Conceptualizing inequities and oppression in oral health research.

Major sociohistorical processes have profound effects on oral health, with impacts experienced through structural oppression manifested in policies and practices across the lifespan. Structural oppression drives oral health inequities and impacts population-level oral health. In this global perspective paper, we challenge old assumptions about oral health inequities, address misleading conceptualizations in their description and operation and reframe oral health through the lens of intersecting systems of oppression. Furthermore, we emphasize the need for oral health researchers to explore causal pathways through which oppression harms oral health and engage in social science concepts to understand the root causes of oral health inequities fully. Finally, we call on policymakers, dental scholars and decision makers to consider health equity in all policies and to take a systems-oriented approach to effectively address oral health inequities.

Oral conditions associated with oral health related quality of life: A population-based cross-sectional study in Brazil.

AIM: To investigate the association between 11 oral conditions and oral health related quality of life (OHRQoL). MATERIALS AND METHODS: This cross-sectional study used a multistage sampling strategy to draw a representative sample of adults aged ≥35 years living in Porto Alegre, Brazil. OHRQoL was assessed using OHIP-14. Oral examinations were conducted to assess gingivitis, dental calculus, tooth loss, gingival recession (GR), dentine hypersensitivity (DHS), dental caries (DFT), dental erosion, and non-carious cervical lesions (NCCL). Questionnaires recorded the following self-reported oral variables: xerostomia, halitosis, and perceived need for dental treatment. Structural Equation Models were used to assess the associations adjusting to demographic and behavioral variables. RESULTS: 1022 individuals were analyzed. The overall OHIP mean equaled 9.2 ± 9.7 points. Xerostomia [coefficient (coef)=0.10], halitosis (coef=0.28), DFT (coef=0.16), and DHS (coef=0.19) were significantly and directly associated with negative impacts of OHIP-14. GR was significantly and indirectly associated with poor OHRQoL due to higher DHS. Perceived need for dental treatment was significantly and directly associated with higher OHIP-14 (coef=0,40). CONCLUSIONS: Poor OHRQoL was observed in a sample of Brazilian adults and old people. Five important oral conditions were associated to poor OHRQoL. Tooth loss, gingivitis, calculus, dental erosion and NCCL did not associate with OHRQoL. CLINICAL SIGNIFICANCE: Poorer oral health related quality of life is observed in a Brazilian urban area compared to other parts of the world. Xerostomia, halitosis, dental caries, gingival recession, and dentine hypersensitivity may be targeted to improve oral health and consequently oral health related quality of life.

Long-term risk factors for old-age social exclusion in Sweden: a 30-year longitudinal study.

PURPOSE OF THE RESEARCH: Social exclusion threatens quality of life in older age. However, there is a lack of research on social exclusion from life-course and gender perspectives. We investigated early- and midlife risk factors for old-age social exclusion among women and men. MATERIALS AND METHODS: Two individually linked studies of Swedish nationally representative samples provided longitudinal data over a 30-year period on 1,819 people at baseline. Indicators of economic exclusion, leisure/social exclusion, and civic exclusion were assessed at early late life (M=70 years) and late life (M=81). Educational attainment, non-employment, psychological health problems and mobility problems were measured as risk factors at midlife (M=54) and late midlife (M=61). Path analysis derived a model of old-age social exclusion. RESULTS: Exclusion on a domain in early late life led to exclusion on the same domain in late life, except for the economic domain. Leisure/social exclusion in early late life also led to civic exclusion in late life. Midlife risk factors influenced late-life exclusion almost exclusively through early late-life exclusion. While model fit could not be significantly improved by allowing coefficients to vary freely by gender, there was a stronger effect of non-employment on exclusion in women and a stronger effect of psychological health problems on exclusion in men. CONCLUSIONS: This study confirms that old-age exclusion is persistent and dynamic, and influenced by risk factors experienced earlier in life. A holistic approach with integrated efforts across different policy areas is needed to efficiently reduce old-age social exclusion.

Where are race-based oral health inequities bound? Protocol for a systematic review on interventions to tackle racial injustice in dental outcomes.

