Oral health disparities disproportionately affect low-income populations, with cost a significant barrier to accessing dental care. In Canada, individuals with untreated oral conditions often visit publicly funded medical services, which are not designed to provide dental treatment. The recently launched Canadian Dental Care Plan (CDCP) is intended to expand access to dental services for low-income populations. This commentary argues that reduced medical service use for non-traumatic dental conditions (NTDCs) is a potential benefit that should be monitored to evaluate the impact of the CDCP. Canadian studies reporting use and cost estimates of physician visits, emergency department use, and hospital-based care for dental conditions were described. Data sources for routine monitoring of use were identified. In Ontario Canada, use and costs of physician and emergency department visits, and hospital-based care for NTDCs were estimated at over $29M annually during 2003-2015 (population approximately 30 million). These estimates were conservative, with other studies suggesting higher visit volumes and costs depending on case definitions. National hospital and provincial physician billing databases are available for routine monitoring but indicators need to be standardized and data quality assessed. Stratified reporting can monitor equity impacts. Medical oral health care use is a potential indicator of effectiveness of public dental programs. A decline could signal improved access to dental services while persistent rates may highlight gaps in program reach. Monitoring this indicator is relevant to Canada and other jurisdictions seeking to advance oral health equity through expanded public coverage.

Oral health workforce shortages are a persistent challenge throughout the United States (US), disproportionately affecting American Indian/Alaskan (AI/AN) Native communities. Shortages limit access to routine and preventive dental care across settings, contributing to oral health inequities and systemic shortfalls. The integration of additional, community-based providers is a viable means of improving access and addressing these disparities. The objective of this study was to evaluate publications focused on community-based providers within the Community Health Aide Program (CHAP) through a workforce health equity lens, with an emphasis on their role serving AI/AN populations. Article screening, and data extraction were done independently by two reviewers. Articles and documents that: (1) examined DHAs or other community-based providers' relation to workforce or health equity; (2) were published in the last 60 years; and/or (3) were peer-reviewed, government reports, and organizational reports, published curriculum, and other dental health aide program materials were included in the analysis. This scoping review yielded a total of 33 articles. Articles discussed recruitment (n = 10), retention (n = 6), curriculum (n = 23), and access to care (n = 24) of a range of mid-level providers. Provider types included the dental therapist (n = 28), primary DHA I and II (n = 5), expanded function DHA (n = 3), dental hygienist (n = 4), all DHAs (n = 3), or other mid-level providers generally (n = 4). This review synthesizes previous work to increase understanding of the integration of dental health aides, through the CHAP Framework. Findings outline the key oral health workforce concepts to increase access to oral healthcare through a culturally adapted approach.

The Interim Canada Dental Benefit (CDB) provided financial support to families to cover dental care expenses for children < 12 years of age. The purpose of this study was to investigate oral health professionals' (OHPs) views of the Interim CDB. OHPs in Manitoba, Canada were invited by e-mail to complete an online questionnaire. Data analysis included descriptive statistics (frequencies, means, and standard deviations), bivariate analysis (chi-squared and t-test), and multivariable logistic regression. A p-value < 0.05 was considered significant. Overall, 383 OHPs participated, the majority being women (80.9%), from metropolitan areas (77.8%), and working for 16.6 ± 12.9 years. Main respondents included dentists (24.3%), dental hygienists (23.3%), and dental assistants (38.7%). Awareness of the benefit was high (92.7%) yet 45.8% were uncertain whether it increased public awareness of children's oral health. Encouragement to apply was low (39.3%), although 56.5% believed that the Interim CDB improved access to children's oral care. Multivariate logistic regression showed that rural OHPs encouraged application 43% more than those working in urban areas. Significantly more positive responses were observed among rural-based OHPs and women toward the benefit's ability to improve access to oral health for children. Overall, awareness was high among the OHPs, but uncertainty remained whether the benefit improved access to care for young children. OHPs in rural areas were more likely to believe that the Interim CDB improved access to care and were more likely to promote the program to families.

To assess the relationship between oral health literacy (OHL) and dental caries among a convenience sample of adult, first-time patients at two U.S. dental schools; we hypothesized that adults with low OHL would have fewer teeth, more untreated dental decay, and fewer restorations. This cross-sectional analysis was part of the larger Multisite Oral Health Literacy Research (MOHLR) Study. OHL was assessed using the Comprehensive Measure of Oral Health Knowledge (CMOHK). The dental caries outcome variables (number of decayed, filled, decayed plus filled, and teeth present) were abstracted from electronic dental records and represented the clinical conditions at the initial visit. We calculated OHL prevalence estimates and crude and adjusted negative binomial regression parameters for the outcome variables, controlling for relevant sociodemographic covariates. We recruited 922 participants into the MOHLR Study, and 688 provided clinical data for this report. Crude analyses showed persons with low OHL had significantly fewer filled teeth (ex = 0.67), decayed plus filled teeth (ex = 0.76), and teeth present (ex = 0.96) than those with high OHL. After controlling for covariates, the low versus high differences remained significant for the number of filled (ex = 0.81) and decayed plus filled teeth (ex = 0.84). There was no significant relationship between CMOHK and the number of decayed teeth. The relationship between OHL and dental caries in an adult population of dental school patients is complex. Additional research, likely involving qualitative studies and more precise epidemiological assessments, is needed to understand this complicated association.

