Advancing the concept of global oral health to strengthen actions for planetary health and One Health.

Advancing the concept of global oral health can help tackle the triple planetary crises of climate change, nature and biodiversity loss, and pollution and waste. A model for oral and planetary health places more explicit focus on understanding the state of the Earth's systems, changing environment in relation to planetary health boundaries and their impact on human well-being. This can facilitate a planet-centric critical thinking for equity in global oral health that contributes to UN 2030 Agenda for Sustainable Development.

Artificial intelligence for sustainable oral healthcare.

OBJECTIVES: Oral health is grounded in the United National (UN) 2030 Agenda for Sustainable Developement and its 17 Goals (SDGs), in particular SDG 3 (Ensure healthy lives and promote well-being for all at all ages). The World Health Organization (WHO) Global Strategy on Oral Health calls for prioritizing environmentally sustainable and less invasive oral health care, and planetary health. Artificial Intelligence (AI) has the potential to power the next generation of oral health services and care, however its relationship with the broader UN and WHO concepts of sustainability remains poorly defined and articulated. We review the double-edged relationships between AI and oral health, to suggest actions that promote a sustainable deployment of AI for oral health. DATA: Concepts regarding AI, sustainability and sustainable development were identified and defined. A review of several double-edged relationship between AI and SDGs were exposed for the field of Oral Health. SOURCES: Medline and international declarations of the WHO, the UN and the World Dental Federation (FDI) were screened. STUDY SELECTION: One the one hand, AI may reduce transportation, optimize care delivery (SDG 3 "Good Health and Well-Being", SDG 13 "Climate Action"), and increase accessibility of services and reduce inequality (SDG 10 "Reduced Inequalities", SDG 4 "Quality Education"). On the other hand, the deployment, implementation and maintenance of AI require significant resources (SDG 12 "Responsible Consumption and Production"), and costs for AI may aggravate inequalities. Also, AI may be biased, reinforcing inequalities (SDG 10) and discrimination (SDG 5), and may violate principles of security, privacy and confidentiality of personal information (SDG 16). CONCLUSIONS: Systematic assessment of the positive impact and adverse effects of AI on sustainable oral health may help to foster the former and curb the latter based on evidence. CLINICAL SIGNIFICANCE: If sustainability imperatives are actively taken into consideration, the community of oral health professionals should then employ AI for improving effectiveness, efficiency, and safety of oral healthcare; strengthen oral health surveillance; foster education and accessibility of care; ensure fairness, transparency and governance of AI for oral health; develop legislation and infrastructure to expand the use of digital health technologies including AI.

Planetary health benefits from strengthening health workforce education on the social determinants of health.

Social inequalities are perpetuating unhealthy living and working conditions and behaviours. These causes are commonly called 'the social determinants of health'. Social inequalities are also impacting climate change and vice-versa, which, is causing profound negative impacts on planetary health. Achieving greater sustainability for human and planetary health demands that the health sector assumes a greater leadership role in addressing social inequalities. This requires equipping health and social care workers to better understand how the social determinants of health impact patients and communities. Integration of the social determinants of health into education and training will prepare the workforce to adjust clinical practice, define appropriate public health programmes and leverage cross-sector policies and mechanisms being put in place to address climate change. Educators should guide health and social workforce learners using competency-based approaches to explore critical pathways of social determinants of health, and what measurements and interventions may apply according to the structural and intermediary determinants of health and health equity. Key institutional and instructional reforms by decision-makers are also needed to ensure that the progressive integration and strengthening of education and training on the social determinants of health is delivered equitably, including by ensuring the leadership and participation of marginalized and minority groups. Training on the social determinants of health should apply broadly to three categories of health and social workforce learners, namely, those acting on global or national policies; those working in districts and communities; and those providing clinical services to individual families and patients.

Understanding dental caries as a non-communicable disease.

The recent developments in the science underpinning our knowledge of both the initiation of dental caries and the subsequent behaviour of lesions over time gives us a solid base to understand caries differently. Advances in understanding the human and oral microbiome have come in parallel with the recognition of the importance of balancing protective and pathological risk factors. Caries prevention and management is now about controlling risk factors to maintain a balanced intraoral biofilm ecology that guards against a continuing low pH driven by the frequent consumption of sugars. Thus, caries control is no longer about attempts at eradicating any specific microorganism. Further, the present knowledge leads to the classification of dental caries as a non-communicable disease (NCD), which is vitally important from a policy perspective (both globally and at the country level). Caries shares similar risk factors with other chronic/systemic diseases, which provides opportunities for developing common prevention strategies and promoting health equity through action on the social determinants of health. So, preventing and controlling caries should be integrated across the so-called upstream, midstream and downstream levels and these activities can also help to control other NCDs.