BACKGROUND: Only three literature reviews have assessed the impact of interventions on the reduction of racial inequities in general health to date; none has drawn from attempts at promoting racial oral health equity. This protocol aims to increase transparency and reduce the potential for bias of an ongoing systematic review conceived to answer the following questions: Are there any interventions to mitigate racial oral health inequities or improve the oral health of racially marginalized groups? If so, how successful have they been at promoting racial oral health equity? How do conclusions of previous reviews change by taking the findings of oral health interventions into account? METHODS: Reviewed studies must deploy interventions to reduce racial gaps or promote the oral health of groups oppressed along ancestral and/or cultural lines. We will analyze randomized clinical trials, natural experiments, pre-post studies, and observational investigations that emulate controlled experiments by assessing interactions between race and potentially health-enhancing interventions. Either clinically assessed or self-reported oral health outcomes will be considered by searching for original studies in MEDLINE, LILACS, PsycInfo, SciELO, Web of Science, Scopus, and Embase from their earliest records to March 2022. Upon examining abstracts of conference proceedings, trial registries, reports of related stakeholder organizations, as well as contacting researchers for unpublished data, we will identify studies in the grey literature. If possible, we will carry out a meta-analysis with subgroup and sensitivity analysis, including formal meta-regression, to address potential heterogeneity and inconsistency among selected studies. DISCUSSION: Conducting a systematic review of interventions to mitigate racial oral health inequities is crucial for determining which initiatives work best and under which conditions they succeed. Such knowledge will help consolidate an evidence base that may be used to inform policy and practice against persistent and pervasive racial inequities in general and oral health. SYSTEMATIC REVIEW REGISTRATION: This protocol has been registered at the International Prospective Register of Systematic Reviews, under the identification number CRD42021261450 .

Advancing racial equity in oral health (research): more of the same is not enough.

By critically appraising the literature on the oral health effects of race-based oppression, this focus article makes four recommendations that may both facilitate more nuanced research on the topic and mitigate racial/ethnic inequities in (oral) health. The first is recognizing that science itself may perpetuate racial/ethnic injustice, such that adopting a 'neutral' position must be replaced with actively fostering anti-racist narratives. The second is to not imply that racial oppression is bad because it harms oral health. Rather, studies should help build a fairer world, wherein oral health inequities would not abound. The third recommendation is encouraging initiatives that understand systems of oppression as conjointly operating to shape oral health. The fourth and final recommendation is taking race-based oppression as a multi-level system that operates on three inter-related conceptual levels - intra-personal, inter-personal, and structural. The extent to which scholars, practitioners, and policymakers are willing to follow these recommendations may determine how successful attempts to eradicate (oral) health inequities might be. Learning from, and avoiding mistakes made in, previous publications is one ethical pathway towards this end.

Spatial distribution of dental caries among preschool children in Canoas, Southern Brazil.

The aims of this study were to analyze the spatial distribution of dental caries among preschool children and create equiprobable scenarios of its occurrence in the city of Canoas, Southern Brazil. Trained, calibrated dentists examined 1,100 children enrolled at public preschools to determine dental caries experience following World Health Organization criteria. The ArcGis 10.0 Geographic Information System was used to analyze spatial and non-spatial data. Geostatistical Modeling Software was used in geostatistical analyses to detect spatial continuity and create maps using stochastic simulation. Overall prevalence of dental caries was 25% with intraurban differentials in distribution. The findings enabled the generation of 100 equiprobable scenarios and maps with the best and worst scenarios. The highest concentration of dental caries occurrence was found in the western portion of the city, while the lowest probability of occurrence was found in the northern and southern portions. Identifying spatial inequalities in health conditions and visualizing them through the creation of maps can help to qualify and organize public health interventions and provide information to gain better understanding of the influence of the surrounding environment on adverse health conditions.

