Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed-methods systematic review.

OBJECTIVES: Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers. METHODS: Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed-method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review. RESULTS: A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual-family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial-system, provider and individual-family levels and illustrated in the rainbow model of CALD oral health. CONCLUSION: The review strengthens evidence for multilayered, system-related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.

Dental hesitancy: a qualitative study of culturally and linguistically diverse mothers.

BACKGROUND: Oral healthcare is paramount and inextricably linked to well-being. Yet, the evidence indicates that culturally and linguistically diverse (CALD) migrant communities have unequal access to mainstream dental services due to several barriers. The purpose of this study was to investigate the oral healthcare experiences, attitudes and barriers to oral healthcare utilisation in CALD mothers. METHODS: A qualitative study with semi-structured interviews was conducted within a social constructivism epistemology. CALD mothers who identified as non-English speaking, foreign country born, with a child under 12, were recruited though purposive snowball sampling. Questions probed oral healthcare experiences, barriers, enablers, and attitudes. Verbatim typed transcripts were thematically analysed using grounded methodology. RESULTS: Thirty-three CALD mothers participated; twenty from India, five from Fiji, four from China, two from Nepal and one each from Israel and Macedonia. Languages included Cantonese, Fiji-Hindi, Gujrati, Hebrew, Hindi, Kannada, Mandarin, Maharashtrian, Macedonian, Nepalese, Punjabi, Sanskrit, Telegu and Urdu. Cost was the foremost barrier to oral healthcare services, followed by Confidence in quality care for the provision of services and treatment. Confusion in navigating a public and private healthcare system was highlighted and Competing priorities took precedence. Complacency referred to 'no need' or lack of urgency in dental care. Subsequently, dental hesitancy (superordinate theme) described the patterning of data as comprising the five 'C' factors and was theorised as the dental hesitancy phenomenon to explain the occurrence of delay or avoidance in utilising dental care. CONCLUSION: Findings highlight the utility of the dental hesitancy phenomenon unearthed within this study. CALD mothers explained five 'C' dimensions: cost, confidence, confusion, competing priorities and complacency as barriers to accessing timely dental care. Multisectoral collaboration between healthcare systems, universal health coverage and primary sector support is required to address dental hesitancy in CALD mothers. Further, this study contributes to the field of behavioural and social sciences in oral health and augments the literature on dental avoidance.

Dental diaspora: oral health care attitudes and experiences in culturally and linguistically diverse mothers in Australia.

BACKGROUND: Globally oral health care is unequally accessible or utilised within culturally and linguistically diverse (CALD) migrant communities. Yet much remains unknown about CALD mothers and their oral healthcare experiences in Australia. Hence, this paper explores the oral health care attitudes and experiences of CALD mothers within the Australian context with the broader objective to reduce oral health inequalities. METHODS: Qualitative semi-structured interviews were conducted from a social constructivism paradigm. Participants were foreign country born, spoke language/s other than English and have a child. Purposive snowball sampling and recruitment was conducted through CALD organisations and social media. Participants were interviewed for their attitudes and experiences to dental care and frequency of utilisation in Australia and the home country. Interviews were transcribed verbatim and grounded analysis (Strauss and Corbin) performed. Researcher bias was reduced through reflexivity and triangulation. RESULTS: The participants (n = 33) included 20 CALD mothers born in India and 13 from either China, Fiji, Nepal, Macedonia and Israel. The theme, experiences with health workforce personnel revealed positive attitudes toward CALD providers from similar cultural and/or linguistic backgrounds. We coin these CALD providers as the 'dental diaspora'. The dental diaspora facilitated CALD mothers through culture and/or language factors, alleviating cost barriers and flexibility in appointments. Dental travel to the home country was affirmed, however family visitation was the foremost reason for travel. CONCLUSION: The findings suggest that the dental diaspora plays a significant role in promoting oral health care utilisation for first generation CALD mothers in Australia. This paper brings to light the phenomenon of the 'dental diaspora' as an essential health workforce that contributes to addressing inequities in oral healthcare utilisation within CALD migrant communities. Universal health coverage in oral health is further affirmed, as aligned to the WHO policy context.

Encounters and management of oral conditions at general medical practices in Australia.

