Using creative, collaborative engagement in an oral health community intervention

Oral health is a multidimensional concept, shaped by biological, behavioral, social, and structural factors, and represents a fundamental element of overall health and wellbeing 1 . Even though dental caries remains one of the most prevalent oral diseases worldwide, it reflects only one aspect of broader inequalities in oral health. These are influenced by unequal distribution of resources, opportunities, and health awareness 2 . Amongst these factors, parental education level and socioeconomic status stand out as key factors that significantly influence the course of oral health in children 3 . Families with low levels of education or limited socioeconomic resources often face cumulative obstacles, including low levels of oral health awareness, limited access to preventive dental services, and increased exposure to unhealthy environments 4,5 . These social factors not only shape oral hygiene behaviors and dietary habits, but also determine the family's ability to cope with health systems and adopt preventive practices, thus perpetuating intergenerational inequalities 2,6 .Despite strong evidence linking parental education, socioeconomic status and oral health outcomes, the mechanisms by which these factors operate are still not adequately covered in the global public health discourse 3 . The differences between countries highlight the structural nature of these inequalities, underscoring the need for comprehensive, system-wide strategies to promote health equity 7,8 . This editorial brings together emerging evidence from diverse settings to illustrate how parental education and socioeconomic status act as overarching determinants of children's oral health. Rather than summarizing individual contributions in isolation, the editorial critically analyzes common themes, identifies persistent knowledge gaps, and considers their implications for public health policy, preventive dentistry, and health equity initiatives.Across all the included studies, a consistent pattern emerges linking parental knowledge, social support structures, socioeconomic conditions, broader social determinants, and children's oral health outcomes. Taken together, the evidence reinforces the central role of families and contextual factors, as described in conceptual models of oral health inequalities, in shaping caries experience, hygiene behaviors, service utilization, and developmental conditions affecting teeth. health status and related behaviors. Higher health literacy and family socioeconomic status were strongly associated with better oral health outcomes, while gender-based differences reflected variations in societal expectations and health communication.These findings reinforce the influence of cultural and educational determinants on adolescent oral health and are consistent with global evidence highlighting the interaction between social context and health behaviors.The studies included in this research topic reveal several interconnected themes, reinforcing the interrelated nature of the determinants of children's oral health. First, parental education and health literacy consistently emerge as key factors influencing children's daily oral hygiene practices, dietary choices, and engagement with preventive dental services. Whether it is social support, knowledge of how to access services, or awareness of appropriate feeding and hygiene behaviors, parental capabilities strongly predict children's oral health outcomes. Second, socioeconomic disadvantage exacerbates barriers to preventive care and healthy behaviors. As low socioeconomic status is associated with higher prevalence of dental caries, suboptimal nutritional practices, reduced access to services, and increased risk of developmental conditions such as MIH. These patterns reflect global evidence showing that inequalities in oral health follow clear social gradients across different countries and health systems. Third, studies highlight the importance of integrated policies and public health interventions, particularly those delivered through schools and family centered programs.Interventions that combine oral health education, nutritional counseling, and structured parental support show promising effectiveness in mitigating inequalities when integrated within broader social and health frameworks.These findings collectively confirm that oral health is shaped by multi-level interactions involving individual behaviors, family dynamics, community resources, and national policy environments. They also underscore that improving children's oral health requires addressing both structural and behavioral factors simultaneously.The body of evidence underscores the need to align oral health promotion with parentcentered educational strategies, particularly during early childhood when health habits This research topic clearly demonstrates that improving children's oral health cannot be achieved through clinical services alone. Sustainable progress requires addressing the educational, behavioral, and socioeconomic foundations that shape oral health from a young age. By integrating parental education, addressing social inequalities, and incorporating preventive strategies into community and school systems, health professionals and policymakers can contribute to reducing disparities and promoting lifelong oral health.

