Search Results (105)

Background/Objectives: Oral diseases are common, largely preventable and closely associated with social determinants, noncommunicable diseases and quality of life. Greece has historically had a high dentist-to-population ratio; however, oral health care remains highly dependent on private provision and out-of-pocket payment. This structured evidence synthesis and health-system mapping aims to summarize the current situation of oral health care in Greece, focusing on access, financing, workforce capacity, epidemiology, prevention, and quality measurement. Methods: A structured evidence synthesis and health-system mapping were conducted using publicly available and verifiable sources, including World Health Organization documents, OECD/European Observatory country health profiles, Eurostat data, official Greek government information, and peer-reviewed studies identified through PubMed, Google Scholar, publisher records, and reference-list searching. The final synthesis included 29 sources: 15 peer-reviewed articles and 14 official or institutional documents/data sources. A formal systematic review, with or without meta-analysis, was not methodologically feasible because the research question was not based on a single intervention, exposure, comparator, or outcome, and because key evidence on oral health-system organization, financing, and governance is contained in heterogeneous policy documents, administrative sources, official reports, and country profiles that are not consistently indexed in bibliographic databases. Evidence was organized across predefined health-system domains: governance, service delivery, financing, workforce, epidemiology, equity, information systems, and quality measurement. Results: Greece combines high dentist density with limited public dental coverage and major financial barriers. Current EOPYY rules list age-specific preventive and treatment benefits, and Dentist Pass provided a preventive dental-care voucher for children; however, no ring-fenced national dental-treatment allocation or nationwide uptake estimate was identified. Most routine adult dental care remains privately financed. Recent Eurostat data indicate that Greece has the highest reported unmet dental care needs in the European Union. Comparative WHO country-profile indicators suggest that Greece’s high dentist density does not, by itself, correspond to lower unmet dental care needs or stronger publicly reported coverage of routine and preventive oral health care. Epidemiological studies show persistent caries, periodontal disease and tooth loss, particularly among children, older adults and socioeconomically disadvantaged groups. Major system-level gaps include limited financial protection, weak integration with primary care, insufficient standardized referral pathways and limited routine measurement of oral health quality and outcomes. Conclusions: The findings suggest that strengthening oral health care in Greece would require a shift from fragmented, curative and privately financed care toward prevention-oriented, publicly accountable and measurable services integrated with universal health coverage and national quality-of-care reforms. Full article

Objectives: To assess differential exposure and differential vulnerability to frequency of unhealthy food consumption in relation to dental caries among 5-year-old children and 12-year-old adolescents in Brazil. Methods: This cross-sectional study included 836 participants, comprising 445 children and 391 adolescents from municipalities in Mato Grosso do Sul, Brazil. Dental caries experience was assessed using the decayed, missing and filled surfaces index for primary teeth among children (dmfs) and permanent teeth among adolescents (DMFS). Unhealthy food consumption was measured according to the weekly frequency of sugar-sweetened beverages and ultra-processed foods and categorized as low, moderate or high. Socioeconomic position was assessed using equivalized per capita household income and parental schooling. Differential exposure was examined by assessing socioeconomic gradients in unhealthy food consumption. Differential vulnerability was assessed using interaction terms between socioeconomic position and unhealthy food consumption in negative binomial regression models. Absolute and relative inequalities were quantified using the Slope Index of Inequality and Relative Index of Inequality. Results: Adolescents from lower-income and lower-education households showed a higher frequency of unhealthy food consumption, whereas this pattern was not clearly observed among children. Socioeconomic inequalities in dental caries were evident in both age groups. However, evidence that socioeconomic position modified the association between frequency of unhealthy food consumption and caries was stronger and more consistent among adolescents. Sensitivity analyses using caries prevalence as a binary outcome supported this pattern. Inequality measures indicated stronger relative socioeconomic gradients among adolescents than among children. Conclusions: Socioeconomic inequalities in dental caries are shaped by unequal exposure to unhealthy food consumption and unequal vulnerability to its effects, particularly during adolescence. Full article