Oral Health Status and Associated Factors in a Stratified Cluster Sample of Marginalized Palestinian Schools: A Cross-sectional Study.

PURPOSE: To assess factors related to the prevalence of dental caries among adolescent schoolchildren attending marginalised schools in the West Bank area of Palestine. MATERIALS AND METHODS: A cross-sectional study was conducted in schools participating in the School Support Program (SSP). Fifty schools identified as marginalised by the SSP were stratified by district, student gender and grade level to select a random sample of 20 schools. Students in the 6th and 9th grades were screened by senior dental students to collect data about their weight, height, gingival health and caries experience. In addition, a structured in-person questionnaire was used to collect data about students' oral hygiene practices, dietary habits, mother's education and father's employment. RESULTS: In total, 1282 students completed interviews and clinical screenings. The mean number of Decayed, Missing and Filled Teeth (DMFT) was 6.4 ± 4.4. Sixty-four percent had moderate gingivitis and 73% had fair oral hygiene. 'Recent visit to the dentist' was associated with mother's level of education (X2 = 22.06, p < 0.001) and father's employment (X2 = 24.02, p < 0.001). The final regression model showed that grade (ß = 0.31, p < 0.001), gender (ß = 0.06, p < 0.03), recent visit to the dentist (ß = -0.06, p < 0.03) and drinking fresh juices (ß = -0.05, p < 0.05) were statistically significant in explaining the high level of caries in this sample. CONCLUSIONS: This study indicates that Palestinian adolescents in marginalised governmental schools suffer the highest burden of dental disease and are disproportionally impacted when compared to other same-age students in the region. A high burden of disease was directly associated with unfavourable dietary habits, poor oral hygiene practices and challenges to accessing dental care services, and was indirectly associated with father's employment and mother's level of education.

Non-communicable Diseases and Oral Health: An Overview.

Non-communicable diseases (NCDs) such as cardiovascular and metabolic diseases, diabetes, cancer and diseases of the oral cavity such as caries or periodontitis represent a global and highly relevant problem due to demographic and epidemiological changes. NCDs are not only responsible for millions of deaths worldwide, but they cause relevant costs for national economies arise for the health care of societies. Assuming that oral health and general health are directly linked, emerging interactions between systemic and oral diseases are increasingly being researched. Common important risk factors have implications for economic, social, and moral determinants of health. Interdisciplinarity trained oral health professionals are needed to address the excessively high rates of inequities in oral health. The main reason that oral diseases are still a global health problem is related to mainly individual subjective high-risk approaches, which resulting in high costs and low effectiveness. A paradigm shift for a public health approach is needed at population level that integrates different health professionals who deal with NCDs. Oral care, like physical activity, is one of the most important lifestyle-related determinants of health. Widespread recognition of this kind of approach is critical to both reducing the impact of oral and non-oral NCDs. A multi-sectoral, comprehensive and integrated strategy is therefore necessary. The focus should be on social, environmental and population strategies, but should also support individual strategies.

COVID-19: A Recommendation to Examine the Effect of Mouthrinses with ß-Cyclodextrin Combined with Citrox in Preventing Infection and Progression.

Considered to be a major portal of entry for infectious agents, the oral cavity is directly associated with the evolutionary process of SARS-CoV-2 in its inhalation of ambient particles in the air and in expectorations. Some new generations of mouth rinses currently on the market have ingredients that could contribute to lower the SARS-CoV-2 viral load, and thus facilitate the fight against oral transmission. If chlorhexidine, a usual component of mouth rinse, is not efficient to kill SARS-CoV-2, the use of a mouth rinses and/or with local nasal applications that contain ß-cyclodextrins combined with flavonoids agents, such as Citrox, could provide valuable adjunctive treatment to reduce the viral load of saliva and nasopharyngeal microbiota, including potential SARS-CoV-2 carriage. We urge national agencies and authorities to start clinical trials to evaluate the preventive effects of ßCD-Citrox therapeutic oral biofilm rinses in reducing the viral load of the infection and possibly disease progression.

