Oral health: prevention is key

The 2020-25 Dietary Guidelines identified dental caries as a diet-related chronic disease of major importance. Preventing dental caries and other oral infectious diseases is critical to maintaining an individual’s capacity to chew food, consume nutrient-rich diets, and sustain optimal nutrition status. Pain and infection from dental caries complicates consumption of adequate amounts of fruits, vegetables, dairy, and lean protein recommended in the Dietary Guidelines. Nutrition and dietary intake can affect the development and integrity of oral cavity and progression of oral diseases. Increased snacking throughout the day in place of three-meals daily raises the risk of obesity and dental caries throughout the life cycle. Older adults who make routine oral health preventive practices, such as brushing, cleaning between teeth, drinking fluoridated water, and chewing sugarfree gum to increase saliva flow can reduce dental caries and oral infectious diseases. Professionals must also consider the impact of sugar-sweetened beverages and sugar intake.

Tobacco cigarette smoking is a well-established risk factor for oral diseases, especially periodontal diseases. Over the past few years, electronic cigarettes (or "E-cigarettes") have gained popularity. There is some evidence that e-cigarettes may play a role in helping people quit smoking, and they are occasionally seen as a less dangerous alternative to tobacco use. However, there are worries about their effects on health, notably in terms of oral health and the emergence of periodontal disease. Limited information is available regarding the effect on oral disease. E-cigarettes come in a variety of nicotine strengths and flavoring combinations, all of which have been associated with detrimental oral health issues. A growing body of research supports the idea that vaping or using electronic cigarettes may increase the chance of developing oral health problems such as tooth decay, gum disease, periodontal disease, cracked or broken teeth, and pain in the tongue or inside of the cheek. Even if e-cigarettes were less harmful, they still could lead to the development of periodontal diseases through the decreased antioxidant capacity of saliva, the inflammatory effect, cell injury, and impaired reparability. High levels of nicotine content and menthol-favoring additives increase risk of periodontal damage in e-cigarette users. However, conflicting study results are also published for smokers who transitioned to e-cigarettes. Even though benefits or value of e-cigarettes as a substitute for tobacco cigarettes are still unknown, their impact on periodontal and general health status is still prominent.

BackgroundA large number of older people depend on others for help with their daily personal care, including oral health care. Nursing home and elder-care staff often face challenges identifying older people, who are exposed to or at an increased risk of oral diseases. Thus, the aim of this study was to identify risk factors that non-dental care staff can use to identify older people at risk of oral diseases and poor oral hygiene.MethodsIn this cross-sectional study, the oral health and risk factors for poor oral health were determined for 217 care dependent older people living in two nursing homes and a rehabilitation centre or receiving home care in two Danish municipalities. The outcome variables for oral disease i.e. caries, periodontitis, and gingivitis, and oral hygiene, i.e. plaque and calculus, were assessed using standardised oral examinations. Risk factors for oral diseases and poor oral hygiene were assessed based on a questionnaire concerning (1) background information, (2) health status, (3) social support, (4) oral health behaviours, and (5) self-reported oral health. The associations between oral health and risk factors were investigated using logistic regression analyses.ResultsIn general, older people with different living arrangements had quite similarly distributed risk factors. The oral examinations showed that 54.5% had oral diseases, and 14.8% had poor oral hygiene. Not seeing a dentist regularly was significantly associated with having oral diseases (Odds Ratio, 2.87; CI, 1.53–5.39) and poor oral hygiene (OR, 4.50; CI, 1.83–11.05). A significant association was found between the presence of an oral disease and adversely affected quality of life (OR, 2.65; CI, 1.42–4.95), especially due to challenges eating (OR, 3.76; CI, 1.64–8.60) and/or smiling and showing teeth (OR, 3.64; CI, 1.27–10.42). A significant association was also found between poor oral hygiene and taking psychotropic drugs (OR, 2.61; CI, 1.08–6.30).ConclusionQuestions regarding the use of the dental care system and oral health problems could be used by nondental care staff in conversations with older people to determine their risk of oral diseases and poor oral hygiene.

Good oral health is necessary to overall health and well-being. Most oral diseases, and in particular dental caries, are entirely preventable. However, in 2010, 3.9 billion people were globally affected by oral conditions, and the global prevalence of untreated caries in permanent teeth was 35.3%. The contemporary thinking is that dental caries starts as an infectious disease which then becomes a chronic disease. Public health measures and other caries-preventive approaches have resulted in dramatic reductions in dental caries across populations. However, in a given population, not all individuals have experienced these successes uniformly. High-risk populations, defined as those with a ‘higher-than-expected risk', exist for most diseases and conditions including caries. The global scientific literature suggests that these are the following: (1) minorities, (2) individuals with low-socioeconomic status and (3) other vulnerable populations such as the very young and elderly who continue to battle with oral health disparities by experiencing higher oral disease levels including dental caries. As the science and resources exist to prevent caries, it is essential to identify and target these high-risk individuals and populations.