Background: Motor and intellectual disabilities (MIDs) belong to a restricted and vulnerable social group with health restrictions for maintaining and preserving adequate oral health. Silver nanoparticles (AgNPs) have appeared as an encouraging therapy due to their excellent antimicrobial effects; however, scientific information on the antimicrobial effectiveness of AgNPs against bacteria in patients with MIDs remains limited. This study aimed to evaluate the antimicrobial substantivity of AgNPs in oral bacteria from patients with and without MIDs. Methods: Fifty-four oral biofilm samples were obtained from 26 participants with MIDs and 28 participants without MIDs. The microbial inhibition activity and the antimicrobial substantivity of AgNPs were determined. The antibiofilm activity of the AgNPs was explored using scanning electron microscopy (SEM). Results: The AgNPs displayed uniform size distributions (9.8 ± 1.7 nm) and electrical charges in surface particles that limit particle clustering (−39.8 ± 3.3 mV). The AgNPs were more effective than chlorhexidine (CHX) in eliminating bacteria from oral biofilms derived from both MID and non-MID patients (p < 0.05); therefore, the antimicrobial substantivity of the AgNPs was statistically better than deionized water but lower than CHX at specific exposure times (p < 0.05). The antimicrobial effectiveness of AgNPs at even low concentrations was associated with the type of oral biofilm, the type of antimicrobial solution, and, in some cases, gender. SEM images indicate a clear alteration in oral biofilm structure when AgNPs were applied. Conclusions: AgNPs exhibited significant potential to limit oral bacterial proliferation from microbial biofilms while contributing to the maintenance of oral condition in individuals with MIDs. Full article

Early childhood dental caries (ECC) remains one of the most prevalent and preventable chronic diseases affecting young children globally, yet behavioral and contextual determinants of its onset during the first 1000 days of life remain poorly understood and infrequently modeled in Latin American populations. This study presents a novel application of the PRECEDE diagnostic framework to conceptualize Early Childhood Dental Caries during the first 1000 days (1000ECDC) as a behaviorally rooted, socio-ecologically conditioned health problem. Drawing on a formative longitudinal pilot study (n = 10 mother–infant dyads, Caracas, Venezuela) and a complementary narrative literature review, we develop the first PRECEDE-based conceptual model linking maternal prenatal and postnatal behaviors to dental caries risk in a Latin American context. The model identifies dietary and feeding behaviors, oral health care practices, and healthcare service utilization as primary behavioral risk factors, modulated by predisposing factors (low oral health knowledge, limited self-efficacy, cultural norms), enabling factors (socioeconomic constraints, fragmented health systems), and reinforcing factors (social norms, family influence). Exploratory pilot findings indicated that more than 60% of children had advanced dental caries lesions at 24-month follow-up, consistent with regional estimates and underscoring the urgency of early intervention. This model provides practitioners and policymakers with a structured, evidence-informed diagnostic tool to guide the design of early-life oral health promotion programs, with particular relevance for low-resource Latin American settings. Future validation through expert consensus and prospective studies is warranted. Full article

Background/Objectives: Oral diseases are a major public health challenge and share behavioral and socioeconomic determinants with other noncommunicable diseases. Although physical activity has been proposed as one of these shared determinants, evidence at the population level remains limited. This study investigated the association between physical activity and oral health indicators using nationwide Brazilian surveillance data. Methods: An ecological study was conducted using aggregated data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL) and the Brazilian National Oral Health Survey (SB Brasil) (2022–2023). Physical activity participation and weekly volume were evaluated against untreated dental caries, toothache, pain intensity, tooth loss, and the Decayed, Missing, and Filled Teeth (DMFT) index. Weighted multivariable linear regression models with heteroskedasticity-consistent standard errors were applied. Results: The analysis included 28,707 VIGITEL participants and 14,753 SB Brasil observations. After adjustment, physical activity participation was inversely associated with untreated dental caries, whereas weekly physical activity volume showed no association with any oral health outcome. No significant associations were observed for tooth loss, dental pain, pain intensity, or the DMFT index. Conclusions: Higher population-level participation in physical activity was associated with a lower prevalence of untreated dental caries but not with other oral health indicators. These findings may suggest that physical activity and oral health share common behavioral and social determinants, supporting integrated public health strategies targeting upstream risk factors. Full article