O objetivo do estudo foi analisar a distribuição espacial de cárie dentária entre crianças préescolares e criar cenários equiprováveis da ocorrência deste agravo na cidade de Canoas, sul do Brasil. Exame clínico para detecção da experiência de cárie dentária de acordo com o critério da Organização Mundial da Saúde foi realizado por cirurgiõesdentistas treinados e calibrados em uma amostra de 1.100 crianças matriculadas em escolas de educação infantil. Utilizouse o Sistema de Informação Geográfica ArcGis 10.0 para a inserção de dados espaciais e não espaciais. O programa GeoMS foi utilizado nas análises geoestatísticas para a detecção da continuidade espacial e construção de mapas através da simulação estocástica. A prevalência de cárie dentária foi 25%, com diferenciais intraurbanos na sua distribuição. Os resultados permitiram a construção de 100 cenários equiprováveis e de mapas com os melhores e piores cenários no município. Uma maior concentração de ocorrên cias foi encontrada na região oeste da cidade, enquanto que as regiões norte e sul tiveram a menor probabilidade de ocorrência de cárie dentária. A identificação de desigualdades espaciais em condições de saúde e a sua visualização por meio de mapas pode auxiliar na qualificação e organização de intervenções de saúde pública, assim como fornecer subsídios que ajudem no entendimento da influência do meio ambiente sobre as condições adversas de saúde.

Perceived discrimination south of the equator: Reassessing the Brazilian Explicit Discrimination Scale.

OBJECTIVE: To reassess the Explicit Discrimination Scale (EDS; Bastos, Faerstein, Celeste, & Barros, 2012), an instrument developed in Brazil to examine intersecting forms of discrimination, with particular attention to the number of underlying dimensions, residual correlations, share of explained item variance, and stability of the configural and metric structure in broader populations. METHOD: Data from two cross-sectional studies and one cohort investigation were used. Although the cross-sectional studies were conducted among racially diverse undergraduate students (n = 1,022, 45% women, mean age = 23 years; n = 424, 59% women, mean age = 22 years), the cohort study included a probabilistic sample of community residents with 18% racial/ethnic minority respondents (n = 1,187, 57% women, mean age = 42 years). A series of exploratory models, exploratory structural equation models, and confirmatory factor analyses models was estimated. RESULTS: The EDS items might be best represented by a 3-factor model, which includes a second-order factor. Although only 1 pair of correlated residuals emerged, at least 4 different items with a sizable share of error variance were observed. The revised scale structure had an excellent fit to the data and was consistent among both undergraduate students and community residents. CONCLUSIONS: As well as demonstrating that discrimination may be structured by proximal, medial, and distal experiences with mistreatment, we suggest that the EDS has the potential to enhance research on the intersectional health impacts of discrimination. Future studies are required to assess scalability and provide scholars with a shortened version of the instrument. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Pathways of socioeconomic inequalities in gingival bleeding among adolescents.

OBJECTIVES: To explore the pathways through which the socioeconomic inequalities may influence gingival bleeding in adolescents, assessing the direct and indirect effects of material and psychosocial variables. METHODS: This cohort study followed a multistage, random sample of 1134 12-year-old adolescents from 20 public schools of Santa Maria, a city in southern Brazil. The percentage of teeth with gingival bleeding was recorded according to the Community Periodontal Index criteria (scored as healthy or bleeding) at baseline and at 2-year follow-up. Biological (dental plaque, caries, and dental crowding), material (socioeconomic position [SEP] operationalized as family income and parents' education), psychosocial (parents' religiosity, self-rated health, and happiness) and behavioural (use of dental service by adolescents) factors were collected at baseline. Structural equation modelling (SEM) was guided by the adapted Commission on the Social Determinants of Health model linking material, psychosocial, biological, and behaviour variables to health. The SEM was employed to estimate standardized direct, indirect, and total effects of material and psychosocial factors on gingival bleeding at follow-up. RESULTS: A total of 770 14-year-old adolescents were reassessed (follow-up rate of 68%). The lower SEP at baseline had a higher direct effect (standard coefficient [SC] = -0.17, P < 0.01) than a mediated effect on percentage of teeth with gingival bleeding at 2-year follow-up. The lower indirect effect (SC = -0.06, P < 0.01) from SEP to gingival bleeding at follow-up ran through biological factors-dental plaque (baseline and follow-up) and gingival bleeding at baseline. The lower religiosity of the parents as a psychosocial aspect had only a small direct effect (SC = -0.10, P = 0.03) on gingival bleeding at follow-up. CONCLUSIONS: Material factors such as SEP contributed most to explanations on inequalities in adolescents' periodontal health because of their higher direct effect and additional shared (indirect) effect (through biological factors) on gingival bleeding. Religious practice as a psychosocial factor only explained part of percentage of teeth with gingival bleeding at follow-up.