BACKGROUND: Poor oral health has been widely recognised as an ongoing public health issue. Patients with oral conditions may visit either a general practitioner (GP) or a dental practitioner for management. The aims of this study are to report (i) the GP management rate of oral health conditions by patient and GP demographics, (ii) what specific oral conditions were managed, and (iii) how GPs managed oral conditions. METHODS: Data from the Bettering the Evaluation and Care of Health study (2006 to 2016 inclusive) were analysed. Descriptive statistics with 95% confidence intervals around point estimates were used to summarise data. Multivariate logistic regression was performed to determine the independent effect of patient and GP characteristics. RESULTS: A total of 972,100 GP encounters were included in the dataset, with oral condition-related encounters managed at a rate of 1.19 oral conditions per 100 GP encounters. Patients who were aged 54 years or younger, resided in a socioeconomically disadvantaged area, came from a non-English speaking background or Indigenous background were more likely to have oral conditions managed by GPs. The most commonly reported oral conditions were dental and oral mucosa-related. Over 60% of oral conditions were managed by GPs through prescribed medications. CONCLUSIONS: This study provided an overview of management of oral conditions by GPs in Australia. Patients from certain vulnerable demographic groups were more likely to attend a GP for management of oral conditions. Common oral conditions and management approaches were identified. The findings of this study contribute to public health and health policy discussions around optimising primary care provision in oral health.

The Indigenous Adolescent Oral Health Partnership Study: A Co-Design Study Protocol.

BACKGROUND: in this protocol we outline a method of working alongside Aboriginal communities to learn about and facilitate improvement in the oral health habits in Aboriginal adolescents. By facilitating positive oral health in Aboriginal adolescents, we hope to achieve lifelong improvement in oral health and general wellbeing. METHODS: this paper outlines a co-design methodology through which researchers and Aboriginal communities will work together to create a custom oral healthcare program aimed at Aboriginal adolescents. Researchers, a youth advisory group, Aboriginal community-controlled health services and three regional NSW communities will together devise an oral health strategy focused on five components: application of topical fluoride, increasing water consumption, improving nutrition, daily toothbrushing, and enhancing social and emotional wellbeing. Capacity building is a key outcome of this program. DISCUSSION: as the gap in health status between Aboriginal and non-Aboriginal people remains wide, it is clear that new approaches and attitudes are needed in Aboriginal public health research. This protocol is representative of this shifting approach; giving power to Aboriginal communities who seek to have sovereignty and self-determination over their healthcare. TRIAL REGISTRATION: TRN: ISRCTN15496753 Date of registration: 20 October 2021.

Dental Practice Patterns for Oral Care in Medical Oncology Patients-a Survey-Based Assessment of Massachusetts Dentists.

Oral complications associated with cancer therapy lead to a significant deterioration of oral health and overall quality of life. The primary aim of this study was to assess dental practice patterns followed by dentists for oral care of medical oncology patients and to identify potential barriers to recommended care. A questionnaire-based survey was developed using the Qualtrics online platform. It was electronically distributed to all dentists within the Massachusetts Dental Society (MDS). Descriptive statistics were automatically computed by Qualtrics. A total of 363 responses (10.7%) were received. Dentists reported minimal correspondence from the oncology team during referrals. Most dentists communicate treatment recommendations to the oncology team with regard to extractions (74.6%), restorations (66.7%), periodontal health (68.8%), and other urgent needs (73.5%). Potential obstacles to providing care included insufficient time for dental care before start of therapy (61%), lack of patient education on oral complications associated with therapy (56%), and lack of dental insurance (31%). Only 50% of the dentists felt adequately trained to treat oncology patients, and 46% of dentists infrequently followed the recommendations set by the National Institute of Dental and Craniofacial research (NIDCR). The findings of this study indicate significant variability in the referral patterns and practice protocols for medically necessary oral care in oncology patients. The major barriers to following established guidelines for care may be attributed to the lack of correspondence between provider teams, inadequate training of professionals, and financial or insurance factors associated with increased cost of supportive care.

Inequalities in the utilisation of the Child Dental Benefits Schedule between Aboriginal and non-Aboriginal children.

