The Global Need for Easy and Valid Assessment Tools for Orofacial Pain.

The World Health Organization recently adopted a historic resolution (WHA74.5) on the urgent need for global oral health improvement. This resolution is particularly relevant in the perspective of the high prevalence of untreated oral diseases. However, one important aspect has been mentioned only in passing, namely that poor oral health often leads to orofacial pain, which is the most common reason for emergency dental visits worldwide. Therefore, an evidence-based decision-making process on oral health should include data related to orofacial pain complaints. To that end, the availability of reliable and valid assessment tools of orofacial pain and related treatment outcomes is essential. INfORM (International Network for Orofacial Pain and Related Disorders Methodology) of the International Association for Dental Research has been one of the driving forces behind the development and implementation of comprehensive sets of tools for such assessments. However, as a prerequisite for the desired global implementation, reliable and valid tools that are also brief, easy to translate, and culturally adaptable need to be further developed and tested. Some of the groundwork to facilitate this process has already been carried out. In addition, a working group within INfORM has developed a short clinical assessment tool for orofacial pain diagnostics that is near completion and will soon be ready for dissemination. Ultimately, reliable and valid orofacial pain assessment is a necessary step toward the development and implementation of appropriate "best buy" interventions that address this major driver of need for oral health care worldwide.

Modifiable Factors Explain Socioeconomic Inequalities in Children's Dental Caries.

The aim of this article was to quantify socioeconomic inequalities in dental caries experience among Australian children and to identify factors that explain area-level socioeconomic inequalities in children's dental caries. We used data from the National Child Oral Health Survey conducted in Australia between 2012 and 2014 (n = 24,664). Absolute and relative indices of socioeconomic inequalities in the dental caries experience in primary and permanent dentition (decayed, missing, and filled surfaces [dmfs] and DMFS, respectively) were estimated. In the first stage, we conducted multilevel negative binomial regressions to test the association between area-level Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) and dental caries experience (dmfs for 5- to 8-y-olds and DMFS for 9- to 14-y-olds) after adjustment for water fluoridation status, sociodemographics, oral health behaviors, pattern of dental visits, and sugar consumption. In the second stage, we performed Blinder-Oaxaca and Neumark decomposition analyses to identify factors that explain most of the area-level socioeconomic inequalities in dental caries. Children had a mean dmfs of 3.14 and a mean DMFS of 0.98 surfaces. Children living in the most disadvantaged and intermediately disadvantaged areas had 1.96 (95% confidence interval, 1.69-2.27) and 1.45 (1.26-1.68) times higher mean dmfs and 1.53 (1.36-1.72) and 1.43 (1.27-1.60) times higher mean DMFS than those living in the most advantaged areas, respectively. Water fluoridation status (33.6%), sugar consumption (22.1%), parental educational level (14.2%), and dental visit patterns (12.7%) were the main factors explaining area-level socioeconomic inequalities in dental caries in permanent dentition. Among all the factors considered, the factors that contributed most in explaining inequalities in primary dental caries were dental visits (30.3%), sugar consumption (20.7%), household income (20.0%), and water fluoridation status (15.9%). The inverse area-level socioeconomic inequality in dental caries was mainly explained by modifiable risk factors, such as lack of fluoridated water, high sugar consumption, and an unfavorable pattern of dental visits.

The Relationship between Income and Oral Health: A Critical Review.