Background and Objectives: Individuals with heroin-related opioid use disorder are at high risk of poor oral health and impaired oral health-related quality of life (OHRQoL). However, data on the determinants of OHRQoL in this population remain limited. This study aimed to assess oral health status and OHRQoL and to identify key predictors of OHRQoL among hospitalized patients with heroin-related opioid use disorder. Materials and Methods: A cross-sectional study was conducted among 97 hospitalized patients with heroin-related opioid use disorder. Data were collected through structured interviews and clinical oral examinations, including the Decayed, Missing, and Filled Teeth (DMFT) index and the Simplified Oral Hygiene Index (OHI-S). OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14). Spearman correlation and multiple linear regression analyses were performed to examine associations and identify predictors of OHRQoL. Results: Participants had poor oral health, with high DMFT (19.1 ± 6.1) and OHI-S (2.0 ± 1.2) scores. OHRQoL was markedly impaired, with a mean OHIP-14 score of 29.6 ± 7.0, particularly in the psychological and social domains. OHIP-14 scores were strongly correlated with DMFT (r = 0.754, p < 0.001) and OHI-S (r = 0.552, p < 0.001). Longer duration of heroin use was associated with higher DMFT scores, poorer oral hygiene, and greater OHRQoL impairment. Multiple linear regression analysis identified unstable housing/homelessness (β = 0.166, p = 0.012), DMFT (β = 0.624, p < 0.001), and OHI-S (β = 0.272, p = 0.007) as significant predictors of poorer OHRQoL. Conclusions: Individuals with heroin-related opioid use disorder experienced substantial oral health burden and impaired OHRQoL, strongly associated with caries experience, poor oral hygiene, and housing instability. These findings highlight the need to integrate prevention-oriented dental care into addiction treatment services and to address the broader social determinants of oral health. Full article

Background/Objectives: Access to dental care is a multilevel challenge shaped by healthcare systems, individual characteristics, and broader social determinants. This study aimed to identify parent-reported barriers to dental care among a sample of children in Saudi Arabia using Levesque’s Conceptual Framework for Access to Healthcare. Methods: A cross-sectional survey was conducted between March and April 2023 among parents of children aged 1–18 years. The 44-item survey assessed sociodemographic, oral health, and dental care utilization, organized using Levesque’s access dimensions. Difficulty accessing needed dental care within the past 12 months served as the main outcome. The chi-square test was used to examine bivariate associations between potential barriers and difficulty accessing needed dental care. Multivariable logistic regression was used to identify factors independently associated with difficulty accessing needed dental care after adjustment for the other variables. Results: This study included 351 parents. The mean age of children was 10.7 ± 4.7 years, and 45.9% were male. One-third of parents reported difficulty accessing needed dental care for their children. The adjusted regression model identified fair/poor oral health (aOR = 13.39, 95% CI: 6.19–28.97), general health condition (aOR = 2.31, 95% CI: 1.11–4.82), and the absence of a nearby dental clinic (aOR = 2.08, 95% CI: 1.11–3.90) as factors independently associated with difficulty accessing dental care. Conclusions: Applying Levesque’s framework highlighted the multidimensional nature of barriers to accessing dental care for the study population. These findings provide preliminary evidence on parent-reported access barriers and may inform larger, representative studies and future policies to improve equitable pediatric oral healthcare in alignment with Saudi Vision 2030. Full article