Objectives The Child Dental Benefits Schedule (CDBS) is an Australian Government initiative providing basic dental care to children from low-income households. We sought to investigate levels of utilisation of the CDBS among Aboriginal and non-Aboriginal children to determine whether there is equal access to dental services provided through the schedule. Methods CDBS data were obtained for four financial (July-June) years (from 2013-14 to 2016-17). The data captured all claims made during this period. The data included estimates of usage by Aboriginal status, age group and Dental Benefits groups (administrative categories of related dental procedures). Results The utilisation of CDBS services was lower for Aboriginal children. However, in 2013-14, although the odds of using the schedule were higher for non-Aboriginal children (odds ratio (OR) 0.89; P<0.0001) this was reversed in 2015-16 and 2016-17 (OR 1.11 and 1.21 respectively; P<0.0001 in both years). The odds of Aboriginal children using preventive services was below that of non-Aboriginal children in 2013-14 (OR 0.82), 2014-15 (OR 0.76), 2015-16 (OR 0.83) and 2016-17 (OR 0.90; P<0.0001) in all years. Conclusions The data are encouraging with regard to equity because they show that for services overall, Australian Aboriginal and non-Aboriginal children have similar levels of utilisation. However, lower levels of the use of preventive services may indicate future inequalities in oral health among Aboriginal children. What is known about the topic? The CDBS is an Australian Government initiative aimed at improving access to dental care for children from low-income households, including for Aboriginal people. By facilitating greater access to dental care, the schedule has the potential to help address inequalities in oral health for both Aboriginal and non-Aboriginal children. What does this paper add? There are no analyses available comparing the utilisation of the CDBS by Aboriginal and non-Aboriginal children. This study compared levels of utilisation of the schedule overall and specifically for preventive services. What are the implications for practitioners? Greater efforts should be made to address inequalities in the utilisation of the CDBS between Aboriginal and non-Aboriginal children. Although there are some hopeful signs, inequalities remain that may affect the oral health of Aboriginal children. There is also potential to encourage utilisation of the CDBS for greater provision of preventive services, including targeted population oral health initiatives.

A national study on the use of opioid analgesics in dentistry.

The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

Dental Sealant Prevalence Among Children with Special Health Care Needs: National Health and Nutrition Examination Survey (NHANES) 2013 to 2014.

Purpose: The purpose of this study was to evaluate dental care access and sealants prevalence among children with special health care needs. Methods: The authors utilized the publicly available National Health and Nutrition Examination Survey (NHANES) 2013 to 2014 datasets collected by trained dental examiners for the Centers for Disease Control and Prevention. This study included 2,651 six- to 19-year-olds who provided demographic, dental visit, disability, and sealants information. Weighted prevalence estimates and odds ratios (OR) were calculated for sealant use by disability, gender, age, race, and economic status. Results: Approximately 68 percent of participants had a dental visit in the past six months, with 84 percent of them being routine dental visits; each had approximately two sealed teeth (mean equals 2.37). Children with a physical disability have lower odds of having a sealant (OR equals 0.5; P=0.04) compared to nondisabled children. Six- to 11-year-olds have lower odds of having a sealant versus older age groups. Sealant use prevalence was lowest among African American children (39 percent) versus Hispanic (47 percent) and Caucasian (54 percent; P=0.01) children. Conclusions: The findings indicate disparities in dental sealants use among those with physical disabilities and younger age groups. Further studies and strategies are needed to intervene at an early age and increase utilization of sealants among children with special health care needs. (Pediatr Dent 2019;41(3):186-90) Received September 15, 2018 | Last Revision February 24, 2019 | Accepted March 4, 2019.

A national study on the use of opioid analgesics in dentistry

Abstract The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

Dental Public Health Practice, Infrastructure, and Workforce in the United States.

Dental public health is a unique specialty of dentistry that focuses on prevention of oral diseases among populations rather than individual patients. It encompasses several complementary disciplines and greatly varies in its functions and activities. Several federal, state, local, and nonpublic entities operationalize the mission of dental public health to improve population oral health through a diverse and vibrant workforce.

Water Intake by Outdoor Temperature Among Children Aged 1-10 Years: Implications for Community Water Fluoridation in the U.S.

