Community dentistry and oral epidemiology最新文献_第5页

Model-Based Cost-Effectiveness of Direct Restorations: Amalgam Dominates. 基于模型的直接修复成本效益：汞合金占主导地位。

IF 2.1 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2025-12-21 DOI: 10.1111/cdoe.70050

O Bailey, S J Stone, G Taylor, L Ternent, C R Vernazza

Objectives: A phase-down of dental amalgam use has been mandated and the feasibility of its phase-out in England by 2030 is being explored. Amalgam use in English National Health Service (NHS) care still predominates for posterior restorations, though access to this care is increasingly limited. The objective of this study was to quantify the relative long-term costs and consequences of amalgam versus composite direct posterior restorations in adult permanent teeth in the English NHS setting.

Methods: A microsimulation model of restoration failure and reintervention was constructed and parameterised in TreeAge Pro, based on a review of the literature. It extrapolated costs and outcomes of directly restoring cariously-cavitated lower premolar teeth in 10 000 18-year-old English NHS patients with amalgam and composite restorations over a lifetime-horizon. Discounting of 3.5% was applied to costs and outcomes. An extended medical-sector perspective with societal considerations was taken. Deterministic and probabilistic sensitivity analyses were performed.

Results: Amalgam robustly dominated conventional and bulk-fill composite restorations, being less costly over a lifetime from patient (£70) and funder perspectives (£34), with the restoration and tooth surviving significantly longer (4-years; 12-years non-discounted). Amalgam also incurred reduced numbers of visits (1), treatment time (43-min), and laboratory costs (£8) for fixed and removable prosthodontics over a lifetime. Time until a direct restoration was no longer possible was significantly higher for amalgam than composite (6-years; 17-years non-discounted).

Conclusions: The model showed good internal and external validity, accurately predicting tooth survival following restoration in relation to long-term NHS claims data. Without considerable educational change to upskill clinicians and health service change, an amalgam phase-out in England will likely have significant lifelong impacts on restoration and tooth survival and costs for all stakeholders, whilst reducing societal productivity and exacerbating already existing issues of limited access to care and socio-economic inequalities.

目标：已强制要求逐步减少牙科汞合金的使用，并正在探索到2030年在英格兰逐步淘汰汞合金的可行性。汞合金在英国国民健康服务（NHS）护理中仍然占主导地位，用于后牙修复，尽管获得这种护理的机会越来越有限。本研究的目的是量化在英国国家医疗服务体系下，汞合金与复合材料直接后牙修复体在成人恒牙中的相对长期成本和后果。方法：在回顾文献的基础上，在TreeAge Pro中构建修复失败和再干预的微观模拟模型并进行参数化。它推断了10000名18岁的英国NHS患者使用汞合金和复合修复体在一生中直接修复仔细空化的下前磨牙的成本和结果。成本和结果贴现率为3.5%。采取了扩大医疗部门的观点并考虑到社会因素。进行了确定性和概率敏感性分析。结果：汞合金在传统和大块填充复合材料修复中占据主导地位，从患者（70英镑）和资助人（34英镑）的角度来看，其终生成本较低，修复体和牙齿的存活时间明显更长（4年；不打折的12年）。汞合金还减少了一生中固定和可移动义齿的就诊次数（1次）、治疗时间（43分钟）和实验室费用（8英镑）。汞合金的直接修复时间明显高于复合材料（6年；17年不打折）。结论：该模型具有良好的内部和外部有效性，能够准确预测牙齿修复后的存活情况。如果没有相当大的教育变革来提高临床医生的技能和卫生服务变革，在英格兰逐步淘汰汞合金可能会对所有利益相关者的修复和牙齿存活以及成本产生重大的终身影响，同时降低社会生产力并加剧已经存在的有限的护理机会和社会经济不平等问题。

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引用次数: 0

Exploring the Education and Perceptions of Dental Professionals Toward Poverty and Oral Health Disparities: A Scoping Review 探索牙科专业人员对贫困和口腔健康差异的教育和认知：范围审查。

IF 2.1 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2025-11-11 DOI: 10.1111/cdoe.70039

Lisa Allen, Janine Doughty, Samantha Beattie, Charlotte Hardman, Sondos Albadri

Objective

The objective of the present study was to map the available research, investigating how dental professionals perceive those who experience poverty, and what educational interventions are available in this area, with the aim of providing a narrative summary and identifying key research gaps within the literature.