Valuing oral health: Accomplishments and challenges

Enamel hypoplasia and dental caries significantly impact children's oral health, with enamel defects increasing susceptibility to bacterial colonization and decay. This review explores the prevalence, causes, and consequences of enamel hypoplasia, particularly molar-incisor hypomineralization (MIH), emphasizing its association with systemic, genetic, and environmental factors. Dental caries remains a major public health concern, especially in low- and middle-income countries, where inadequate fluoride exposure, poor oral hygiene, and socio-economic disparities exacerbate the condition. Given the strong correlation between enamel hypoplasia and caries, early detection, preventive measures, and appropriate clinical management are essential. Public health interventions, policy development, and further research are crucial in mitigating the burden of these conditions and improving children's oral health outcomes. Accordingly, the main aim of this review is to review recent findings on enamel hypoplasia and dental caries in children, highlighting their prevalence, causes, consequences, and the need for early detection, prevention, and public health interventions.

Black children in the United States have lower rates of dental visits and higher rates of poor oral health. However, few studies have examined the role of structural racism as a contributor to racial gaps in children's oral health. This study assessed associations between state-level structural racism and oral health outcomes of children and the related Black-White disparities. This repeated cross-sectional observational study examined children aged 1 to 17 y in the 2016 to 2021 National Survey of Children's Health (NSCH). Three outcomes were examined: utilization (dentist visit in past 12 mo), any oral health problem (difficulty in past 12 mo with bleeding gums, cavities, or toothaches), and oral health (teeth in excellent or very good condition). A state-level index was constructed to measure Black-White structural racism composed of 5 dimensions (judicial, educational, economic, political, and neighborhood segregation) and linked to the NSCH. Estimated population-weighted logit regression models were used to assess associations between the outcomes and race and structural racism, adjusting for demographics and socioeconomic status. The dataset consisted of 98,423 Black (11%) or White (88%) children. Black children had relatively worse outcomes than White children did, with the largest difference observed for the children having teeth in excellent or very good condition (73% vs. 83%). State-level structural racism was not statistically significantly associated with a child receiving dental care, having any oral health problem, or having teeth in excellent or very good condition. US Black-White disparities in these outcomes were unchanged after adjustment for state-level structural racism. Expanded efforts are needed to address US Black-White disparities in child oral health outcomes. State-level structural racism was not associated with these outcomes. Future research should explore whether findings change when examining these associations at a different geographic level and whether indices of structural racism should explicitly include items specific to health care access and child-specific institutional domains.Knowledge Transfer Statement:Black children in this US study had relatively worse oral health and were less likely to have a dental visit than White children were. Structural racism did not explain these disparities, which suggests the need for further research to study mechanisms driving these disparities and how to address them. Policy makers should consider policies that expand where care is delivered, who delivers care, and increase dentists' Medicaid participation, strategies identified previously for reducing disparities.

The global nutrition transition has increased the prevalence of childhood dental caries. Greater understanding is needed of the impact of social determinants—including maternal education—on child oral health. This is a cross-sectional analysis of a convenience sample of families of 458 indigenous Ecuadorian children aged 6 months through 6 years from 2011–2013. Data was collected by mother interviews and child dental and anthropometric examinations. Multivariate logistic and Zero-Inflated-Poisson regression analyses assessed associations between years of maternal education and maternal-child oral health practices and child oral health outcomes. Each additional year of maternal education was significantly (p < 0.05) associated with some healthier practices including greater likelihood of mothers and children drinking milk daily (OR 1.20; 95% CI 1.08, 1.34); and less healthy practices including greater likelihood of bottle-feeding children with sugary liquids (OR 1.14; 95% CI 1.06, 1.22) and to older age, giving children sweets daily, calming children with a bottle or sweets, and less likelihood of helping brush their children’s teeth (OR 0.93; 95% CI 0.88, 0.98). Each year of maternal education had a small but statistically non-significant influence on increasing the odds of children being among those who are cavity-free (OR 1.03; 95% CI 0.92, 1.16). Interventions to improve health outcomes should focus not just on maternal education but also address social and commercial determinants of health through nutrition and oral health education, as well as policies to reduce sugar and ensure universal access to oral health care.

