Community dentistry and oral epidemiology最新文献

{"title":"Can the Relationship Between Breastfeeding and Malocclusion in Primary Dentition Change According to Pacifier Use Duration and Intensity? Evidence From a Birth Cohort Study","authors":"Fernanda Burkert Mathias,&nbsp;Marília Leão Goettems,&nbsp;Flávio Fernando Demarco,&nbsp;Marlos Domingues,&nbsp;Mariana Gonzalez Cademartori","doi":"10.1111/cdoe.70079","DOIUrl":"10.1111/cdoe.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate whether the association between exclusive breastfeeding and malocclusions in primary dentition is modified by pacifier use duration and intensity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from a birth cohort study conducted in southern Brazil were used (<i>n</i> = 3591). Poisson regression with robust error variance was used to assess the association between exclusive breastfeeding and malocclusion. The exposure to exclusive breastfeeding was collected through information about breastfeeding duration at 3 and 12 months follow ups. Malocclusion outcomes were assessed at 48 months of follow up using criteria of the World Health Organization. Effect measure modification (EMM) analysis was adopted to verify the association between exclusive breastfeeding and malocclusions, which vary according to pacifier use duration and intensity. EMM was assessed by means of the relative excess risk due to interaction (RERI), which corresponds to the additional risk that would be expected if the combination of exclusive breastfeeding and pacifier use intensity and duration was fully additive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children who were not exclusively breastfed for 6 months and who used a pacifier throughout the first 4 years showed a prevalence of 7.82 higher than malocclusion (95% CI 4.70–12.92). Even among children who were exclusively breastfed, pacifier use during this period was also associated with a higher prevalence of malocclusion (PR 5.98; 95% CI 3.50–10.21). When occurrence of malocclusion by pacifier use intensity at 48 months was analysed, children full-time users and those children who were not exclusively breastfed presented a malocclusion prevalence of 4.87 (95% CI 3.43–6.93), and those children who were full-time users and who were exclusively breastfed showed a prevalence of 3.96 higher for malocclusion (95% CI 32.66–5.90). Positive RERI for both duration and intensity of pacifier use were observed, suggesting that the joint effect of breastfeeding and pacifier use on malocclusion is larger than the sum of their individual values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pacifiers use duration and intensity in the first 4 years of life modify the protective effect of exclusive breastfeeding for the first 6 months of life on the malocclusion prevalence at 48 months of life. These findings reinforce the deleterious effects of pacifier use on occlusal development, even with the practice of exclusive breastfeeding.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 5","pages":"613-621"},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Oral Health Status Predict Incident Frailty Over the 13-Year Follow-Up in Older Adults in England?","authors":"Egle Petrauskiene,&nbsp;Paola Zaninotto,&nbsp;Anja Heilmann,&nbsp;Anne Peasey,&nbsp;Georgios Tsakos","doi":"10.1111/cdoe.70067","DOIUrl":"10.1111/cdoe.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to assess longitudinal associations between oral health and incident frailty, assessed by a multidimensional frailty index, in a national sample of older adults in England with participant mortality and drop out considered as competing risks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A nationally representative sample of adults aged ≥ 50 from the English Longitudinal Study of Ageing (ELSA) was analysed. Oral health was assessed using edentulousness, self-rated oral health and the Oral Impacts on Daily Performances (OIDP) measures. Frailty was evaluated with the Rockwood frailty index. Competing risks regression models assessed the association between oral health at Wave 3 (2006/7) and incident frailty up to Wave 9 (2018/19), sequentially adjusting for demographic characteristics, socioeconomic factors and smoking, and accounting for participants' mortality and dropout.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 5760 non-frail respondents at baseline, 1395 (24.2%) became frail during the 13-years follow-up. Edentate males had 1.40 (1.12<b>–</b>1.76) times higher risk of incident frailty than dentate males, whereas the association was not significant among females. Respondents with fair or poor self-rated oral health had 1.48 (1.29<b>–</b>1.70) times and those that reported oral impacts had 1.85 (1.54<b>–</b>2.21) times higher risk of incident frailty than those reporting better oral health and no oral impacts respectively. Oral impacts on functional aspects (i.e., difficulties eating and speaking) were associated with increased incident frailty risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Poor oral health can serve as a ‘canary in the coal mine’ and act as an early marker of frailty development among older adults in England. Future research should investigate whether public health strategies, such as oral health promotion and disease prevention, can help reduce the risk of frailty in later life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 5","pages":"556-567"},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Parent-Reported Caries in Preschool Children From the KUNO-Kids Health Study—Repeated Cross-Sectional Analysis","authors":"Áine M. Lennon,&nbsp;Katharina Fluch-Maier,&nbsp;K.