Method

Following Joanna Briggs scoping review methodology, databases searched included PubMed, Scopus, CINAHL, Dentistry and Oral Sciences, Health Research Premium and Web of Science databases. A manual search was also performed on Google Scholar to identify grey literature. Search strategies included medical subject headings and key terms including poverty, financial hardship, social deprivation, oral health, oral diseases, dental caries, communication, learning and dental education.

Results

A total of 1046 articles were assessed for eligibility, of which 34 studies met the predefined inclusion criteria. The studies included in this review highlight conflicting understandings about what it means to be living in poverty. Outreach activities shared lived experiences, and immersive opportunities were reported to improve dental professionals' attitudes and willingness to provide dental care for people living in poverty.

Conclusion

To the study teams' knowledge, this is the first review to examine specifically how poverty and oral health are understood by the dental profession. This review highlights the need for further research as to the long-term effectiveness and cost-effectiveness of educational interventions to increase understanding.

目的：本研究的目的是绘制现有研究的地图，调查牙科专业人员如何看待那些经历贫困的人，以及在这一领域有哪些教育干预措施，目的是提供一个叙述性的总结，并确定文献中的关键研究差距。方法：采用Joanna Briggs的范围综述方法，检索的数据库包括PubMed、Scopus、CINAHL、Dentistry and Oral Sciences、Health Research Premium和Web of Science数据库。在b谷歌Scholar上进行人工检索，以识别灰色文献。搜索策略包括医学主题标题和关键术语，包括贫困、经济困难、社会剥夺、口腔健康、口腔疾病、龋齿、沟通、学习和牙科教育。结果：共有1046篇文章被评估为合格，其中34篇研究符合预定义的纳入标准。本综述中包含的研究强调了对生活在贫困中意味着什么的相互矛盾的理解。据报道，外展活动分享了生活经验，并提供了沉浸式机会，以改善牙科专业人员为贫困人口提供牙科护理的态度和意愿。结论：据研究小组所知，这是第一次专门研究牙科专业人员如何理解贫困和口腔健康的综述。这篇综述强调需要进一步研究教育干预的长期有效性和成本效益，以增加理解。

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引用次数: 0

Refining Scale Measurement: Reassessing Oral Impacts on Daily Performances Properties With Item Response Theory 改进量表测量：用项目反应理论重新评估口腔对日常表现特性的影响。

IF 2.1 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2025-11-06 DOI: 10.1111/cdoe.70034

Roger Keller Celeste, Matheus de França Perazzo, Georgios Tsakos, Michael Reichenheim

Objectives

Many oral health-related quality of life instruments have been developed but few have undergone a comprehensive psychometric assessment. One commonly used measure is the Oral Impact on Daily Performance (OIDP). This study revised the configural and metric properties as well as the performance of items based on Item Response Theory (IRT) of a dichotomous-item version of OIDP in Brazil.

Methods

The nine-item dichotomous version of the OIDP was analysed using data from a nationally representative sample from the Oral Health Survey (SBBrasil 2010). It consisted of 30 064 individuals aged 12 to 75 and was split into two partitions comprising n₁ = 20 040 and n₂ = 10 024, respectively. Confirmatory factor analyses (CFA) were conducted on the larger partition and cross-validated on the smaller to assess configural and metric properties. The item performance was evaluated using a 2-parameter item response theory (IRT) model. Sampling weights were used in all analyses.

Results

The unidimensional model presented two violations of conditional independence, one between items i5 (practising sports) and i4 (going out) and another between items i6 (trouble in speaking) and i7 (shame of speaking or smiling). A CFA of the most parsimonious model (removing i5, i6 and i7) yielded a RMSEA = 0.02, WRMR = 1.42, CFI = 0.99 and TLI = 0.99. The IRT analyses showed that three pairs of items had very similar levels of difficulty and discrimination suggesting redundancy.

Conclusions

A shorter dichotomous version of the OIDP scale has acceptable configural and metric properties. Being more concise and thus efficient, it may be better suited for large-scale population surveys than the version currently in use.