To assess the value of Smiles for Life: A National Oral Health Curriculum (SFL) in influencing oral health practices of primary care professionals (PCPs).The National Maternal and Child Oral Health Resource Center’s Partnership for Integrating Oral Health Care into Primary Care (PIOHCPC) project is working with five project teams in Georgia, Illinois, Maryland, Michigan, and Rhode Island that are integrating interprofessional oral health core clinical competencies into primary care practice. The competencies were developed to facilitate change in the clinical practice of PCPs working with vulnerable or underserved populations that lack or have limited access to oral health care.An initial PIOHCPC project requirement was for PCPs (physicians, nurse practitioners, nurse midwives, nurses) to complete at least two SFL courses based on their project population of focus (eg, pregnant women, children, adolescents). The curriculum consists of the following courses: Course 1: Relationship of Oral and Systemic Health; Course 2: Child Oral Health; Course 3: Adult Oral Health; Course 4: Acute Dental Problems; Course 5: Oral Health for Women: Pregnancy and Across the Lifespan; Course 6: Caries Risk Assessment, Fluoride Varnish, and Counseling; Course 7: The Oral Exam; and Course 8: Geriatric Oral Health. Three months after completion of the SFL courses, a 10‐question feedback form was sent to PCPs.PCPs working in primary care settings (community health centers, local health department, medical center women’s health clinic) serving pregnant women, children, and adolescents who completed at least two SFL courses as part of the PIOHCPC project.Thirteen PCPs (three physicians, three nurse practitioners, three nurse midwives, four nurses) completed the feedback form. One hundred percent of respondents strongly agreed/agreed that SFL courses (1) reinforced the importance of oral health to a patient’s overall health and well‐being, (2) increased their awareness of and familiarity with oral health issues in their patients, and (3) increased their confidence in integrating oral health care into primary care. Seventy‐seven percent of respondents strongly agreed/agreed that SFL courses helped reduce barriers to incorporating oral health care into primary care. Sixty‐two percent of respondents strongly agreed/agreed that integrating oral health care into primary care improved their patients’ oral health outcomes. The majority (ranging from 85 to 100 percent) of PCPs strongly agreed/agreed that SFL courses helped them integrate the interprofessional oral health core clinical competencies into primary care.Three months after completing SFL courses, PCPs indicated that the curriculum had a positive influence on oral health practices in the primary care setting. These findings are consistent with a 2017 study that examined SFL influence on clinical practice and found that the curriculum positively influenced oral health practices in the primary care setting. Additional feedback could be gathered 1 year post‐training to assess retention of PCPs’ practices related to integrating oral health care into primary care.Oral health training is essential for enhancing PCPs’ knowledge and practices related to integrating oral health care into primary care. To respond to the need to integrate oral health care into primary care, SFL should be considered as a training for PCPs.Health Resources and Services Administration.

Introduction: The habits children have included in life; continues to make the choices they make as adults. According to social learning theory these habits are derived through supervision, learning and modelling. For a child, most significant are primarily father and mother and their immediate family members. All these factors have the collective ability to influence the child's oral health outcomes.&#x0D; Objective: To examine the dental caries rate in 5 year’s old school children and influence of their family related habits and socio demographic factors on child’s dental caries experience and their oral health behavior.&#x0D; Methodology: This study conducted upon sample of 600 school children selected through random sampling from primary private and Government primary schools of Qasimabad Hyderabad Sindh during period of October 2015 to December 2015. &#x0D; Results: shows that out of 600 children 330 (55%) were boys and 270 (45%) were girls. Boys 245 (40%) were affected from caries and 85 (14%) were free from caries. In relation to parental education; 44 (7.3%) child boys whom parents were highly educated were found affected by caries 44(7.3%), while 3 (0.5%) boys were free from caries. Girls whose parents were highly educated affected by caries were 44(7.3%), caries free were 12(2%) Boys whose parents have incomplete secondary education/ vocational school were affected by caries 162(27%) and caries free were 82(13.6%). Girls whose parents have incomplete secondary / vocational school were affected by caries 145 (24.1%). Boys whose parents were having low level of education affected by caries were 39(6.5%) while caries free were 0 (0%). Girls whose parents have low level of education were affected by caries were 69 (11.5%) while caries free were 0 (0%) .&#x0D; Conclusion: Life style choices are the habits that are formed in childhood and dictated as in adult hood. Thus, assessing family related risk factor regarding oral health is essential when conducting preventive treatment programs for children because education on oral hygiene maintenance and regular preventive dental health checkups are very important in order to prevent oral diseases.&#x0D; Key words: Dental Caries, primary dentition.&#x0D;