-A. Hiller,&nbsp;Isabelle Schenke,&nbsp;Nils Gade,&nbsp;W. Buchalla,&nbsp;Susanne Brandstetter,&nbsp;Angela Köninger,&nbsp;Michael Melter,&nbsp;Christian Apfelbacher,&nbsp;Michael Kabesch,&nbsp;KUNO-Kids Study group","doi":"10.1111/cdoe.70078","DOIUrl":"10.1111/cdoe.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This questionnaire-based study aimed to assess parent-reported caries (PRC) at ages 2–5 years and identify potential influencing factors using an exploratory, repeated cross-sectional analysis within an ongoing birth-cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Parental factors included health, socioeconomic status, maternal age and dental check-up attendance. Child factors included birth mode and weight, antibiotic, probiotic, bottle use, early dentition, weaning age, oral hygiene, diet, body mass index (BMI) and mouth-breathing. Environmental factors included sibling caries, contact with other children, pets, or farms. Families (<i>n</i> = 1296) who completed the 2-year caries questionnaire were included, corresponding numbers were 1276 at 3 years, 993 at 4 years, and 768 at 5 years. A subgroup comprised children who had visited a dentist since their last birthday (<i>n</i> = 735, at 2 years, <i>n</i> = 951, 891 and 662 at 3, 4 and 5 years respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PRC rate was 0.4%, 1.3%, 2.7% and 4.4% for ages 2–5. Rates were 0.4%, 1.6%, 3.3% and 4.7% for the subgroup at the same ages. At Age 2, maternal migration background, lower paternal education and unemployment, late weaning, infrequent maternal dental check-ups and pet contact were associated with PRC. Except for paternal education, the same factors remained associated in the subgroup. At Age 3, single-parent status, maternal physical health, late weaning, sibling caries and pet contact were significantly associated with PRC. With the addition of infrequent maternal dental check-ups, the same factors remained associated in the subgroup. At Age 4, early dentition, mouth-breathing aged 1 were associated with PRC. Including late weaning, the same factors remained significantly associated in the subgroup. At Age 5, poor dietary and toothbrushing behaviour aged 2, younger mother, low BMI aged 1, infrequent maternal dental check-ups, pet contact, and pacifier hygiene were associated with PRC. Except dietary behaviour aged 2, with the addition of paternal employment, the same factors were significantly associated in the subgroup.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study identifies key parental, child, and environmental risk factors for early childhood caries, revealing novel factors for further investigation and targeted prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 5","pages":"596-612"},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor Regarding “Socio-Economic Differences in the Oral Health of Irish Adolescents: The Potential Role of Behavioural, Material and Psychosocial Factors”","authors":"Vinay Sharma,&nbsp;Michael O'Sullivan,&nbsp;Lewis Winning,&nbsp;Oscar Cassetti,&nbsp;Aifric O'Sullivan,&nbsp;Bahman Honari,&nbsp;Michael Crowe","doi":"10.1111/cdoe.70118","DOIUrl":"10.1111/cdoe.70118","url":null,"abstract":"","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 5","pages":"633-636"},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Socio-Economic Differences in the Oral Health of Irish Adolescents: The Potential Role of Behavioural, Material and Psychosocial Factors","authors":"Maajid Mohi Ud Din Malik","doi":"10.1111/cdoe.70100","DOIUrl":"10.1111/cdoe.70100","url":null,"abstract":"","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 5","pages":"631-632"},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Modified Oral Status Survey Tool: Development and Psychometrics for Accessible Oral Health Data Collection","authors":"Katrina Byrne,&nbsp;Blánaid Daly,&nbsp;Philip McCallion,&nbsp;Mary McCarron,&nbsp;Caoimhin Mac Giolla Phadraig","doi":"10.1111/cdoe.70052","DOIUrl":"10.1111/cdoe.70052","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Understudied populations such as those with intellectual disabilities (ID) face significant disease burden and oral health disparities. Systematic exclusion from oral health research contributes to resultant health inequalities, limits understanding of the determinants and implications of disease, and hinders the ability to improve health through evidence-based policy and healthcare planning. This study reports the development of the Modified Oral Status Survey Tool (MOSST), an accessible, low burden oral health assessment tool designed for use with populations who require communication and cognitive supports. It explores the MOSST's key measurement attributes: conceptual coverage, content validity, reliability, feasibility, and cost.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Method&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The study followed an iterative tool development process. The MOSST was tested in two steps: (1) attribute testing of an interim version (MOSST v0.1) for inter and intra-rater reliability, burden, cost and feasibility; and (2) content validity testing of MOSST v1.0 using an expert and a Public and Patient Involvement (PPI) panel. Field testing involved data collection from Wave 5 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), with data from &lt;i&gt;n&lt;/i&gt; = 469 participants undertaking a MOSST assessment.