目的：许多口腔健康相关的生活质量仪器已经开发出来，但很少有经过全面的心理测量评估。一种常用的测量方法是口服对日常表现的影响（OIDP）。本研究基于条目反应理论（IRT）修正了巴西二分类条目版OIDP的构形属性和度量属性以及条目的表现。方法：使用来自口腔健康调查（SBBrasil 2010）的全国代表性样本的数据，对OIDP的九项二分法版本进行分析。样本年龄在12 ~ 75岁之间，共30 064人，分为n1 = 20 040和n2 = 10 024两个分区。验证性因子分析（CFA）在较大的分区上进行，并在较小的分区上进行交叉验证，以评估结构和度量特性。采用双参数项目反应理论（IRT）模型评价项目绩效。所有分析均采用抽样权。结果：单维模型存在两个条件独立性违反，一个是在项目i5（运动）和项目i4（外出）之间，另一个是在项目i6（说话困难）和项目i7（说话害羞或微笑）之间。最精简模型（去掉i5、i6和i7）的CFA得出RMSEA = 0.02, WRMR = 1.42, CFI = 0.99, TLI = 0.99。IRT分析显示，三对题目的难度和辨别程度非常相似，这表明存在冗余。结论：较短的OIDP量表的二分版本具有可接受的结构和度量特性。它比目前使用的版本更简洁，因而效率更高，可能更适合大规模人口调查。

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引用次数: 0

Fluoride and Neurodevelopmental Hazard Modelling: An Assessment of Concentration-Response Analysis 氟化物和神经发育危害模型：浓度-反应分析的评估。

IF 2.1 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2025-10-31 DOI: 10.1111/cdoe.70027

Jayanth V. Kumar, Mark E. Moss, Honghu Liu, Susan Fisher-Owens, Andrew Rugg-Gunn, Julia Kuring

Objectives

A National Academies Consensus Study report concluded that the evidence did not support an assessment that fluoride is a neurodevelopmental hazard. However, some researchers have undertaken benchmark dose modelling to determine a safe fluoride concentration level in water. Therefore, the suitability of the data for modelling fluoride concentration in urine and water and cognition response using standard criteria was assessed.

Methods

Data quality was evaluated using a standard tool. A random-effects meta-analysis of standardised mean difference (SMD) and regression coefficients was conducted to assess effect sizes and heterogeneity. The Environmental Protection Agency (EPA) benchmark dose modelling was utilised to determine the association between fluoride concentrations and cognition scores.

Results

All four maternal urinary fluoride (MUF) studies did not meet the standards for acceptable quality, as identified by the EPA data quality criteria, which are necessary for combining data from different studies for dose–response analysis. The pooled estimate was not statistically significant (β_MUF = −1.06, 95% CI: −3.63, 1.50; p = 0.42; I² = 62%). A meta-analysis of five studies conducted in fluoridated areas showed a pooled SMD effect size of 0.04 (95% CI: −0.06, 0.14; p = 0.42; I² = 0%), favoring higher fluoride. The benchmark dose models did not reveal a functional relationship between MUF or water fluoride concentration and cognitive outcomes (Goodness-of-fit p < 0.1).

Conclusions

The data quality assessment revealed serious flaws that render the maternal urinary studies unacceptable for hazard assessment and benchmark dose modelling. Therefore, more appropriate studies in endemic fluorosis areas are needed to accurately determine whether fluoride is associated with adverse cognitive outcomes in populations with meaningful exposure.

目的：美国国家科学院共识研究报告得出结论，证据不支持氟化物是神经发育危害的评估。然而，一些研究人员进行了基准剂量模拟，以确定水中的安全氟化物浓度水平。因此，评估了使用标准标准模拟尿液和水中氟化物浓度以及认知反应的数据的适用性。方法：采用标准工具评价资料质量。对标准化平均差（SMD）和回归系数进行随机效应荟萃分析，以评估效应大小和异质性。环境保护署（EPA）的基准剂量模型被用来确定氟化物浓度和认知评分之间的关系。结果：所有四项产妇尿氟化物（MUF）研究均未达到EPA数据质量标准所确定的可接受质量标准，这是将不同研究的数据合并进行剂量-反应分析所必需的。合并估计无统计学意义（βMUF = -1.06, 95% CI: -3.63, 1.50; p = 0.42; I2 = 62%）。在加氟地区进行的五项研究的荟萃分析显示，合并SMD效应大小为0.04 (95% CI: -0.06, 0.14; p = 0.42; I2 = 0%)，有利于较高的氟化物。基准剂量模型没有揭示MUF或水中氟化物浓度与认知结果之间的函数关系（拟合质量p）结论：数据质量评估揭示了严重的缺陷，使得母体尿液研究无法用于危害评估和基准剂量模型。因此，需要在地方性氟中毒地区进行更适当的研究，以准确确定氟化物是否与有意义接触人群的不良认知结果有关。