Redefining the non-communicable disease framework to a 6 × 6 approach: incorporating oral diseases and sugars

The immune system plays a critical, albeit complex, role in oral health, mediating the host response to microbial challenges that lead to prevalent diseases like periodontal disease and dental caries. While essential for protection, immune responses, particularly chronic inflammation, can paradoxically contribute significantly to tissue destruction. This comprehensive review uniquely integrates recent advances in oral immunology with clinical applications, providing novel insights into immunomodulatory therapeutic strategies that distinguish it from previous reviews by emphasizing translational approaches and personalized immunogenetic‐based interventions. This review synthesizes current understanding of the intricate interplay between the oral microbiome, innate and adaptive immunity, and the pathogenesis of periodontal disease and caries. We investigate how key immune cells (neutrophils, macrophages, and lymphocytes) and mediators (cytokines and chemokines) orchestrate responses that can lead to alveolar bone loss and enamel demineralization. Saliva′s crucial role in modulating oral immunity is also highlighted. The clinical significance of this work lies in its potential to guide evidence‐based immunomodulatory treatments, improve patient outcomes through personalized therapeutic approaches, and reduce the systemic health burden associated with chronic oral inflammatory diseases. By dissecting these immunological mechanisms, this article is aimed at underscoring the potential for developing novel, targeted immunomodulatory strategies—including vaccines, host modulation therapies, and personalized approaches based on immunogenetics—for more effective prevention and management of these common oral diseases, ultimately promoting better oral and systemic health.

A comprehensive summary of evidence about oral health in slum settings that could inform policy directions is lacking. To summarise the latest evidence regarding oral disease burden and their determinants, perceptions, practices, and service utilization in the slums and non-slum urban settings of LMICs. Systematic review. Embase and MEDLINE (Ovid); PubMed; Scopus, Web of Science, CRD DARE Database; ELDIS; Essential Health Links; HINARI; African Index Medicus (AIM); and Bioline International, all searched from January 2000 to June 2023 using slum-related terms. Empirical studies of all designs were eligible. Studies published in English with full-text available and reporting disease burden, perceptions, behaviours and service utilisation related to oral health of residents of slums or broader settings including slums in low and middle-income countries were included. Studies were categorised and data were extracted and charted according to a preliminary conceptual framework refined by emerging findings. The Mixed Methods Assessment Tool (MMAT) was used to appraise the quality of empirical studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and (where applicable) the Synthesis Without Meta-analysis (SWiM) guideline were adopted for guiding synthesis and reporting. Results were tabulated and narratively summarised. Full-text articles for 56 records were assessed for eligibility and 23 of the articles were included in this review. The majority (13 studies, 57%) were conducted in Asia, and nine studies (39%) in Africa. Six focused on slums (two examined slum and urban non-slum and four examined purely slum settings), two examined general urban settings, eight included both rural and urban areas in their settings, two examined disadvantaged/low socioeconomic, one assessed rural/urban/metropolis/municipal/district, three covered the national population or whole country, and one looked at high versus low socioeconomic regions. The commonest oral diseases reported were dental caries (prevalence: 13% - 76%), and periodontal diseases (prevalence: 23% - 99%). These were higher in slum settings and showed differences across age groups, gender, and socioeconomic classes. Most participants in the studies perceived their oral health status as satisfactory, a belief commoner among younger people, males, those in higher socio-economic classes, and employed. Mouth cleaning was mostly once daily, usually in the mornings. The use of toothpaste and brush was commonest. Other oral hygiene implements included toothpowder, chewing-stick, neem, charcoal, sand, snuff, salt, and the fingers. There was widespread engagement in home remedies for oral disease cure or prevention, while the use of professional dental care facilities was generally low and problem-driven. The systematic review identified a sparse body of literature on oral health surveys in slums and other urban settings in LMICs. Available data suggest a high oral disease burden, worse in slums, use of inappropriate mouth cleaning tools, self-care practices for pain relief, and few visits to care facilities. Systematic review registration with PROSPERO in February 2020, number CRD42020123613.

Scientific Investments Continue to Fuel Improvements in Oral Health (May 2000–Present)

Introduction: Oral diseases being a preventable oral condition and a non-communicable disease could be of little concern but about 3 billion people suffer from these conditions worldwide. This study seeks to evaluate the means and methods of oral hygiene and disease prevention in the city of Douala by adults. The population of Douala is chosen due to the fact Douala is a metropolitan city and most representative of the Cameroonian population in which similar studies have not been carried out. Methodology: A cross-sectional questionnaire study was carried out with random sampling of 498 participants. Data was collected using a questionnaire based on the objectives which included identifying the means and methods used, the behaviors of the population in relation to oral disease prevention, the reasons for the behaviors and the methods and used as well as determining their satisfaction in oral disease prevention using the latter means, methods and behaviors. The data inputted, organized and analyzed using Microsoft excel 2016 and SPSS version 26. In addition to percentages, chi square and regression analyses were carried out and represented for various variables in the questionnaire. Results: It was found out that the population of Douala generally had an above average satisfaction in oral disease prevention due to the use of more conventional means and methods like toothbrushes (94.78%) and bicarbonate mouthwash (27.4%) while the main traditional substance was the neem extract (18.75%), and green tea extracts (16.67%). Their main reasons for using these methods were effectiveness (38.55%), low cost (20.88) and availability (20.08%) with a significant relationship between traditional methods and low cost. Majority of the population used both conventional and traditional methods (55.16%). The studied population show better oral hygiene and disease prevention with a higher level of education and greater monthly allowance. Conclusion: After this evaluation, proper oral healthcare in disease prevention produces satisfaction with oral hygiene at least twice a day with toothbrush and bicarbonate mouthwash, carrying out routine dental visits, participating in sensitization which are directly related to education and finances. In the same light, traditional methods include chew stick, extracts like green tea and neem.