Background/Objectives: Dental caries is socially patterned, but the magnitude of the inequality associated with social exclusion is difficult to quantify when populations are compared across different countries and health systems. This study estimated the oral health gap between socially vulnerable children attending escuelas singulares and a contemporaneous reference paediatric population attending university dental clinics within the same city and health-system context. Methods: A cross-sectional analytical study was conducted in 231 children aged 6–12 years in Valencia, Spain: 129 from two state-funded schools serving communities at high risk of social exclusion, hereafter referred to as escuelas singulares (Colegio Madre Petra, n = 64; Colegio Santiago Apóstol, n = 65), and 102 reference children examined at the University Dental Clinics of the Catholic University of Valencia. Caries experience (DMFT/dmft-derived global score), the Simplified Oral Hygiene Index (OHI-S), toothbrushing frequency and sugar consumption were recorded under standardised conditions. The groups were compared with non-parametric tests, and multivariable logistic and modified Poisson regression models estimated the independent association (adjusted OR and adjusted prevalence ratio, respectively) between school context and the presence of caries, adjusting for age, sex and behaviours. Results: Caries experience was markedly higher in vulnerable children (global caries score 4.07 ± 3.44 vs. 0.61 ± 1.96; p < 0.001), with a caries prevalence of 76.0% vs. 13.7% (a prevalence ratio of 5.5) and a 6.7-fold higher mean burden. Only 24.0% of vulnerable children were caries-free versus 86.3% of reference children. Vulnerable children also showed poorer oral hygiene (OHI-S 1.49 ± 0.84 vs. 0.19 ± 0.34; p < 0.001), less frequent brushing (50.4% vs. 79.4% brushing ≥ twice daily; p = 0.002) and higher sugar consumption (p < 0.001). After adjustment for age, sex, brushing and sugar, attendance at an escuela singular was associated with an adjusted prevalence ratio of 5.4 (95% CI 3.3–8.9; primary effect measure) and, in a secondary logistic model, with an adjusted OR of 20.5 (95% CI 9.6–43.8). Conclusions: Within a single high-income setting with formally universal health coverage, social exclusion was associated with a very large, graded excess of childhood caries that the measured behavioural differences alone were unlikely to explain, underscoring the role of social and structural determinants beyond individual behaviours. These cross-sectional findings are consistent with proportionate-universalism strategies (targeted, school-based preventive and restorative care embedded within the universal system), since formal coverage alone may be insufficient to achieve oral health equity. Full article

Background and Objectives: Oral health is a key but often overlooked component of healthy aging and functional wellbeing in older adults. Population aging, multimorbidity, and social determinants of health interact in order to shape oral disease patterns, particularly in primary care settings. Understanding age- and sex-specific distributions of oral diseases is essential for informing integrated public health strategies aimed at promoting healthy aging. Materials and Methods: We conducted a cross-sectional population-based analysis using the SIMEF primary care database, including 7386 adults aged 60 years and older, who were attended between January and December 2022. Oral diseases were identified using ICD-10 codes K00–K14. Prevalence estimates were calculated by life decade and sex. Associations were assessed using chi-square tests and sex-stratified analyses. Results: The overall prevalence of oral diseases was 5.2%, with a significant and progressive decline across age groups, from 6.5% in sexagenarians to 1.6% in nonagenarians (p < 0.001). The most prevalent conditions were disorders of teeth and supporting structures (2.6%, 95% confidence interval [95% CI] 2.3–3.0), dentofacial anomalies (2.2%, 95% CI 1.8–2.5), and dental caries (1.7%, 95% CI 1.4–2.0). Women showed a slightly higher prevalence of selected oral and mucosal conditions. Among older adults with oral diseases (n = 384), the most frequent comorbidities were hypertension (40.4% 95% CI 35.7–45.3), type 2 diabetes (29.2% 95% CI 24.7–33.8), and dyslipidemia (21.1% 95% CI 17.2–25.3), with marked sex-specific differences in endocrine, urinary, musculoskeletal, and mental health conditions. Conclusions: Oral disease burden in older adults decreases with advancing age but remains strongly linked to cardiometabolic and systemic comorbidities, reflecting shared risk factors relevant to healthy aging. The observed age- and sex-specific patterns underscore the need to integrate oral health into primary care and public health policies targeting aging populations, supporting comprehensive and equitable strategies for healthy longevity. Full article