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引用次数: 0

Trends of Dispensed Opioids Prescribed by Australian Dentists: 2013–2022 澳大利亚牙医处方阿片类药物的趋势：2013-2022。

IF 2.1 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2025-10-07 DOI: 10.1111/cdoe.70022

Leanne Teoh, Marietta Taylor, Erin Kelty, Frank M. Sanfilippo, Mathew Lim, Michael McCullough, Christopher Etherton-Beer, Alex Park, David Preen, Amy Page

Background

In Australia, the prescribing of opioid medicines by dentists has increased in recent years, despite opioids not being first-line treatment for dental pain. The aim of this longitudinal study was to examine the dispensing of opioids prescribed by dentists in Australia during 2013–2022.

Method

A nationally representative 10% sample of patients identified from the Australian Pharmaceutical Benefits Scheme dispensing data from 2013 to 2022 was used. Three outcomes were assessed: (1) incidence of dispensing of all dental prescriptions; (2) incidence of dispensing of opioids prescribed by dentists; (3) average number of tablets/capsules of dental opioid supply. Outcomes pertaining to opioid use were examined overall, and by year, age and sex.

Results

From 2013 to 2022, 998 774 dental prescriptions (of any kind) were dispensed to 470 118 patients. The mean annual incidence rate for dispensing any dental medication was 48.4 (95% CI: 48.3–48.5)/1000 person-years. Opioids accounted for 183 303 prescriptions (18.4%), with a mean annual incidence rate of 11.0 (95% CI: 11.0–11.1)/1000 person-years. The majority of patients (99.1%) were dispensed ≤ 4 opioid prescriptions across the 10-year period, with 0.9% of patients (n = 1312) receiving between 5 and 149 dispensed opioids. Over the study period, the average annual incidence of dispensed dental opioids increased by 4.4% (95% CI: 1.0–8.2). A reduction in the mean quantity of opioid pills dispensed was observed over time. Dental opioids were dispensed to 2727 children and adolescents.

Conclusion

The incidence of dispensing of dental opioids in Australia increased by an average of 4.4% per year over a decade. While there was a reduction in opioid quantities dispensed, dispensing of opioids for children occurred, and a small number of patients were dispensed excessive quantities of dental opioids. Evidence-based tailored opioid stewardship interventions need to include dentists, and dentists should be provided access to drug monitoring programmes to enable more informed prescribing decisions.

背景：在澳大利亚，尽管阿片类药物不是治疗牙痛的一线药物，但近年来牙医开具的阿片类药物处方有所增加。这项纵向研究的目的是检查2013-2022年澳大利亚牙医处方的阿片类药物的分配情况。方法：采用从2013年至2022年澳大利亚药品福利计划调剂数据中确定的具有全国代表性的10%患者样本。评估了三个结果：(1)所有牙科处方的配药率；(2)按牙医处方配发阿片类药物的发生率；(3)牙科阿片类药物平均供应片剂/胶囊数量。与阿片类药物使用有关的结果进行了总体检查，并按年份、年龄和性别进行了检查。结果：2013 - 2022年，共发放各类牙科处方998 774张，惠及470118例患者。配发任何牙科药物的平均年发病率为48.4 (95% CI: 48.3-48.5)/1000人年。阿片类药物占处方183 303张（18.4%），平均年发病率为11.0 (95% CI: 11.0-11.1)/1000人年。大多数患者（99.1%）在10年期间获得了≤4张阿片类药物处方，0.9%的患者（n = 1312）获得了5至149张阿片类药物处方。在研究期间，牙科阿片类药物的平均年发病率增加了4.4% （95% CI: 1.0-8.2）。随着时间的推移，观察到阿片类药物的平均配药量减少。为2727名儿童和青少年配发了牙科阿片类药物。结论：十年来，澳大利亚牙科阿片类药物配药的发生率平均每年增加4.4%。虽然发放的阿片类药物数量有所减少，但仍发生了为儿童发放阿片类药物的情况，少数患者被发放了过量的牙科阿片类药物。基于证据的量身定制的阿片类药物管理干预措施需要包括牙医，并应向牙医提供药物监测规划，以使他们能够做出更明智的处方决策。