In this critical review, we summarized the evidence on associations between individual/household income and oral health, between income inequality and oral health, and income-related inequalities in oral health. Meta-analyses of mainly cross-sectional studies confirm that low individual/household income is associated with oral cancer (odds ratio, 2.41; 95% confidence interval [CI], 1.59-3.65), dental caries prevalence (prevalence ratio, 1.29; 95% CI, 1.18-1.41), any caries experience (odds ratio, 1.40; 95% CI, 1.19-1.65), tooth loss (odds ratio, 1.66; 95% CI, 1.48-1.86), and traumatic dental injuries (odds ratio, 0.76; 95% CI, 0.65-0.89). Reviews also confirm qualitatively that low income is associated with periodontal disease and poor oral health-related quality of life. Limited evidence from the United States shows that psychosocial and behavioral explanations only partially explain associations between low individual/household income and oral health. Few country-level studies and a handful of subnational studies from the United States, Japan, and Brazil show associations between area-level income inequality and poor oral health. However, this evidence is conflicting given that the association between area-level income inequality and oral health outcomes varies considerably by contexts and by oral health outcomes. Evidence also shows cross-national variations in income-related inequalities in oral health outcomes of self-rated oral health, dental care, oral health-related quality of life, outcomes of dental caries, and outcomes of tooth loss. There is a lack of discussion in oral health literature about limitations of using income as a measure of social position. Future studies on the relationship between income and oral health can benefit substantially from recent theoretical and methodological advancements in social epidemiology that include application of an intersectionality framework, improvements in reporting of inequality, and causal modeling approaches. Theoretically well-informed studies that apply robust epidemiological methods are required to address knowledge gaps for designing relevant policy interventions to reduce income-related inequalities in oral health.

Race- and Income-Related Inequalities in Oral Health in Australian Children by Fluoridation Status.

Inequality in child oral health exists by race and income. Water fluoridation (WF) is effective in caries prevention, but evidence for WF reducing inequality in caries experience is equivocal. This study tested the hypothesis that WF reduces race- and income-related inequality in child caries experience. A cross-sectional national population-based study of child oral health was conducted across 2012 to 2014 for Australian children aged 5 to 14 y, involving a parental questionnaire and an oral epidemiological examination. Children were stratified by fluoridated (F) and nonfluoridated (NF) area of residence, equivalized household income quartiles, and Indigenous and non-Indigenous status. Directly standardized caries experience (measured by the decayed, missing, or filled tooth surfaces [dmfs/DMFS] in both primary [age 5-10] and permanent dentitions [age 9-14]) was estimated for each stratum accounting for the complex sampling design. Differences in caries experience by Indigenous status and equivalized income quartiles were examined between F and NF strata. Socioeconomic inequality in caries experience was examined using the Absolute Concentration Index (ACI), Slope Index of Inequality (SII), Relative Concentration Index (RCI), and Relative Index of Inequality (RII). A total of 21,328 (86.5%) children had complete data. Caries experience was higher in NF than F strata. Race- and income-related gradients in caries experience were observed in both F and NF areas. All indexes of inequality indicated that caries experience was concentrated among lower income groups. Absolute inequalities were consistently lower in F than in NF areas. For the primary dentition, SII values were -4.18 versus -6.20 in the F and NF areas, respectively. The respective values were -0.60 versus -1.66 for the permanent dentition. Income-related inequality in caries was lower in F than in NF areas for both Indigenous and non-Indigenous children. WF was associated with lower caries experience and reduced inequality among children. Knowledge Transfer Statement: The results of this study greatly increase the evidence base that water fluoridation is effective and socially equitable. Dental caries has remained one of the most prevalent chronic conditions in children worldwide. The presented evidence can be used by policy makers and the profession to support the maintenance or expansion of this important public health program to benefit those most at risk of dental caries, the groups at the lowest socioeconomic position in any society.

Does early-life family income influence later dental pain experience? A prospective 14-year study.

BACKGROUND: The aim of this study was to investigate the association between early-life family income and dental pain experience from childhood to early adulthood. METHODS: Data came from a 14-year prospective study (1991/1992-2005/2006) carried out in South Australia, which included children and adolescents aged 4-17 years (N = 9875) at baseline. The outcome was dental pain experience obtained at baseline, 14 years later in adulthood and at a middle point of time. The main explanatory variable was early-life family income collected at baseline. RESULTS: The prevalence of dental pain was 22.8% at baseline, 19.3% at 'middle time' and 39.3% at follow up. The proportion of people classified as 'poor' at baseline was 27.7%. Being poor early in life was significantly associated with dental pain at 14-year follow up (odds ratio = 1.45; 95% confidence interval = 1.27-1.66). CONCLUSIONS: Early-life relative poverty is associated with more frequent dental pain across the 14-year follow up and may be a key exposure variable for later dental conditions.