Escalating healthcare costs and persistent disparities in outcomes have been linked to delayed engagement in preventive care and the ongoing influence of social determinants of health (SDoH). Current care models often assume that individuals can effectively manage their health and seek care at appropriate times, despite evidence that contextual constraints limit this capacity. This perspective proposes that oral health may serve as a practical and scalable entry point for earlier engagement in preventive care. Oral health problems are highly prevalent, behaviorally influenced, clinically observable, and associated with systemic health conditions. We present a six-pillar conceptual framework linking consumer-reported behaviors with clinician-observed oral health status to support risk identification, engagement, and population health strategies. The framework integrates behavioral science, predictive modeling, social risk factors, digital health infrastructure, and policy innovation. We outline a research agenda, identify implementation challenges, and discuss equity considerations. While oral–systemic relationships are well-documented as associations, further prospective and interventional studies are needed to establish causality and population-level impact. Full article

Obesity and dental caries are highly prevalent chronic conditions with significant global health impact. Although an association between these diseases has been suggested, the nature of this relationship remains unclear. This state-of-the-art review aims to synthesize current evidence on the interplay between obesity and dental caries, focusing on shared risk factors, salivary alterations and underlying biological mechanisms. Evidence indicates that obesity and dental caries share common behavioral and socioeconomic determinants, namely unhealthy dietary patterns with high intake of free sugars, poor oral hygiene habits and social disadvantage. Salivary alterations observed in obesity may also create a more cariogenic oral environment. Additionally, inflammatory mediators, oxidative stress markers and changes in the oral microbiome suggest biologically plausible links between both conditions. However, current data does not support a direct causal relationship, but rather a complex multifactorial interaction between obesity and dental caries driven by shared risk factors and modifiable behaviors. Preventive strategies should adopt an integrated approach targeting shared determinants, particularly diet, oral hygiene habits and socioeconomic status. Nevertheless, the predominance of cross-sectional evidence limits causal inference, highlighting the need for longitudinal studies that simultaneously assess obesity and dental caries, and that address salivary biomarkers using standardized methodologies across different age groups to clarify underlying mechanisms and assess their clinical relevance. Full article

Introduction/Objectives: Dental caries is a significant public health burden in Brazil, with regional disparities deeply affecting children in the North and Northeast. This study assessed the prevalence and severity of dental caries in preschool children from Balsas (MA) and investigated its association with fluoride concentrations in the public water supply. Methods: A cross-sectional study was conducted with 256 children (aged 3–5 years) enrolled in municipal schools. Schools were selected using a stratified sampling strategy based on the water network, with exposure validated via chemical analysis. Calibrated dentists performed examinations using the FOA-UNESP risk scale, assessing biofilm and gingivitis as objective clinical proxies for hygiene. Fluoride levels were analyzed using an ion-selective electrode. Statistical analysis included Fisher’s exact test, Kruskal–Wallis, and Multiple Correspondence Analysis (MCA). Results: Caries prevalence was 60.16%, with 41.8% of children in severe risk categories (F: 27.0%; G: 14.8%). Water analysis revealed universal hypofluoridation (0.02–0.34 µg F/mL). A significant association was found between residual fluoride (0.02 µg F/mL) and greater caries severity (p = 0.04). Poor hygiene markers (biofilm and gingivitis) were significantly associated with a higher number of decayed teeth (p < 0.05). MCA identified a cluster linking residual fluoridation to severe clinical conditions and social vulnerability. Conclusions: High caries prevalence associated with inadequate fluoridation highlights critical regional health inequalities in Balsas. These findings underscore the urgent need for policies ensuring universal water fluoridation and strengthening school-based preventive strategies to mitigate the impact of social determinants on child development. Full article