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引用次数: 0

Perceived Barriers and Potential Strategies for People Who Use Drugs in Accessing Oral Healthcare: A Qualitative Study of Service Providers 感知障碍和潜在策略的人使用药物在获得口腔保健：服务提供者的定性研究。

IF 2.1 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2025-09-30 DOI: 10.1111/cdoe.70028

Tejashree Kangutkar, Mark Gussy, Ronald Knevel, Hanny Calache

<div> <section> <h3> Objective</h3> <p>Access to appropriate oral healthcare is vital for overall health and well-being. However, people who use drugs (PWUD) often face significant barriers in accessing oral healthcare services. This qualitative study focused on exploring the perspectives of public oral health service providers and harm reduction workers to understand the barriers that they perceived were experienced by PWUD in accessing oral healthcare and identified potential strategies to address these barriers.</p> </section> <section> <h3> Method</h3> <p>Thirty-five participants (20 public oral health service providers and 15 harm reduction workers) were recruited from both metropolitan and regional areas of Victoria, Australia, through purposive sampling and a snowballing technique. Individual online semi-structured interviews were conducted, and data were analysed using a hybrid approach to thematic analysis.</p> </section> <section> <h3> Results</h3> <p>Service providers felt that continuous drug use impacted PWUD's ability to perceive dental pain, which delayed identification of oral health symptoms at the individual level. Major life crises meant that PWUD had limited awareness about the oral health consequences of their drug use, which further hindered their access to care. Service providers described how negative experiences and perceived judgements by PWUD about the visual effects of drugs created barriers to accessing dental care. Triggers of memories of traumatic abuse associated with the dental environments were also identified as a distressing factor for PWUD. Perceived service-level barriers included the lack of explicit recognition of PWUD as eligible for priority access in public dental clinics, financial impediments and coercive tactics from some oral health service providers. Service providers with experience of working in rural areas shared how the lack of anonymity and the risk of being identified as a drug user was an additional challenge for PWUD in accessing oral health services in rural areas. The participants proposed several potential strategies including drop-in oral health sessions at harm reduction facilities involving case managers to address appointment issues and training oral health service providers in trauma-informed care. They emphasised the need for interprofessional collaboration between oral health and harm reduction sectors. One key recommendation proposed by the participants was to establish oral health integrated harm reduction programmes that require careful consideration of feasibility, acceptability, resource allocation and potential implications on service quality.</p> </section>

目的：获得适当的口腔保健对整体健康和福祉至关重要。然而，吸毒者（PWUD）在获得口腔保健服务方面往往面临重大障碍。本定性研究的重点是探索公共口腔卫生服务提供者和减少伤害工作者的观点，以了解他们认为puwud在获得口腔卫生保健方面遇到的障碍，并确定解决这些障碍的潜在策略。方法：采用有目的抽样和滚雪球法，从澳大利亚维多利亚州市区和郊区招募35名参与者（20名公共口腔卫生服务提供者和15名减少危害工作者）。进行了个人在线半结构化访谈，并使用主题分析的混合方法分析数据。结果：服务提供者认为持续的药物使用影响了puwud感知牙齿疼痛的能力，从而延迟了个体对口腔健康症状的识别。重大的生命危机意味着，吸毒者对吸毒对口腔健康的影响认识有限，这进一步阻碍了他们获得护理。服务提供者描述了PWUD对药物视觉效果的负面体验和感知判断如何对获得牙科护理造成障碍。与牙科环境相关的创伤性虐待记忆的触发也被确定为PWUD的痛苦因素。感知到的服务水平障碍包括没有明确承认puwud有资格优先获得公共牙科诊所的服务，财政障碍和一些口腔保健服务提供者的强制手段。具有在农村地区工作经验的服务提供者表示，缺乏匿名性和被确定为吸毒者的风险是妇女和妇女在农村地区获得口腔保健服务的另一个挑战。与会者提出了几项可能的战略，包括在减少伤害设施举行由病例管理人员参与的临时口腔卫生会议，以解决预约问题，并对口腔卫生服务提供者进行创伤知情护理方面的培训。他们强调需要在口腔卫生和减少危害部门之间进行专业间合作。与会者提出的一项重要建议是制定口腔健康综合减少危害方案，这些方案需要认真考虑可行性、可接受性、资源分配和对服务质量的潜在影响。结论：本研究突出了以前未被认识到的服务提供者与puwud合作的感知障碍，这些障碍可能影响旨在改善puwud获得牙科服务的任何干预措施的实施。通过综合解决个体和服务水平的障碍，卫生保健系统可以更好地满足PWUD的口腔卫生需求，减少获得保健的差距。