Active commuting reduces sociodemographic differences in adherence to recommendations derived from leisure-time physical activity among Brazilian adults.

OBJECTIVE: To investigate the consequences of including active commuting, compared with the leisure domain only, in the prevalence and sociodemographic factors associated with attending the physical activity recommendations, in Brazilian adults. STUDY DESIGN: Population-based cross-sectional study. METHOD: Adults between 20 and 59 years of age (n = 1720) were face-to-face interviewed from September 2009 to January 2010. Sociodemographic indicators and leisure-time and commuting physical activity were assessed by a validated questionnaire. Poisson regression was used to estimate crude and adjusted prevalence ratio (PR) and 95% confidence interval (95% CI). RESULTS: The prevalence of adherence to recommendations when only leisure-time physical activity was considered was 15.5% (95% CI: 13.6; 17.4) and was associated with men (PR: 1.57, 95% CI: 1.25; 1.96), adults without a partner (PR: 1.38 95% CI: 1.05; 1.81) and higher educational level and income. The prevalence of adherence to physical activity recommendations after the combination of leisure-time and commuting was 29.1% (95% CI: 26.5; 31.6). Percentages differences in favor of men, white adults and those with higher educational level and income were no longer significant after the inclusion of active commuting. CONCLUSION: The inclusion of active commuting expands the percentage of adults who achieved the health-related physical activity recommendations and reduced important sociodemographic differences derived from the analysis of leisure-time physical activity alone. Public health strategies should consider the different domains of physical activity in the monitoring and promotion of a more active lifestyle.

Amalgam or composite resin? Factors influencing the choice of restorative material.

OBJECTIVES: This study aimed to investigate the patient and tooth factors associated with selection of restorative material in direct posterior restorations in young adults from a population-based birth cohort. METHODS: A representative sample (n=720) of all 5914 births occurring in Pelotas in 1982 were prospectively investigated, and posterior restorations were assessed in 2006, when the patients were 24 years old. Tooth-related variables (individual level) included restorative material (amalgam or composite), type of tooth, size of cavity, and estimated time in mouth. Data regarding demographic and socio-economic characteristics, oral health, and service utilization patterns during the life course were also assessed (contextual level). RESULTS: Logistic Regression Multilevel models showed that individuals who have accessed dental services by private insurance by age 15 [odds ratio (OR)=1.66 (0.93-2.95)] and who had a higher dental caries index at age 15 (high DMFT tertile) [OR 2.89 (1.59-5.27)] presented more amalgam restorations in the posterior teeth. From tooth-level variables, the frequency of amalgams decreases with increasing number of surfaces enrolled in the cavity preparation (p<0.001) and was almost 5 times greater in molars than in premolars. CONCLUSIONS: The present findings suggest that variables related to type of dental service, dental caries (higher DMFT index), and cavity characteristics (tooth type, size) determine the choice of dentists for restorative materials. Other individual characteristics such as demographic and socioeconomic status have not influenced this choice. CLINICAL SIGNIFICANCE: This is the first population-based study that assesses the determinant factors for the choice of dentists for composite or amalgam in posterior direct restorations, showing that, independently of socioeconomic and demographic characteristics, type of payment of dental services and clinical factors are associated with this choice.

[Public figures on trial: an assessment of the use of the "jury court" technique for city officials in Santa Catarina, Brazil]. / O homem público em julgamento: avaliação da aplicação da téchnica "tribunal do júri" para dirigentes municipais em Santa Catarina.

This study describes the 'Law Court' technique as applied to City Health Departments in the State of Santa Catarina, in dealing with the issue of obligations on the part of public officials. The project was the first part of a training course for public administrators held in 1997. The article presents the technique's components and results. Some 98% of the 156 participants had a positive opinion of the training course, considering it dynamic/participatory (31%), educational/stimulating reflection (27%), and realistic (24%). The technique fostered the discussion of the main subjects pertaining to the country's Unified Health System (SUS). Although all five juries acquitted the defendants, the issue of ethics was reported by 58% of the participants as the main prerequisite for a public administrator.