Reducing inequalities in health has become one of the main health policy issues in the late 1990s. The Labour Government set up an independent inquiry into inequalities in health under Sir Donald Acheson to make recommendations on approaches to reducing health inequalities. This paper reviews the evidence on inequalities in oral health in Britain. Dramatic improvements in dental health in children and young adults have taken place in the past 30 years. The levels of caries in permanent teeth of children is low. Widening inequalities in oral health however exist between social classes, regions of England, and among certain minority ethnic groups in pre-school children. The main social class and minority ethnic differences in dental caries is in pre-school children. Wide district and regional differences also exist in prevalence of caries in young children. The area differences relate very strongly to deprivation. In adults the differences in decay experience is less unequal than in children but there are marked social class inequalities in edentulousness. Dental caries decreased in all social classes in the United Kingdom. The main causes of the inequalities are differences in patterns of consumption of non milk extrinsic sugars and fluoridated toothpaste. Improvements in oral health that have occurred over the last 30 years have been largely a result of fluoride toothpaste and social, economic and environmental factors. Oral health inequalities will only be reduced through the implementation of effective and appropriate oral health promotion policy. Treatment services will never successfully tackle the underlying cause of oral diseases.

This review underscores the crucial role of parental oral health behaviors in shaping the oral health of children. It highlights the significance of parental knowledge, attitudes, and actions in influencing children's oral hygiene practices and overall well-being. Mothers, in particular, play a pivotal role in guiding their children's oral health habits. Parental oral health behaviors encompass a wide range of practices, including regular dental check-ups, proper oral hygiene routines, diet choices, and the avoidance of harmful habits like smoking and excessive sugar consumption. Active parental involvement in their children's oral care routines during their formative years is instrumental in establishing strong oral hygiene habits. Parents serve as primary role models and educators for their children, leading by example in maintaining good oral health practices. Encouraging parental engagement in oral health promotion programs is crucial for better oral health outcomes in future generations. Public health initiatives should emphasize the importance of parental involvement and provide resources and education to help parents instill sound oral health practices in their children. Recognizing the interconnectedness of oral health with overall well-being, it becomes evident that parental involvement is critical, especially for children who are vulnerable to oral health issues. Parents not only nurture and educate but also shape their children's oral health habits and attitudes. Additionally, contextual factors such as social, cultural, environmental, and economic conditions significantly influence family life and, consequently, oral health attitudes and behaviors.