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引用次数: 0

Assessing the Impact of Periodontal Therapy on Tooth Loss: A Register-Based Longitudinal Study in Denmark 评估牙周治疗对牙齿脱落的影响：丹麦一项基于注册的纵向研究。

IF 2.1 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2025-09-26 DOI: 10.1111/cdoe.70026

Eero Raittio, Vibeke Baelum

Objectives

While regular periodontal care is advocated to reduce tooth loss considerably among periodontitis patients, evidence from observational studies is often limited to small single-center studies. This study aims to quantify the effect of periodontal care on tooth extractions among 40-year-old new periodontitis patients over 20 years.

Methods

A nationwide register-based cohort study was conducted, encompassing 40-year-old individuals with incident periodontitis in 2001, tracked through Danish registers until the end of 2021. Receiving any periodontal care was determined annually, and the number of tooth extractions served as the annually varying outcome. G-estimation of structural nested mean models adjusted for time-varying confounding and loss to follow-up was employed to estimate the average treatment effect of periodontal therapy on subsequent tooth extractions.

Results

The study included 1251 40-year-olds with incident periodontitis in 2001. The average follow-up from 2002 onwards was 19.1 years and amounted to 23,878 person-years. On average, participants received periodontal care in 12.1 years (SD 6.3) and lost an average of 2.3 teeth (SD 3.5). G-estimation showed that receiving periodontal therapy in a given year compared to not receiving any periodontal therapy reduced the number of teeth extracted in the following year by 0.04 (95% CI: 0.02; 0.06). Receiving periodontal therapy for 5 years in a row compared to not receiving any periodontal therapy was associated with an average of 0.08 (95% CI: 0.04; 0.13) fewer extracted teeth, while on average 0.62 teeth were lost in a 5-year period (0.12 per year).

Conclusions

Periodontal therapy resulted in a modest reduction in tooth extractions among 40-year-olds with incident periodontitis over 20 years. The effectiveness of periodontal therapy against tooth loss seems to be considerably smaller than indicated by earlier clinical studies.

目的：虽然提倡定期牙周护理以显著减少牙周炎患者的牙齿脱落，但观察性研究的证据通常仅限于小型单中心研究。本研究旨在量化牙周护理对40岁新发牙周炎患者拔牙的影响。方法：在全国范围内进行了一项基于登记的队列研究，纳入了2001年发生牙周炎的40岁个体，通过丹麦登记册追踪到2021年底。每年确定接受任何牙周护理，拔牙次数作为每年变化的结果。采用经时变混杂因素和随访损失调整的结构嵌套均值模型的g估计来估计牙周治疗对后续拔牙的平均治疗效果。结果：该研究包括1251名2001年发生牙周炎的40岁人群。从2002年起的平均随访时间为19.1年，总计23,878人年。参与者平均在12.1年（SD 6.3）内接受牙周护理，平均脱落2.3颗牙齿（SD 3.5）。g -估计显示，与未接受任何牙周治疗的患者相比，在某一年接受牙周治疗的患者在下一年拔牙数量减少了0.04 （95% CI: 0.02; 0.06）。与不接受任何牙周治疗的患者相比，连续5年接受牙周治疗的患者拔牙数量平均减少0.08颗（95% CI: 0.04; 0.13），而5年期间平均脱落0.62颗牙齿（每年0.12颗）。结论：牙周治疗导致40岁的牙周炎患者在20年内拔牙的数量适度减少。牙周治疗对牙齿脱落的效果似乎比早期临床研究表明的要小得多。

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引用次数: 0

Oral Health Outcomes and Their Sociodemographic and Service Utilisation Determinants in a Rural Population 农村人口口腔健康结果及其社会人口统计学和服务利用决定因素

IF 2.1 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2025-09-25 DOI: 10.1111/cdoe.70024

Mariana Silveira Echeverria, Rafaela do Carmo Borges, Sarah Arangurem Karam, Gabrielle Haubert, Mariana Gonzalez Cademartori, Bernardo Antonio Agostini, Flávio Fernando Demarco

Objectives

The aim of the study was to evaluate the number of remaining teeth, use of dental prosthesis, and self-perception of oral health according to sociodemographic variables and use of dental services in a rural population of the Municipality of Pelotas, RS, through a cross-sectional population-based study.