OBJECTIVE: The U.S. water fluoridation recommendations, which have been in place since 1962, were based in part on findings from the 1950s that children's water intake increased with outdoor temperature. We examined whether or not water intake is associated with outdoor temperature. METHODS: Using linked data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 and the National Oceanic and Atmospheric Administration, we examined reported 24-hour total and plain water intake in milliliters per kilogram of body weight per day of children aged 1-10 years by maximum outdoor temperature on the day of reported water intake, unadjusted and adjusted for age, sex, race/ethnicity, and poverty status. We applied linear regression methods that were used in previously reported analyses of data from NHANES 1988-1994 and from the 1950s. RESULTS: We found that total water intake was not associated with temperature. Plain water intake was weakly associated with temperature in unadjusted (coefficient 5 0.2, p=0.015) and adjusted (coefficient 5 0.2, p=0.013) linear regression models. However, these models explained little of the individual variation in plain water intake (unadjusted: R(2)=0.005; adjusted: R(2)=0.023). CONCLUSION: Optimal fluoride concentration in drinking water to prevent caries need not be based on outdoor temperature, given the lack of association between total water intake and outdoor temperature, the weak association between plain water intake and outdoor temperature, and the minimal amount of individual variance in plain water intake explained by outdoor temperature. These findings support the change in the U.S. Public Health Service recommendation for fluoride concentration in drinking water for the prevention of dental caries from temperature-related concentrations to a single concentration that is not related to outdoor temperature.

Michigan dentists' attitudes toward Medicaid and an alternative public dental insurance system for children.

PURPOSE: Healthy Kids Dental (HKD) was created as a pilot program of the Michigan State Medicaid program to increase access to care for Medicaid-eligible children. The purpose of this study was to evaluate dentist's attitudes toward Healthy Kids Dental and Medicaid in Michigan. METHODS: An online survey was sent to practitioners with an e-mail address registered with the Michigan Dental Association (N=4,285). RESULTS: Surveys were returned from 965 practitioners (~23 percent). Although practitioners were not fully satisfied with the HKD, their satisfaction with the program was significantly higher than their satisfaction with the traditional Medicaid program (P<.001). Sixty-four percent of providers that accept Medicaid limit the number of children seen in some manner, while 28 percent of providers that accept HKD limit the number of children seen. Families with traditional Medicaid who contact an office are significantly less likely to receive treatment for their child than families with HKD insurance who contact the same office (P<.001). CONCLUSIONS: Practitioners were more satisfied with programmatic and patient-related factors of the Healthy Kids Dental program than they were with Medicaid. Dentists were more likely to treat children with HKD than children with Medicaid when the parent contacts a dentist in Michigan.

Recruitment, development, and retention of dental faculty in a changing environment.

The scarcity of full-time clinical faculty members in dental schools across the country is a major crisis confronting dentistry. Dental schools are experiencing critical faculty shortages and are struggling to maintain appropriate faculty to student ratios. The adage of "doing more with less" applies, in many ways, to dental schools and their mission of educating future dentists. Solutions to the problem have included plans to recruit, develop, and mentor faculty members. However, progress has been slow. Dental schools have created incentive programs to help with faculty shortages and develop future educators in dentistry. This requires commitment and resources and will take years before these efforts and their impact can be assessed. Creative solutions need to be developed both nationally and locally to reverse the trend more rapidly.

Perceived everyday discrimination and psychological distress: does social support matter?

OBJECTIVES: We investigate the association between perceived everyday discrimination and psychological distress among urban African-American women with young children (under 6 years) living in low-income neighborhoods. Specifically, we examine whether instrumental and emotional social support moderates the association between perceived everyday discrimination and psychological distress. DESIGN: The data come from the Detroit Dental Health Project, a two-stage area probability sample representative of low-income African-American children in the city of Detroit. The analysis focuses on 969 female caregivers of young children. A series of hierarchical regression analyses were performed to examine the role of social support in the link between perceived everyday discrimination and psychological distress, with appropriate adjustments for the complex sample design. RESULTS: Both moderate and high frequency levels of discrimination were associated with higher levels of psychological distress after controlling for age, education, income, and self-rated health. There was a main effect of emotional support so that availability of emotional support was associated with less psychological distress. Instrumental support exerted a buffering effect to mitigate the negative influence of moderate levels of perceived discrimination on psychological distress. CONCLUSION: Findings suggest that instrumental social support provides some protection from everyday stress. Social support, however, does not offset the impact of acute stress caused by frequent perceptions of everyday discrimination.

Assessing patterns of restorative and preventive care among children enrolled in Medicaid, by type of dental care provider.