Spatial distribution of dental caries among preschool children in Canoas, Southern Brazil

The aims of this study were to analyze the spatial distribution of dental caries among preschool children and create equiprobable scenarios of its occurrence in the city of Canoas, Southern Brazil. Trained, calibrated dentists examined 1,100 children enrolled at public preschools to determine dental caries experience following World Health Organization criteria. The ArcGis 10.0 Geographic Information System was used to analyze spatial and nonspatial data. Geostatistical Modeling Software was used in geostatistical analyses to detect spatial continuity and create maps using stochastic simulation. Overall prevalence of dental caries was 25% with intraurban differentials in distribution. The findings enabled the generation of 100 equiprobable scenarios and maps with the best and worst scenarios. The highest concentration of dental caries occurrence was found in the western portion of the city, while the lowest probability of occurrence was found in the northern and southern portions. Identifying spatial inequalities in health conditions and visualizing them through the creation of maps can help to qualify and organize public health inter ventions and provide information to gain better understanding of the influence of the surrounding environment on adverse health conditions (AU)

O objetivo do estudo foi analisar a distribuição espacial de cárie dentária entre crianças préescolares e criar cenários equiprováveis da ocorrência deste agravo na cidade de Canoas, sul do Brasil. Exame clínico para detecção da experiência de cárie dentária de acordo com o critério da Organização Mundial da Saúde foi realizado por cirurgiõesdentistas treinados e calibrados em uma amostra de 1.100 crianças matriculadas em escolas de educação infantil. Utilizouse o Sistema de Informação Geográfica ArcGis 10.0 para a inserção de dados espaciais e não espaciais. O programa GeoMS foi utilizado nas análises geoestatísticas para a detecção da continuidade espacial e construção de mapas através da simulação estocástica. A prevalência de cárie dentária foi 25%, com diferenciais intraurbanos na sua distribuição. Os resultados permitiram a construção de 100 cenários equiprováveis e de mapas com os melhores e piores cenários no município. Uma maior concentração de ocorrên cias foi encontrada na região oeste da cidade, enquanto que as regiões norte e sul tiveram a menor probabilidade de ocorrência de cárie dentária. A identificação de desigualdades espaciais em condições de saúde e a sua visualização por meio de mapas pode auxiliar na qualificação e organização de intervenções de saúde pública, assim como fornecer subsídios que ajudem no entendimento da influência do meio ambiente sobre as condições adversas de saúde (AU)

Factor analysis of two versions of the Oral Impacts on Daily Performance scale.

The aim of this study was to explore the factorial structure and agreement of two scoring versions of the Oral Impacts on Daily Performance (OIDP) scale, and to compare the fit of the originally proposed factorial structure, as opposed to an alternative model. Exploratory factor analyses (EFA) were conducted to explore the dimensional structure of the OIDP on a convenience sample of 200 adults (S1). Confirmatory factor analyses (CFA) were performed on a random sample of 720 adults (S2). The Cronbach's alpha coefficients for the total and frequency versions of the OIDP scale were, respectively, 0.81 and 0.70 for S1, and 0.82 and 0.79 for S2, with a quadratic Kappa κ = 0.83 (95% CI: 0.75-0.89) in S1 and κ = 0.92 (95% CI: 0.89-0.94) in S2. Exploratory factor analyses showed one factor for the total version and three factors (non-interpretable) for the frequency version. Confirmatory factor analyses showed that the frequency version for the one-factor model (Model 1) had the best fit [Root Mean Square Error of Approximation (RMSEA) = 0.04; Comparative Fit Index (CFI) = 0.98; Tucker-Lewis index (TLI) = 0.97, χ(2) P-value < 0.01]. The one-factor model was not significantly different from the original three-factor model. These findings suggest that the scale captures only one overall quality of life dimension, and that the frequency version was the most parsimonious model of the OIDP scale.

Effect of orthodontic treatment on oral health-related quality of life.