Methods

A cross-sectional study was conducted in the rural area of Pelotas, Brazil, aiming to assess the oral health status of adults aged 18 or older. Data collection occurred through a systematic sampling process in two stages, with sociodemographic factors and oral health outcomes analysed. The number of remaining teeth, use of dental prosthesis, self-perception of oral health and dental visit patterns were among the variables examined. Prevalence ratios were estimated using Poisson regression and odds ratios were estimated using ordinal logistic regression.

Results

Out of 1519 adults surveyed, the majority were male, aged 40–59, and had incomplete elementary education. Elderly women and people in the richest income quintile exhibited lower rates of remaining teeth and higher use of prosthesis, while people with higher education and use of dental services in the last year had more teeth. Worse self-perception of oral health was more prevalent in men, at age 40–59 and who had used dental services for curative reasons.

Conclusions

The study highlights the need for targeted interventions to address oral health disparities in rural areas, emphasising the importance of preventive measures and equitable access to dental services. Strategies focusing on increasing access and reducing financial barriers can contribute to improving oral health outcomes among rural populations.

目的：本研究的目的是通过一项基于人口的横断面研究，根据社会人口统计学变量和RS Pelotas市农村人口的牙科服务使用情况，评估剩余牙齿的数量、义齿的使用情况和口腔健康的自我认知。方法：在巴西佩洛塔斯农村地区进行了一项横断面研究，旨在评估18岁及以上成年人的口腔健康状况。通过两个阶段的系统抽样过程收集数据，并分析了社会人口因素和口腔健康结果。调查的变量包括剩余牙齿的数量、义齿的使用、口腔健康的自我认知和牙科就诊模式。使用泊松回归估计患病率，使用有序逻辑回归估计比值比。结果：在接受调查的1519名成年人中，大多数是男性，年龄在40-59岁之间，初等教育程度不高。老年妇女和收入最高的五分之一人群的牙齿剩余率较低，假牙使用率较高，而去年接受过高等教育和牙科服务的人的牙齿剩余率较高。年龄在40-59岁之间、以治疗为目的使用牙科服务的男性对口腔健康的自我认知更差。结论：该研究强调需要有针对性的干预措施，以解决农村地区口腔健康的差距，强调预防措施和公平获得牙科服务的重要性。侧重于增加可及性和减少财政障碍的战略可有助于改善农村人口的口腔健康结果。

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引用次数: 0

Dental Shame: A Call for Understanding and Addressing the Role of Shame in Oral Health 牙齿羞耻：呼吁理解和解决羞耻在口腔健康中的作用。

IF 2.1 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2025-09-21 DOI: 10.1111/cdoe.70019

Louise Folker, Luna Dolezal, Astrid Pernille Jespersen, Martha Paisi, Lyndsey Withers, Christina Worle, Esben Boeskov Øzhayat

This commentary highlights dental shame as a pervasive but underexplored phenomenon with significant implications for oral health and systemic inequities. It proposes dental shame as a critical lens for understanding and addressing the complex interplay between personal, social, economic, cultural and systemic factors contributing to oral health challenges. Drawing on interdisciplinary expertise, the authors collectively propose that dental shame is both a consequence and determinant of oral health issues, leading to a self-reinforcing dynamic of avoidance, withdrawal and exacerbated inequities. They identify five key aspects of oral health where dental shame warrants deeper investigation: clinical encounters, care and social services, daily oral health behaviours, systemic inequities and psychological trauma. On this basis, the authors call for more research on dental shame and advocate for shame-sensitive practices in dentistry and other health care and social settings. This approach includes fostering shame competence in practitioners, addressing systemic barriers and designing empathetic, inclusive care environments. Ultimately, the authors state that understanding and addressing dental shame can transform oral health promotion, reduce inequities and improve overall health outcomes.

