) targeted adults, 93% (37/40) were free to download, and 65% (26/40) were recently updated. Oral hygiene was the most common dental caries prevention behavior domain, addressed in 93% (37/40) of the apps, while dietary intake was addressed in 45% (18/40) of the apps and fluoride usage was addressed in 42% (17/40) of the apps. Overall, 50% (20/40) of the apps addressed only 1 behavior, and 38% (15/40) of the apps addressed all 3 behaviors. The mean MARS score was 2.9 (SD 0.7; range 1.8-4.4), with 45% (18/40) of the apps categorized as high quality, with a rating above 3.0 out of 5.0. We identified 21 distinctive features across all dental caries prevention behaviors; however, the top 5 most common features focused on oral hygiene. The highest-ranking app was the Brush DJ app, with an overall MARS score of 4.4 and with the highest number of features (n=13). We did not find any apps that adequately addressed dental caries prevention behaviors in very young children. Conclusions Apps addressing dental caries prevention commonly focus on oral hygiene and target young adults; however, many are not of high quality. These apps use a range of features to support consumer engagement, and some of these features may be helpful for specific patient populations. However, it remains unclear how effective these apps are in improving dental caries outcomes, and further evaluation is required before they are widely recommended.

Background To review the international literature on community-based interventions aiming to improve the oral health of Indigenous adolescents and identify which demonstrate a positive impact. Methods Data sources were MEDLINE, EMBASE, CINAHL, SCOPUS, the COCHRANE library and the Australian Indigenous HealthInfoNet. Articles were included where they: were published in English from 1990 onwards; described oral health outcomes for Indigenous adolescents aged 10 to 19 years; implemented a community based oral health intervention. The Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project was applied. Results Nine studies met inclusion criteria; two rated strong in quality; only one study was conducted with an urban community; five reported moderate community engagement. Five intervention strategies were identified, and schools were the most common setting reported. Statistically significant improvements were described in eight studies with the most frequently reported outcome being change in decayed missing or filled teeth. Conclusions Few good quality peer reviewed international studies of community-based oral health interventions which address the needs of Indigenous adolescents exist. Studies must include strong Indigenous community leadership and governance at all stages of the research, adopt participatory action-based research approaches, and are required in urban communities.

Objectives The Child Dental Benefits Schedule (CDBS) is an Australian Government initiative providing basic dental care to children from low-income households. We sought to investigate levels of utilisation of the CDBS among Aboriginal and non-Aboriginal children to determine whether there is equal access to dental services provided through the schedule. Methods CDBS data were obtained for four financial (July-June) years (from 2013-14 to 2016-17). The data captured all claims made during this period. The data included estimates of usage by Aboriginal status, age group and Dental Benefits groups (administrative categories of related dental procedures). Results The utilisation of CDBS services was lower for Aboriginal children. However, in 2013-14, although the odds of using the schedule were higher for non-Aboriginal children (odds ratio (OR) 0.89; P0.0001) this was reversed in 2015-16 and 2016-17 (OR 1.11 and 1.21 respectively; P0.0001 in both years). The odds of Aboriginal children using preventive services was below that of non-Aboriginal children in 2013-14 (OR 0.82), 2014-15 (OR 0.76), 2015-16 (OR 0.83) and 2016-17 (OR 0.90; P0.0001) in all years. Conclusions The data are encouraging with regard to equity because they show that for services overall, Australian Aboriginal and non-Aboriginal children have similar levels of utilisation. However, lower levels of the use of preventive services may indicate future inequalities in oral health among Aboriginal children. What is known about the topic? The CDBS is an Australian Government initiative aimed at improving access to dental care for children from low-income households, including for Aboriginal people. By facilitating greater access to dental care, the schedule has the potential to help address inequalities in oral health for both Aboriginal and non-Aboriginal children. What does this paper add? There are no analyses available comparing the utilisation of the CDBS by Aboriginal and non-Aboriginal children. This study compared levels of utilisation of the schedule overall and specifically for preventive services. What are the implications for practitioners? Greater efforts should be made to address inequalities in the utilisation of the CDBS between Aboriginal and non-Aboriginal children. Although there are some hopeful signs, inequalities remain that may affect the oral health of Aboriginal children. There is also potential to encourage utilisation of the CDBS for greater provision of preventive services, including targeted population oral health initiatives.