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Data from &lt;i&gt;n&lt;/i&gt; = 469 adults with ID were analysed. The MOSST demonstrated very strong/strong inter- and intra-rater reliability for tooth count (ICC = 0.999), denture wear, occlusal pairs, and oral pain (k = 0.808–1.00). Content validity was confirmed through expert and PPI panel reviews; item-level Content Validity Indices (iCVI) ranging from 0.85 to 1.00 were gained from the expert panel responses to measure agreement. This review process led to refinements, including replacing items representing occlusal function with functional tooth units and relocating the subjective oral pain item. This led to a final MOSSTv1.0 tool and associated training, protocol and resources. The MOSST was acceptable: 98% (&lt;i&gt;n&lt;/i&gt; = 65) reporting data collection process acceptable; 100% (&lt;i&gt;n&lt;/i&gt; = 66) painless and 100% (&lt;i&gt;n&lt;/i&gt; = 66) not time-consuming. The cost per assessment was low (approx. €6.69) due to low equipment and staff costs.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The MOSST is a seven-item tool recording indicators of oral function and disease. It was shown to be reliable, valid, and feasible for use by non-dental assessors among people w","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 5","pages":"546-555"},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public Dental Expenditure and Dental Visits in Europe and Japan","authors":"Yuko Inoue,&nbsp;Jun Aida,&nbsp;Richard G. Watt,&nbsp;Anja Heilmann","doi":"10.1111/cdoe.70076","DOIUrl":"10.1111/cdoe.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dental care is important for oral health, but access to dental services is subject to social inequalities and varies between countries. Despite this, few cross-national studies have examined how public dental expenditure relates to dental service use among older adults. This study aimed to investigate the associations between public dental expenditure and dental visits among older adults using an international comparative design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were obtained from the Survey of Health, Ageing and Retirement in Europe (SHARE, Wave 8, 2019), covering 25 European countries and Israel, and the Japanese Gerontological Evaluation Study (JAGES, 2019). The final sample included 48 497 adults aged 65 years or older. The outcome was any dental visit in the past year, while the explanatory variable was country-level annual per capita public dental expenditure on outpatient dental care in 2019 (USD), obtained from the OECD database and adjusted for purchasing power parity. A multilevel modified Poisson regression model was used to estimate prevalence ratios (PRs), accounting for between-country variability. Interaction terms between household income and public dental expenditure were included to examine effect modification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall dental visit rate was 59.5%, with higher rates among women, those with higher education, and those in higher income groups. Each $10 increase in per capita public dental expenditure at the country level was associated with higher dental visit rates (PR: 1.05, 95% CI: 1.03–1.07). The association was stronger among lower-income groups, suggesting that income-related inequalities in dental visits were smaller in countries with higher public dental expenditure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Public expenditure on dental care was associated with higher dental visit rates, particularly among low-income groups. These findings suggest that public financing of dental care may help reduce income-related inequalities in dental visits among older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 5","pages":"578-587"},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation Into the Effectiveness of Community Water Fluoridation and Dental Caries Experience in 4-Year-Old Aotearoa New Zealand Children: A National Repeated Cross-Sectional Study From 2010 to 2022","authors":"Tim Chambers,&nbsp;Philip J. Schluter,&nbsp;Frank Dean,&nbsp;Matt Hobbs,&nbsp;Jonathan Broadbent","doi":"10.1111/cdoe.70080","DOIUrl":"10.1111/cdoe.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To provide contemporary national evidence on the effectiveness of community water fluoridation (CWF) for the prevention of early childhood caries (ECC) among 4-year-old children in Aotearoa New Zealand (NZ), and to examine potential effect modification by ethnicity and other sociodemographic characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A national repeated cross-sectional study was conducted using routinely collected B4 School Check data (2010–2022). Children aged 4 years were linked to a national spatial dataset of water distribution zones and council-reported fluoridation histories to classify exposure over the assessment year and preceding 3 years. ECC was identified via the ‘lift-the-lip’ screening. Multilevel mixed-effects modified Poisson regression models, with children nested within meshblocks, estimated incidence rate ratios (IRRs), adjusting for ethnicity, area-level deprivation, age, sex, rurality, and assessment year. Two-factor interactions were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 630 926 children, 14.2% had ECC. In crude analyses, ECC appeared more common in fluoridated areas; however, after adjustment for sociodemographic characteristics, CWF was associated with a lower rate of ECC (IRR = 1.13; 95% CI: 1.11–1.15 for non-fluoridated vs. fluoridated). A significant interaction between CWF and ethnicity was observed. The protective association was strongest