Background/Objectives: The dental setting has been suggested as a location for opportunistic diabetes screenings. Diabetes screening is a pathway consisting of several steps that must be completed to reach a diagnosis. Previous research has found that most patients in the dental setting, when offered the opportunity to screen for diabetes, are willing to do so; however, amongst those who are referred for medical follow-up, there is low compliance. If diabetes screening in the dental setting is to be effective, strategies are required to maximise uptake and ensure completion of the screening pathway. Methods: This qualitative study examined participants in a diabetes screening trial held at dental clinics in Victoria, Australia. Semi-structured interviews were conducted by telephone, transcribed and analysed thematically. The themes identified were then deductively mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Results: Ten individuals who were screened for diabetes and referred to their general medical practitioner (GP) for a diabetes diagnosis were interviewed. The themes identified from the interviews were mapped to five COM-B domains: reflective motivation and automatic motivation, social and physical opportunity and psychological capability. These were linked to eight TDF domains associated with issues related to knowledge, environmental context and resources, memory, attention and decision processes, social influences, beliefs about consequences, emotions, and beliefs about capability. Conclusions: This study investigated the determinants influencing individuals’ decision to participate in diabetes screening and comply with referral advice. The results demonstrate the need to increase community knowledge around diabetes and screening for the condition, facilitate risk interpretation, and streamline the referral pathway between oral health professionals (OHP) and GPs. The study provides evidence that can be utilised for the development of future interventions that promote diabetes screening participation and maximise medical follow-up of referred individuals. Full article

In recent years, social media platforms have emerged as major sources of health-related information. The aim of this study was to evaluate the alignment between TikTok videos on oral hygiene and official dental protocols, and to determine the prevalence of misinformation. A quantitative, observational, cross-sectional study was conducted to analyze 246 Spanish-language TikTok videos collected between May and July 2025 using 11 hashtags. Videos were assessed using a standardized summary based on guidelines from the Fédération Dentaire Internationale, American Dental Association, Federación Odontológica Ecuatoriana, and Federación Dental Española. Content was classified as aligned if it aligned with at least one protocol. Statistical analyses included descriptive statistics, Z-tests for proportions, chi-square tests, and Mann–Whitney U tests. As results, only 1% of videos cited official references. Overall, 26.19% aligned with at least one protocol, while 73.81% contained unsupported or non-aligned information. Misrepresentation was most frequent for fluoride concentration, toothpaste quantity, dental floss characteristics, and mouthwash use. Video format, presentation style, and creator profile were significantly associated with accuracy. Engagement metrics did not consistently favor accurate content. In conclusion, most TikTok oral hygiene content does not reflect official dental protocols, highlighting the need for improved digital health literacy and responsible professional communication. Full article

Background/Objectives: Adolescence is a critical developmental stage during which lifestyle and dietary habits are established, influencing both general and oral health outcomes. Territorial disparities between rural and urban environments may contribute to nutritional inequalities and health vulnerabilities. The aim of this study was to analyze differences between rural and urban environments in terms of lifestyle behaviors, dietary patterns, and oral health outcomes among adolescents in Mallorca, Spain. Methods: A cross-sectional study was conducted among 463 adolescents corresponding to the WHO index ages (12 and 15 years). Data were collected through questionnaires assessing dietary habits, oral hygiene behaviors and lifestyle characteristics. Clinical oral examinations were performed following the World Health Organization Pathfinder methodology. Statistical analyses included descriptive statistics and comparative analyses between rural and urban populations. Results: Urban adolescents reported higher consumption of sugar-sweetened beverages and ultra-processed foods (p < 0.001), whereas rural adolescents showed higher weekly physical activity (4.45 ± 2.34 vs. 3.62 ± 2.41 h/week; p < 0.001). Caries prevalence was higher in rural students (45.0% vs. 28.6%; p < 0.001), who however demonstrated better periodontal indicators. Conclusions: Geographic environment is associated with differences in dietary patterns, physical activity levels, lifestyle behaviors, and oral health outcomes among adolescents. These findings highlight the importance of targeted public health interventions adapted to geographic context and support the role of broader social and environmental determinants in adolescent oral health. Full article