Dental caries remains one of the most prevalent but preventable diseases among children worldwide and especially affects children with a lower socioeconomic status or ethnic minority background. It is important that all groups of children are reached by preventive interventions to reduce oral health inequalities. So far, it is unknown whether children from different social and ethnic groups benefit equally from potentially effective oral health interventions. This scoping review aimed to identify European public health interventions that report their effect on dental caries across different social groups. Four databases were searched for studies evaluating the effect of oral health interventions on dental caries among children from 0 to 12 y, and studies were included when results were presented by children of different social groups separately. A total of 14 studies were included, representing 4 different countries: 3 randomized and 11 nonrandomized studies. Most studies were performed at schools. Six studies showed results indicative of a reduction in oral health inequalities, 4 studies showed results that potentially widen oral health inequalities, and 5 studies showed results that were indicative of no impact on oral health inequalities. Interventions that contain early approaches, with a high frequency, approaching multiple levels of influence, and including at least the broader organizational or public policy level, may have the potential to reduce oral health inequalities among children from birth to young adolescence. We recommend researchers to perform high-quality intervention studies and to evaluate the effectiveness of oral health intervention always in different socioeconomic or ethnic groups separately, to better understand their contribution toward oral health (in)equalities. This review offers insight in the differential effects that oral health interventions might have across different social groups. Its results can be used to develop interventions that might reduce oral health inequalities among children. Also, we recommend future researchers to always evaluate the effects of any preventive oral health measure in different social groups separately.

The family environment, especially parents, plays a very big role in developing positive behavior towards dental and oral health. Parental involvement in developing positive behavioral patterns in maintaining oral health is implemented in their children in daily life, both directly and indirectly. The way to improve dental and oral health is for parents to pay attention to children's behavior regarding dental health and children's eating patterns that consume little cariogenic food. The aim of this research is to determine the role of parents in maintaining children's dental and oral health at Abdi Agape Elementary School. The method used in this research is a quantitative method with a descriptive approach. The total population was 260 parents using a sampling technique, namely purposive sampling with the Slovin formula, namely 72 respondents. The results of this study show that parents who carry out their role in maintaining children's dental and oral health are in the good category for the role of parents in regulating food diet as much as 88.89%, the good category for brushing children's teeth as much as 76.39%, and the bad category for brushing children's teeth. control of children's dental health was 51.39%. This research can be concluded that the majority of parents' role in maintaining children's dental and oral health in the role of parents in regulating food diet and the role of parents in brushing children's teeth have good criteria. Then the role of parents in controlling children's dental health has poor criteria. Keyword : Role of Parents, Maintaining Children’s, Dental and Oral Health

New Zealand’s School Dental Service (SDS) was founded in 1921, partly as a response to the “appalling” state of children’s teeth, but also at a time when social policy became centered on children’s health and welfare. Referring to the Commission on Social Determinants of Health (CSDH) conceptual framework, this review reflects upon how SDS policy evolved in response to contemporary constraints, challenges, and opportunities and, in turn, affected oral health. Although the SDS played a crucial role in improving oral health for New Zealanders overall and, in particular, children, challenges in addressing oral health inequalities remain to this day.Supported by New Zealand’s Welfare State policies, the SDS expanded over several decades. Economic depression, war, and the “baby boom” affected its growth to some extent but, by 1976, all primary-aged children and most preschoolers were under its care. Despite SDS care, and the introduction of water fluoridation in the 1950s, oral health surveys in the 1970s observed that New Zealand children had heavily-filled teeth, and that adults lost their teeth early. Changes to SDS preventive and restorative practices reduced the average number of fillings per child by the early 1980s, but statistics then revealed substantial inequalities in child oral health, with Ma¯ ori and Pacific Island children faring worse than other children.In the 1990s, New Zealand underwent a series of major structural “reforms,” including changes to the health system and a degree of withdrawal of the Welfare State. As a result, children’s oral health deteriorated and inequalities not only persisted but also widened. By the beginning of the new millennium, reviews of the SDS noted that, as well as worsening oral health, equipment and facilities were run-down and the workforce was aging. In 2006, the New Zealand Government invested in a “reorientation” of the SDS to a Community Oral Health Service (COHS), focusing on prevention. Ten years on, initial evaluations of the COHS appear to be mostly positive, but oral health inequalities persevere. Innovative strategies at COHS level may improve oral health but inequalities will only be overcome by the implementation of policies that address the wider social determinants of health.