among European/Other children (IRR = 1.25; 95% CI: 1.21–1.29) and attenuated among Māori and Asian children, with minimal effect among Pacific children. The ethnicity-weighted population attributable fraction was 4.4%, equating to approximately 282 ECC cases annually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings are consistent with CWF being an effective population-level oral health intervention. However, its association with caries experience varies by ethnicity, highlighting the importance of addressing structural inequities alongside universal preventive strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 5","pages":"622-630"},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural Determinants and the Limits of the Clinical Model in Periodontal Disease","authors":"Fábio R. M. Leite,&nbsp;Gustavo G. Nascimento,&nbsp;Marco A. Peres","doi":"10.1111/cdoe.70107","DOIUrl":"10.1111/cdoe.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Periodontitis remains one of the most prevalent chronic diseases worldwide and is strongly socially patterned. However, contemporary disease classifications and guideline-based management largely emphasise individualised, clinically intensive, long-term maintenance approaches. Whether these models are feasible, equitable, or sustainable when applied at the population level has received little attention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We synthesised evidence from global and national epidemiological studies, health systems research, clinical practice guidelines, and health policy analyses to examine the implications of current periodontitis classifications and care models for service demand, workforce capacity, equity, and universal health coverage. We developed a conceptual framework linking disease definitions, recommended care intensity, and health system constraints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Current periodontitis classifications and maintenance-oriented care recommendations generate levels of service demand that substantially exceed the capacity of most oral health systems. This creates a feasibility paradox whereby increasingly comprehensive disease definitions and intensive maintenance schedules lead to implicit rationing of care and socially patterned access, disproportionately disadvantaging populations already at highest risk. The prevailing clinical paradigm also places limited emphasis on structural determinants of disease, population prevention, and value-based allocation of resources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A population-oriented reorientation of periodontal care is needed. We propose a framework that prioritises documented disease progression, risk of harm, and person-centred outcomes; aligns treatment intensity with expected benefit through risk-based and value-oriented approaches; and explicitly incorporates health system capacity together with the structural and commercial determinants of health. Moving beyond maintenance-for-all models toward feasible, equitable, and system-aware strategies is essential to reducing the population burden of periodontitis and advancing universal health coverage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 5","pages":"517-526"},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Dental Treatment and Glycemic Control in Primary Health Care Patients With Type 2 Diabetes: A Retrospective Cohort Study","authors":"Carlos Oviedo Contreras,&nbsp;Marco Cornejo Ovalle","doi":"10.1111/cdoe.70074","DOIUrl":"10.1111/cdoe.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Type 2 diabetes mellitus (T2DM) and periodontal disease are linked through a bidirectional inflammatory relationship that can impair glycaemic control. This study aimed to evaluate the association between comprehensive dental treatment and glycaemic control in adults with T2DM enrolled in Chile´s Cardiovascular Health Programme (CVHP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study was based on routine electronic health records from primary care services in La Reina, Chile, between 2021 and 2023. The exposure variable was the completion of comprehensive dental treatment, and the outcome was final glycated haemoglobin (HbA1c), analysed both as a continuous measure and as a binary indicator of glycaemic compensation. Multivariable linear and logistic regression models were fitted, adjusted for baseline HbA1c, age, sex and body mass index (BMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final analytical cohort included 392 participants (196 treated and 196 untreated). The balanced group sizes resulted from the inclusion of all eligible individuals with complete HbA1c data from each exposure category rather than from sampling or matching. Comprehensive dental treatment was associated with lower mean final HbA1c values (<i>β</i> = −0.94; 95% CI: −1.15 to −0.72; <i>p</i> &lt; 0.001) and was also associated with lower odds of final glycaemic decompensation in the adjusted logistic model (OR = 0.19; 95% CI: 0.10–0.34).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Comprehensive dental treatment was significantly associated with improved glycaemic control among adults with T2DM. These findings reinforce the relevance of integrating oral health care into chronic disease management and align with person-centred, multimorbidity care frameworks. Further prospective research is warranted to confirm causality and inform public health policy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"54 5","pages":"568-577"},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}