Dental fluorosis is considered to be a public health concern globally, including in India. This review aims to determine the prevalence of dental fluorosis in India and its distribution by geographical region, water fluoride level, and severity. A systematic search of major electronic databases and gray literature was undertaken until 29th May 2024. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Studies Reporting Prevalence Data. Out of 6652 records identified, 55 studies including 108,678 individuals accounted for available data for meta-analysis. The pooled prevalence of overall dental fluorosis was estimated to be 34.5% (95% CI; 28.9-40.3) for all age groups, and in children (5 to 18 years) was 32.1% (95% CI; 26.6-37.9). The dental fluorosis commonly reported was in the very mild (10.6%) to mild (9.7%) category. There was a more than three-fold increase in prevalence in regions with water fluoride levels of more than 1 ppm compared to those with less than 1 ppm (50.3% versus 15.1%). Further, a higher prevalence was observed in males (40.7%), community settings (40.7%), rural populations (38.1%), and the western Indian region (43.9%). Dental fluorosis in India was found to be highly prevalent, with the milder forms being the most common. A high prevalence was found in regions with high water fluoride levels, with a wide variation across India. Drinking water is the main source of exposure studied, though the effect of other factors and fluoride intake pathways needs to be explored.

Individuals with intellectual or developmental disabilities (IDD) often experience more negative oral health outcomes. We implemented and tested a comprehensive strategy in 39 IDD group homes to examine whether skills-based training for direct support professionals (DSP) and individualized oral health planning for residents could improve DSP assistance and provision of oral health care for residents and oral health status. Our sample comprised 19 intervention homes and 20 control group homes, with 61 residents with IDD and 77 DSP. The strategy involved providing didactic and experiential skills-based training, combined with in-home coaching to DSP with resident participation over the course of 16 weeks. DSP in control homes received educational brochures. DSP attitudes, skills, and behaviors; and resident oral health outcomes were measured at baseline, 4 months later (post-intervention), and 12 months after baseline. Analyses compared the intervention and control conditions at 4-months and 12-months. Results suggest that the intervention influenced DSP skills and behaviors. Among residents, results showed improved outcomes for teeth in the lower anterior sextant only; intervention effects largely abated by 12-month follow-up. Findings demonstrate that skills-based, experiential training with coaching can be effective in enhancing skill sets and increasing behaviors about oral health among DSP. In addition, results showed that the strategy used can improve oral health outcomes for residents. However, given that there were only improved outcomes in residents' lower anterior sextant, more research is needed to determine how to adequately assess and improve resident outcomes.

ABSTRACTObjectivesThis study aimed to examine public sentiment regarding community water fluoridation (CWF) using data from “X” (formerly Twitter) over the past decade. The goal was to understand public opinion trends and identify opportunities for targeted public health communication.MethodsWe conducted a sentiment analysis utilizing a natural language processing technique. Specifically, we applied the Sentiment Intensity Analyzer tool to classify tweets related to CWF into negative, positive, or neutral categories. Additionally, a word co‐occurrence network analysis was performed to explore key discussion themes. We also compared machine learning models to assess their accuracy in classifying tweet sentiments.ResultsAnalysis of the tweets revealed a balanced distribution of sentiments: 37.4% negative, 34.4% positive, and 28.2% neutral. Peaks in public engagement occurred between 2015 and 2016, with a subsequent decline after 2018. Sentiment spikes were often associated with significant events, including policy changes and media coverage. The word co‐occurrence network highlighted recurring themes related to safety and dental health. Among the machine learning models evaluated, Logistic Regression demonstrated the highest accuracy in sentiment classification.ConclusionsOur findings highlight the polarized nature of public sentiment toward CWF and the temporal fluctuations in public engagement. These insights can inform public health policymakers in developing timely, targeted communication strategies. Specifically, efforts to engage neutral audiences through transparent messaging and counter misinformation during key periods may strengthen public trust in CWF. The application of machine learning in this analysis underscores its value in enhancing real‐time monitoring and supporting evidence‐based public health strategies.

ABSTRACTObjectivesAntibiotic prescription trends in dentistry in Japan remain underexplored. This study aimed to describe these trends and evaluate the impact of the national antimicrobial stewardship program launched in 2016.MethodsUsing Japan's national administrative claims database from fiscal year (FY) 2015 to FY 2020, this cross‐sectional study comprehensively analyzed trends in antibiotic prescription by dentists. Prescription rates were computed per 1000 inhabitants yearly and standardized to the FY 2015 national population. Changes in prescription rates were evaluated using Poisson regression analysis.ResultsIn FY 2020, the total number of antibiotic prescriptions was 134.4 per 1000 inhabitants per year, showing a 6% decline over the 6‐year period (95% confidence interval, 6%–6%). Third‐generation cephalosporins constituted 52.3% of dental antibiotic prescriptions in FY 2020, though the proportion had slightly decreased. In hospitals, prescriptions of third‐generation cephalosporins decreased from 64.9% in 2015 to 20.3% in 2020, being replaced by penicillin (from 15.0% to 64.0%). However, in clinics, the magnitude of the change was small (third‐generation cephalosporins, 60.5%–53.1%; penicillin, 10.2%–22.2%).ConclusionsThird‐generation cephalosporins continue to dominate dental antibiotic prescriptions. The increase in penicillin use was much more pronounced in hospitals than in clinics. Strengthening antimicrobial stewardship, particularly in clinics where the majority of dental care is provided, is crucial.