To systematically evaluate the association of individual and contextual social capital with oral health outcomes in children and adolescents. Electronic searches were performed in PubMed/Medline, Embase, Web of Science and Scopus databases for articles published from 1966 up to June 2021. Two calibrated reviewers screened and critically appraised the identified papers. Observational studies that evaluated the relationship of individual or/and contextual social capital or their proxies with oral health outcomes in children and adolescents using validated methods were included. Quality assessment was conducted using the Newcastle-Ottawa Scale. Data were extracted for narrative synthesis and meta-analysis followed by a meta-regression model. Meta-analysis using random effects method was used to estimate pooled prevalence ratio (PR) and 95% confidence intervals (CI). Of the 3060 studies initially retrieved, 31 were included in the systematic review and 21 in the meta-analysis, totalling 81241 individuals. The clinical outcomes included dental caries and gingival bleeding and subjective outcomes were oral health-related quality of life (OHRQoL) and self-rated oral health (SROH). Individuals with lower levels of individual social capital had a higher prevalence of poor clinical (PR 1.11; 95%CI 1.02-1.22) and subjective (PR 1.25; 95%CI 1.09-1.45) oral health conditions. The prevalence of worse clinical (PR 1.34; 95%CI 1.11-1.61) and subjective (PR 1.56; 95%CI 1.13-2.16) oral health outcomes were also associated with lower levels of contextual social capital. In general, the contextual level of social capital exerted more impact, and the subjective oral health outcomes were the more affected. Contextual and individual social capital were positively related to oral health outcomes, such as dental caries, gingival bleeding, SROH and OHRQoL in children and adolescents.

We tested hypotheses regarding socioeconomic status (SES) disparities in oral health amongst children and adolescents and the extent to which such SES disparities may be mediated by parenting stress. We analysed data from the 2011/2012 US National Survey of Children's Health for ages 6-11years (n=21596) and 12-17years (n=23584). Our models estimated associations between SES indicators (family income and parental education) and parenting stress with two oral health outcomes: parent-reported child oral health and preventive dental visits. For both age groups, SES was positively associated with both oral health outcomes. Parenting stress mediated the relationship between SES and child oral health, not preventive dental visits-such that lower SES was associated with worse oral health via higher parenting stress. Amongst children, the indirect effect of parenting stress was observed for parental education and family income, whilst amongst adolescents, no indirect effect of parenting stress was observed. Parenting stress was an important determinant of children's oral health and partially explained the SES-related oral health disparities in children. Future research is needed to explore the causal pathways in this association.

Promoting equal opportunities for young children's oral health is a global health priority. Several interventions have been developed to address persistent oral health inequalities. However, the understanding of how these interventions improve children's oral health remains limited. This scoping review aims to explore researchers' explanations for the success of interventions promoting oral health in young children (≤5 years) and their families living in vulnerable circumstances in Western countries to strengthen future interventions. A comprehensive search strategy was developed and applied to three electronic databases: PubMed, Embase.com, and Clarivate Analytics/Web of Science Core Collection. This yielded 21,415 articles, which were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The included articles were analysed thematically using a macro, meso, and micro system level framework. From a total of 21,415 references, 251 were assessed for eligibility; 39 articles were included, covering 37 interventions. In particular, interventions implemented at the macro level (n = 1), macro-meso levels (n = 4) and macro-meso-micro levels (n = 10) seem to be the most promising. The researchers argue that interventions with a personalised, educational and culturally sensitive approach, delivered through interdisciplinary collaboration between professionals within and outside the dental sector, supported by adequate resources (e.g., appropriate time, funding, location), are key to success. Future interventions require a careful account of families' complex daily realities by intensifying collaboration between parents, community workers, school staff, dental professionals, primary care providers and government, providing training and balanced workloads for professionals and ensuring sufficient resources. According to the researchers, engaging with actors from macro, meso, and micro system levels is essential in child oral health promotion. Government leadership is needed to address oral health inequalities as a societal responsibility in partnership with families, their social network, food shops, (pre-)schools, dental practices, community and primary care organisations.