Dental caries and periodontal diseases have historically been considered the most important part of the global burden of oral diseases. At present, the distribution and severity of oral diseases vary in different parts of the world and within the same country or region. Dental caries is still a major public health problem in most industrialized countries, affecting 60-90% of schoolchildren and the vast majority of adults. It is also a prevalent oral disease in several Asian and Latin American countries, while it appears to be less common and less severe in most African countries. It is expected, however, that the incidence of dental caries will increase in the near future in many developing countries of Africa, as a result of growing consumption of sugars and inadequate exposure to fluorides. The significant role of socio-behavioural and environmental factors in oral disease and health is demonstrated in a large number of epidemiological surveys. The current pattern of dental caries reflects primarily distinct risk profiles across countries (related to living conditions, lifestyles and environmental factors) and the implementation of preventive oral health systems. In some industrialized countries there has been a positive trend in the reduction of tooth loss among adults in recent years, though the proportion of edentulous persons in the elderly population is still high in some countries. In most developing countries, access to oral health services is limited and teeth are often left untreated or are extracted because of pain or discomfort. Tooth loss and impaired oral function are therefore expected to increase as a public health problem in many developing countries. Tooth loss in adult life may also be attributable to poor periodontal health. Severe periodontitis, which may result in tooth loss, is found in 5-15% of most populations. In industrialized countries, studies show that tobacco use is a major risk factor for adult periodontal disease. With the growing consumption of tobacco in many developing countries, the risk of periodontal disease and tooth loss may therefore increase. Oral cancer is closely related to the use of tobacco and excessive consumption of alcohol. The prevalence of oral cancer is particularly high among men, and is the eighth most common cancer worldwide. In south and central Asia, consumption of tobacco in various forms is particularly high, and cancer of the oral cavity ranks among the three most common types of cancer. Periodontal disease and tooth loss are also related to chronic diseases such as diabetes mellitus: the growing incidence of diabetes may further impact negatively on oral health of people in several developing countries. …

Despite great improvements in oral health in the past decades, oral disease remains a major public health problem worldwide. The burden of oral disease is particularly high among the disadvantaged population groups in both developing and developed countries. The pattern of oral disease reflects distinct risk profiles across countries that are related to living conditions, lifestyles, environmental factors, and the availability and accessibility of oral health services. In several developing countries, people at large do not benefit from preventive oral health programmes. It is expected that the incidence of dental caries will increase in the near future in many of these countries as a result of growing consumption of sugars and inadequate exposure to fluorides. With the rising use of tobacco in developing countries, the risk of periodontal disease, tooth loss and oral cancer may therefore increase. Several oral diseases are linked to non-communicable chronic diseases or conditions that share common risk factors, such as diabetes, obesity and cancer. Similarly, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS).

Oral health at a tipping point

Dental caries is the most common of all chronic childhood diseases. Parenting practices can either contribute to or protect against the formation of dental caries in children. Because children rely on parents and caregivers for oral disease prevention and treatment, parents and caregivers must be motivated to use oral disease prevention behaviors that are based on accurate information. A survey was administered to 582 WIC recipients in rural southern Illinois to assess mothers’ knowledge, opinions, and behaviors related to oral health. Deficits existed in mothers’ ability to identify drinks, foods, and behaviors that contribute to or protect against dental caries development. Nevertheless, most believed that they did not need additional oral health education in order to take good care of their children’s teeth. Many women reported having untreated caries in their own mouth, failed to have annual professional dental cleanings, and did not have a dental home. A multidisciplinary approach to early intervention is needed to promote oral wellness in one of the most vulnerable populations. WIC staff are positioned to share responsibility in children’s oral health through consistent and effective nutrition and oral health counseling.

Saliva is an important body fluid in the oral cavity containing lots of biomarkers, whose inherent micro-ecosystem holds significant value for early diagnosis and monitoring of oral diseases. Simultaneously, saliva has particular advantages, such as ease of sampling, painless and non-invasive collection, and suitability for repeated sampling, making it highly appropriate for surveillance and follow-up of diseases. In a series of studies conducted by the research group for preventive dentistry in Peking University School and Hospital of Stomatology, we compared different segments of saliva and those samples collected via different sampling methods using proteomic/peptidomic and microbiomic technologies to explore the stability of saliva samples. Besides, the significance of applying representative salivary biomarkers in early prevention and control of representative oral diseases (e.g. dental caries, periodontal diseases) and systemic conditions (e.g. type 2 diabetes mellitus, chronic kidney disease) was confirmed as well.

Position of the American Dietetic Association: Oral Health and Nutrition