OBJECTIVE: To assess changes in oral health-related quality of life (OHQoL) in children undergoing fixed orthodontic treatment and compare it to that of two groups not receiving treatment. MATERIALS AND METHODS: Two hundred eighty-four subjects aged 12-15 years were followed for 2 years; 87 were undergoing treatment at a university clinic (TG), 101 were waiting for treatment at this clinic (WG), and 96 were attending a public school and had never sought treatment (SG). OHQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T1), 1 year later (T2), and 2 years later (T3). OHIP-14 scores were analyzed using negative binomial regression in generalized estimating equations for correlated data. RESULTS: During the follow-up period, the WG and TG OHIP-14 scores showed a statistically significant increase and decrease, respectively (P < .001). At T1, the TG had an OHIP-14 score that was 1.9 times higher than that of the SG; however at T3, the TG score was 60% lower than the initial score of the SG. Adjusting for age, gender, dental health status (DMFT), socioeconomic position, malocclusion severity, and self-perceived esthetics did not change the effect of orthodontic treatment on OHQoL. CONCLUSION: Fixed orthodontic treatment in Brazilian children resulted in significantly improved OHQoL after 2 years.

Influence of orthodontic treatment on adolescents' self-perceptions of esthetics.

INTRODUCTION: The aim of this prospective evaluation was to assess changes in esthetic self-perception of Brazilian adolescents who were receiving fixed orthodontic treatment during a 2-year period. METHODS: The treatment group consisted of 92 patients, ages 12 to 15 years, treated at the Rio de Janeiro State University orthodontic clinic. The control group consisted of 226 untreated adolescents; 124 subjects were waiting for treatment at this clinic, and 102 subjects were attending public school and had never undergone or sought treatment. The index of orthodontic treatment need was used to assess malocclusion severity, esthetic status (measured by an orthodontist), and esthetic self-perception. All subjects were interviewed 3 times during the study: at baseline; 1 year after placement of the fixed appliance for the treatment group and 1 year after the first interview for the school and waiting groups; and 2 years after placement of the fixed appliance for the treatment group and 2 years after the first interview for the school and waiting groups. The index of orthodontic treatment need scores were analyzed by using negative binomial regression in generalized estimating equations for correlated data. RESULTS: During the follow-up period, the treatment group's esthetic self-perception scores had a statistically significant decrease (P <0.01), the waiting group's scores had an increase (P = 0.08), and the school group's scores were stable (P = 0.79). At baseline, the treatment group had an esthetic self-perception score of 96% (risk ratio = 1.96; 95% confidence interval, 1.70-2.26) higher than the school group, but at the final interview, the treatment group's score was 20% lower (risk ratio = 0.81; 95% confidence interval, 0.68-0.96) than the initial score of the school group. Age; sex; the index of decayed, missing, and filled teeth; and socioeconomic position did not affect the adolescents' esthetic self-perceptions at follow up, but malocclusion severity and the group had a significant interaction. CONCLUSIONS: Fixed orthodontic treatment in patients 12 to 15 years of age significantly improved their esthetic self-perceptions.

Análise comparativa da legislaçäo sobre rótulo alimentício do Brasil, Mercosul, Reino Unido e Uniäo Européia / Comparative analysis of the Brazilian/ Mercosul and British/ European Union food labeling legislation

OBJETIVO: Analisar a legislação sobre rótulo alimentício do Mercosul, Brasil, União Européia e Reino Unido. MÉTODOS: Utilizou-se uma lista de critérios com os pontos considerados mais importantes para a descrição e a comparação das legislações. Também pesquisaram-se 19 pontos mais importantes para caracterizar as diferentes legislações. RESULTADOS: As legislações são semelhantes em quase todos os aspectos. Considerando-se a propaganda nutricional, existem deficiências nas legislações. Elas permitem que seja passada informação ao consumidor de forma inútil e potencialmente enganosa. Em relação à descrição nutricional, existem dois problemas. Primeiro, em nenhuma legislação ela é compulsória. Segundo, o formato de apresentação dos macronutrientes exige descrição por peso, enquanto as recomendações internacionais são dadas em percentagem de energia. CONCLUSÕES: As legislações deveriam ser revistas. Propaganda nutricional não deveria ser permitida e a descrição nutricional deveria ser compulsória. Além disso, o modo de apresentação dos macronutrientes deveria ser expresso em percentagem de calorias para que os consumidores pudessem seguir as recomendações nutricionais