The effect of sugared beverages on dental caries has been widely studied in dental literature. A major limitation of these studies was examining the beverages as a single source. To overcome this limitation, a few studies used cluster analysis to group people into similar beverage consumption patterns. These studies did not differentiate between sugared beverages and diet drinks. Therefore the aim of this study is to examine the effect of consuming diet drinks on dental caries among US children by using cluster analysis.In this cross-sectional study, the authors analyzed the dietary data of children aged 3 through 10 years, using 2 24-hour recall interviews in the 2011-2014 National Health and Nutrition Examination Survey data. Cluster analysis has been used to overcome the limitations of examining the beverages as a single source. Clusters were identified based on the RSix beverage consumption clusters were identified: high soda, high 100% juice, high juice drinks, high diet drinks, high milk, and high water. Regression analysis showed that the high soda cluster had a tendency to increase caries risk (odds ratio [OR], 1.69, 95% confidence interval [CI], 0.9 to 3.1), while the high diet drinks cluster had neutral effect compared with the high water cluster (OR, 0.94, 95% CI, 0.5 to 1.8).The results of this study suggest that diet drinks have no adverse effect on teeth among US children. Additional well-designed longitudinal studies should be conducted to establish the effect of diet drinks on caries when consumed during childhood.Although this study did not show an association between caries and diet drinks, dental practitioners should be cautious about recommending these drinks, as they have been linked to systemic diseases. In addition, the American Academy of Pediatrics and National Academy of Medicine do not recommend that children consume these beverages.

Additional file 1. Description of EPHPP Quality Assessment Component Ratings by study. All components of EPHPP Quality Assessment tool described by study

Additional file 2. Key Features of Indigenous community initiation of the research, governance, engagement and/or capacity building. Proportion of included studies that described the key features of Community Engagement including community initiation of the research, governance, engagement and/or capacity building

Knowledge Transfer Statement: Irrespective of country, socially disadvantaged children experience greater levels of preventable dental disease than their more socially advantaged peers. Motivational interviewing (MI) is recognized as a potential intervention tool for reducing prevalence of child dental disease. The challenges of implementing MI in 4 trials involving socially vulnerable children are highlighted in this commentary, with some potential solutions offered.

AIM: This paper seeks to describe the social networks and support available to caregivers of young children, and their links to behavioural and clinical dimensions of children’s oral health. DESIGN: A cross-sectional study was conducted on the third wave of a cohort of 612 child-caregiver pairs of the Detroit Dental Health Project (DDHP). Caregivers and their children came to a central location in Detroit where they completed interviewer-administered questionnaires, health and nutritional assessments, and received an oral examination. Caregiver’s social networks were measured using the hierarchical mapping technique. Child’s oral health measures included previous dental visits and untreated decay. RESULTS: Caregivers reported an average network size of approximately seven people, who on average were 37 years old. Ninety percent of members in the network lived within an hour’s drive, and contact frequency occurred on average between once a week and daily. Caregivers reported receiving emotional support most frequently and money support least frequently. Caregivers with larger networks had a slightly higher probability of reporting frequent errand support. Child’s age interacted with money support to predict whether or not the child had visited the dentist since the last DHHP visit and to predict the number of untreated decayed surfaces. CONCLUSIONS: The association between network characteristics and types of social support appear to be limited. There are no main effects of caregiver social network characteristics or support type on child’s oral health. Having no money support appears most influential on children’s oral health depending on their age.

Objectives In 2013, the United Nations Environment Programme (UNEP) reached a binding agreement – a.k.a. the Minamata treaty – to decrease dental amalgam use. This study aims to investigate US dentists' current practice and opinions about amalgam use, and to determine factors affecting their amalgam use and opinions. Methods A total of 45,557 general dentists and 5,101 pediatric dentists were invited to participate in a pre-tested electronic survey. The survey consisted of 12 close-ended questions using a 5-point Likert Scale. The Qualtrics™ software was used to distribute the survey, followed by three reminders. Results Response rate was 5.2 percent for general dentists, and 17.6 percent for pediatric dentists. Sixty-two percent of general dentists and 56 percent of pediatric dentists reported using amalgam. Most dentists disagreed with banning amalgam, while agreeing with installing amalgam separators. Environmentally conscious dentists were more likely to agree with banning amalgam and installing amalgam separators. Conclusion Responding dentists favor the continued use of dental amalgam. Their perspectives vary by several factors including dentists' environmental consciousness. Policies toward minimizing amalgam's environmental impact need to be implemented.