The built environment and health: fostering interprofessional collaboration for better policy recommendations.

This paper describes the initiation and proceedings of a national consultation organized to appraise issues in the local built environment affecting public health, using an interprofessional and intersectoral approach. The consultation was hosted as a part of the onsite session of an international fellowship program in interprofessional education and practice, organized by the Manipal FAIMER Institute for Leadership in Interprofessional Education, India. One hundred and eight delegates from across academic disciplines including the health professions, management, public health, architecture, and engineering, participated in this event. Plenary lectures and case studies highlighted the theoretical basics of built environment. Participants were also introduced to fundamental parameters for evaluating health-related aspects of the built environment. Delegates were then grouped into 18 teams and assigned to visit predetermined locations which they appraised and provided recommendations for. These were then thematically coded and synthesized for communication to relevant local municipal authorities. The consultation scope was limited by involving only academics in the appraisal process, and next steps include the engagement of local citizens and policy-makers to ensure the implementation of recommendations. This event illustrates how engaging interprofessional stakeholders can facilitate knowledge-driven development for promoting health equity, through action on the social determinants of health.

Integrating the social determinants of health into two interprofessional courses: Findings from a pilot study.

Five colleges and universities in Upstate New York, United States, created the 'Route-90 Collaborative' to support faculty implementing the Institute of Medicine's (IOM) Framework for Educating Health Professionals to Address the Social Determinants of Health. The two courses described herein used a flipped classroom approach in which students from 14 different nations were responsible for facilitating individual classes. This descriptive study used an educational intervention in two interprofessional courses - reproductive health and global health - based on the IOM Framework into two courses. The evaluation used quantitative and open-ended text response data from students. Course evaluations indicated the students found the courses helped them to learn more about health issues and service delivery in various countries, expand their knowledge base on sociocultural and ecological influences on health care, and broaden their perspectives on various health topics so they will be able to provide higher quality healthcare. Although this is the first effort of our Collaborative to implement the Framework, given the student feedback, we believe implementing the Framework in various courses has the potential to enhance healthcare service delivery and reduce the negative impact of social determinants of health.

Caries management pathways preserve dental tissues and promote oral health.

In May 2012, cariologists, dentists, representatives of dental organizations, manufacturers, and third party payers from several countries, met in Philadelphia, Pennsylvania, to define a common mission; goals and strategic approaches for caries management in the 21th century. The workshop started with an address by Mr. Stanley Bergman, CEO of Henry Schein Inc. which focused on the imperative for change in academia, clinical practice, and public health. For decades, new scientific evidence on caries and how it should be managed have been discussed among experts in the field. However, there has been some limited change, except in some Scandinavian countries, in the models of caries management and reimbursement which have been heavily skewed toward 'drilling and filling'. There is no overall agreement on a caries' case definition or on when to surgically intervene. The participants in the workshop defined a new mission for all caries management approaches, both conventional and new. The mission of each system should be to preserve the tooth structure, and restore only when necessary. This mission marks a pivotal line for judging when to surgically intervene and when to arrest or remineralize early noncavitated lesions. Even when restorative care is necessary, the removal of hard tissues should be lesion-focused and aim to preserve, as much as possible, sound tooth structure. Continuing management of the etiological factors of caries and the use of science-based preventive regimens also will be required to prevent recurrence and re-restoration. These changes have been debated for over a decade. The Caries Management Pathways includes all systems and philosophies, conventional and new, of caries management that can be used or modified to achieve the new mission. The choice of which system to use to achieve the mission of caries management is left to the users and should be based on the science supporting each approach or philosophy, experience, utility, and ease of use. This document also presents a new 'Caries Management Cycle' that should be followed regardless of which approach is adopted for caries prevention, detection, diagnosis, and treatment. To aid success in the adoption of the new mission, a new reimbursement system that third party payers may utilize is proposed (for use by countries other than Scandinavian countries or other countries where such systems already exist). The new reimbursement/incentive model focuses on the mission of preservation of tooth structure and outcomes of caries management. Also described, is a research agenda to revitalize research on the most important and prevalent world-wide human disease. The alliance of major dental organizations and experts that started in Philadelphia will hopefully propel over the next months and years, a change in how caries is managed by dentists all over the world. A new mission has been defined and it is time for all oral health professionals to focus on the promotion of oral health and preservation of sound teeth rather than counting the number of surgical restorative procedures provided.