BACKGROUND: The authors investigate the relationship of preventive dental treatment to subsequent receipt of comprehensive treatment among Medicaid-enrolled children. METHODS: The authors analyzed Medicaid dental claims data for 50,485 children residing in Wayne County, Mich. The study sample included children aged 5 through 12 years in 2002 who had been enrolled in Medicaid for at least one month and had had at least one dental visit each year from 2002 through 2005. The authors assessed dental care utilization and treatment patterns cross-sectionally for each year and longitudinally. RESULTS: Among the Medicaid-enrolled children in 2002, 42 percent had had one or more dental visits during the year. At least 20 percent of the children with a dental visit in 2002 were treated by providers who billed Medicaid exclusively for diagnostic and preventive (DP) services. Children treated by DP care providers were less likely to receive restorative and/or surgical services than were children who were treated by dentists who provided a comprehensive mix of dental services. The logistic model showed that children who visited a DP-care provider were about 2.5 times less likely to receive restorative or surgical treatments than were children who visited comprehensive-care providers. Older children and African-American children were less likely to receive restorative and surgical treatments from both types of providers. CONCLUSIONS: The study results show that the type of provider is a significant determinant of whether children received comprehensive restorative and surgical services. The results suggest that current policies that support preventive care-only programs may achieve increased access to preventive care for Medicaid-enrolled children in Wayne County, but they do not provide access to adequate comprehensive dental care.

Fluoride ingestion is related to fluid consumption patterns.

OBJECTIVES: There have been few reports regarding variations of fluoride intake by fluid consumption patterns. The purpose of this study was to estimate fluoride intake among children in the United States based on their fluid consumption patterns. METHODS: Fluid intakes of children aged 1-10 years from plain water, beverages, and water from foods were assessed in a 24-hour recall diet survey as a part of the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994). The amount of fluoride ingested from fluids in NHANES III was estimated from several assumptions about the concentration of fluoride in drinking water and beverages. Logistic regression analysis was conducted using SAS and SUDAAN. RESULTS: Children at the 75th percentile or higher of F intake from fluids (not including water used in cooking) ingested 0.05 mg F/kg/day or more, and children at the 90th percentile or higher ingested 0.07 mg F/kg/day or more. This finding held across all age groups. There was substantial variation in the estimated amount of fluoride ingestion depending on the children's fluid consumption patterns as well as age, gender, and race/ethnicity. African-American children ingested significantly more fluoride than White children in bivariate analysis. This association remained significant after accounting for fluid consumption pattern and other confounding factors in the model. CONCLUSION: Our results raise concerns that some children are ingesting significantly more fluoride than others depending on sociodemographic factors and fluid consumption patterns. Additional research is warranted to investigate the variation in the amounts of fluoride ingestion by these factors and its impact on fluorosis prevalence in different population groups.

Characteristics of African-American male caregivers in a study of oral health in Detroit--a brief communication.

OBJECTIVE: The role of fathers among African-American men, particularly related to oral health, has received relatively little scholarly attention. This paper describes the characteristics of African-American men who self-identified as primary caregiver to an index child participating in the Detroit Dental Health Project. METHODS: Of 1,021 caregiver-child pairs recruited to this oral health study, 52 were male. Data were collected at a central site in Detroit on: 1) demographics; 2) social support; 3) oral health beliefs, behaviors, and knowledge; 4) caregivers' and child's oral health. RESULTS: Participants reported good availability of social support and high perceived self-efficacy to take care of their child's teeth, yet, they possessed limited knowledge on preventing oral health problems. Moreover, male caregivers had high levels of caries, missing teeth, and poor hygiene. CONCLUSIONS: Findings may inform the development of effective interventions aimed at male caregivers to improve knowledge and understanding of the caries process, particularly concerning their children.

Resilience to urban poverty: theoretical and empirical considerations for population health.

OBJECTIVES: To better understand the trajectory that propels people from poverty to poor health, we investigated health resilience longitudinally among African American families with incomes below 250% of the federal poverty level. METHODS: Health resilience is the capacity to maintain good health in the face of significant adversity. With higher levels of tooth retention as a marker of health resilience, we used a social-epidemiological framework to define capacity for health resilience through a chain of determinants starting in the built environment (housing quality) and community context (social support) to familial influences (religiosity) and individual mental health and health behavior. RESULTS: Odds of retaining 20 or more teeth were 3 times as likely among adults with resilience versus more-vulnerable adults (odds ratio=3.1; 95% confidence interval [CI]=1.3, 7.4). Children of caregivers with resilience had a lower incident rate of noncavitated tooth decay at 18- to 24-month follow-up (incidence risk ratio=0.8; 95% CI=0.7, 0.9) compared with other children. CONCLUSIONS: Health resilience to poverty was supported by protective factors in the built and social environments. When poverty itself cannot be eliminated, improving the quality of the built and social environments will foster resilience to its harmful health effects.