这篇评论强调，牙齿羞耻感是一种普遍存在但未得到充分探讨的现象，对口腔健康和系统性不平等具有重大影响。它提出，牙齿羞耻感是理解和解决个人、社会、经济、文化和系统性因素之间复杂相互作用的关键视角，这些因素导致了口腔健康挑战。利用跨学科的专业知识，作者共同提出，牙齿羞耻既是口腔健康问题的结果，也是决定因素，导致回避、退缩和加剧不公平的自我强化动态。他们确定了牙齿羞耻感值得深入调查的口腔卫生五个关键方面：临床接触、护理和社会服务、日常口腔卫生行为、系统性不平等和心理创伤。在此基础上，作者呼吁对牙齿羞耻感进行更多的研究，并倡导在牙科和其他医疗保健和社会环境中采取对羞耻感敏感的做法。这种方法包括培养从业者的羞耻感能力，解决系统障碍，设计同理心和包容性的护理环境。最后，作者指出，理解和解决牙齿羞耻可以改变口腔健康促进，减少不公平现象，改善整体健康结果。

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引用次数: 0

‘How Good to Finally Have Options!’ A Qualitative Reflexive Thematic Analysis Exploring Parents' Perceptions of Non-Invasive and Minimally Invasive Caries Management Strategies “终于有选择了，多好啊！”一项探讨家长对非侵入性和微创性龋齿治疗策略认知的定性反思性专题分析。

IF 2.1 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology

Pub Date : 2025-09-21 DOI: 10.1111/cdoe.70025

Una Stamere, Inese Stars, Nicola Innes, Natalija Protasa, Sergio E. Uribe, Rodrigo Mariño, Ilze Maldupa

Objectives

Caries prevalence remains high in Latvia, with limited adoption of minimally invasive dentistry (MID). While provider barriers are known, parental perspectives are underexplored. This study examined Latvian parents' views on MID to identify key barriers and facilitators to its acceptance.

Methods

An inductive qualitative approach was applied to explore parents' perceptions of non-invasive and minimally invasive caries management strategies. Data were collected using semi-structured interviews, conducted with parents (n = 19) whose children had experience of either minimally invasive or traditional caries management. All interviews were recorded, transcribed verbatim and analysed with reflexive thematic analysis.

Results

Four main themes were generated: (1) ‘avoiding unnecesary discomfort and distress’ described parents' views and experiences of non-invasive and minimally invasive caries management strategies as physically and psychologically less traumatic for their child and themselves; (2) ‘prioritising treatment qualities’, explored parents' expectations and priorities regarding the qualities offered by different dental treatment options; (3) ‘the power of information’, illustrated that parents' awareness of non-invasive and minimally invasive caries management strategies contributed to a better understanding of treatments and promoted choice, but required access to that information; and (4) ‘choices of suitable options’, described parents' reflections on having a variety of options for dental treatment, rather than a single option offered.

Conclusions

Parents value effective communication, clear information and access to treatment options when considering minimally invasive caries management. Their views highlight the need for a shift towards patient-centred care models that prioritise comfort, informed decision-making and choice in paediatric dentistry.

目的：拉脱维亚的龋齿患病率仍然很高，微创牙科（MID）的采用有限。虽然提供者的障碍是已知的，但父母的观点尚未得到充分探讨。本研究调查了拉脱维亚父母对MID的看法，以确定其接受的主要障碍和促进因素。方法：采用归纳定性方法探讨家长对非侵入性和微创性龋齿治疗策略的看法。通过半结构化访谈收集数据，对19名儿童接受过微创或传统龋齿治疗的家长进行访谈。所有访谈都被记录下来，逐字抄录，并用反身性主题分析进行分析。结果：产生了四个主题：(1)“避免不必要的不适和痛苦”描述了父母对非侵入性和微创性龋齿管理策略的看法和经验，这些策略对他们的孩子和他们自己的身体和心理创伤较小；(2)“优先考虑治疗质量”，探讨家长对不同牙科治疗方案所能提供的质量的期望和优先考虑；(3)“信息的力量”，说明父母对非侵入性和微创性龋齿管理策略的认识有助于更好地理解治疗方法并促进选择，但需要获得这些信息；(4)“选择合适的选择”，描述了父母对牙科治疗有多种选择而不是单一选择的思考。结论：在考虑微创龋齿治疗时，家长重视有效的沟通、清晰的信息和可获得的治疗方案。他们的观点强调需要转向以患者为中心的护理模式，优先考虑儿童牙科的舒适、知情决策和选择。

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引用次数: 0