Is Starch Intake Associated With Periodontal Status? An 11-Year Longitudinal Analysis Among Finnish Adults.

AIM: To evaluate the association between baseline starch intake (amount and sources) and changes in periodontal status over 11 years in adults. METHODS: Adults aged 30-82 years, who participated in the Finnish Health 2000 survey and were re-examined in 2004/2005 and/or 2011 were included in the study. The consumption of total starch and six relevant food groups (potatoes, fried potatoes, roots and tubers, pasta, wholegrains and legumes) over the past year was determined at baseline with a validated food frequency questionnaire. The number of teeth with periodontal pocketing ≥ 4 mm (NTPP) was recorded during clinical examinations in 2000, 2004/2005 and 2011. The association between baseline starch intake and the 11-year change in the NTPP was tested in mixed-effects negative binomial regression models, adjusting for covariates. RESULTS: A total of 1369 adults were included in the analysis. The mean NTPP was 4.1 ± 5.6, 6.3 ± 5.6, and 4.8 ± 5.9 in waves 1, 2 and 3, respectively. Baseline starch intake (in g/day or % energy intake) was not associated with changes in the NTPP after adjustment for covariates. In analysis by food groups, the baseline intake of wholegrains was negatively associated with the NTPP at baseline. CONCLUSION: This study found no evidence of an association between baseline starch intake and changes in periodontal status. Baseline intake of wholegrains was associated with better periodontal status at baseline.

Ethnicity, Social Support and Oral Health Among English Individuals.

OBJECTIVE: To determine whether social support explains ethnic inequalities in oral health among English individuals. METHODS: Data from 42704 individuals across seven ethnic groups in the Health Survey for England (1999-2002 and 2005) were analysed. Oral health was indicated by self-reports of edentulousness and toothache. Social support was indicated by marital status and a 7-item scale on perceived social support. Confounder-adjusted regression models were fitted to evaluate ethnic inequalities in measures of social support and oral health (before and after adjustment for social support). RESULTS: Overall, 10.4% of individuals were edentulous and 21.7% of dentate individuals had toothache in the past 6 months. Indian (Odd Ratio: 0.50, 95% Confidence Interval: 0.32-0.78), Pakistani (0.50, 95%CI: 0.30-0.84), Bangladeshi (0.29, 95%CI: 0.17-0.47) and Chinese (0.42, 95%CI: 0.25-0.71) individuals were less likely to be edentulous than white British individuals. Among dentate participants, Irish (1.21, 95%CI: 1.06-1.38) and black Caribbean individuals (1.37, 95%CI: 1.18-1.58) were more likely whereas Chinese individuals (0.78, 95%CI: 0.63-0.97) were less likely to experience toothache than white British individuals. These inequalities were marginally attenuated after adjustment for marital status and perceived social support. Lack of social support was associated with being edentulousness and having toothache whereas marital status was associated with edentulousness only. CONCLUSION: The findings did not support the mediating role of social support in the association between ethnicity and oral health. However, perceived lack of social support was inversely associated with worse oral health independent of participants' sociodemographic factors.

The Role of Area Deprivation in Explaining Ethnic Inequalities in Adult Oral Health in England.

BACKGROUND: The circumstances of the area where people live may affect their health and ethnic minority groups are often overrepresented in deprived areas. This study explored ethnic inequalities in adult oral health and the contribution of area deprivation to explain such inequalities. METHODS: Data from 15667 adults across 8 ethnicities (White British, Irish, Black Caribbean, Black African, Indian, Pakistani, Bangladeshi, Chinese) in the Health Survey for England 2010/2011 were analysed. Oral health was indicated by having a non-functional dentition, poor self-rated oral health and oral impacts on daily activities. Survey logistic regression and the Blinder-Oaxaca decomposition method were used. RESULTS: There were ethnic inequalities in the non-functional dentition, but not in self-rated oral health or oral impacts. Compared to White British adults (19.7%, 95% CI: 18.9, 20.6), a non-functional dentition was more common in Irish (33.1%, 95% CI: 25.9, 41.2) and less common in Black Caribbean (14.9%, 95% CI: 9.9, 21.7), Black African (6.9%, 95% CI: 3.9, 11.9), Indian (10.5%, 95% CI: 6.3, 17.2), Pakistani (7.2%, 95% CI: 4.5, 11.5), Bangladeshi (12.7%, 95% CI: 4.3, 32.3) and Chinese (2.2%, 95% CI: 0.6, 7.9) adults. In decomposition analysis, observed population characteristics explained over half of the ethnic inequalities in the non-functional dentition. Age, area deprivation and SEP were the main contributors, although results varied by ethnicity. CONCLUSION: Ethnic inequalities in adult oral health varied according to oral health measure and ethnicity. Area deprivation and SEP contributed to, but did not fully, explain such inequalities.

Family Functioning and Dental Behaviours of Pre-school Children.

OBJECTIVES: To examine the association of family functioning with child dental behaviours and to identify family functioning domains associated with those behaviours. METHODS: Cross-sectional data from the East London Oral Health Inequalities (ELOHI) study were analysed in a subsample of 733 parent-child (3-4-years-olds) dyads. Family functioning was measured with the 60-item Family Assessment Device that yielded a general functioning score and six domain scores (roles, communication, problem solving, affective involvement, affective responsiveness, and behaviour control). Child dental behaviours were sugar intake, dental attendance and toothbrushing frequency. The association of family functioning with each dental behaviour was assessed in logistic regression models adjusted for confounders (parental sociodemographic and child demographic factors). RESULTS: Unhealthy general functioning was associated with greater odds of reporting high child intake of sugars (OR: 1.78, 95%CI: 1.01-3.13) as well as lower odds of reporting frequent child brushing (OR: 0.76, 95%CI: 0.50-1.18) and a child visit for dental check-up in the past year (OR: 0.98; 95%CI: 0.62-1.53), after adjustment for confounders. Unhealthy functioning in roles, affective involvement and behaviour control were associated with high child sugar intake whereas unhealthy functioning in roles was inversely associated with frequent child toothbrushing. No family functioning domain was associated with child dental attendance pattern. CONCLUSIONS: Healthy family functioning was associated with more favourable child dental behaviours. How a family functions, particularly in terms of how they define roles and support each other emotionally, is likely to be relevant to child oral health.

Is the Performance of a Periodontal Prediction Model for Identification of Diabetes affected by Participants' Characteristics?

OBJECTIVE: To evaluate whether the diagnostic accuracy of a novel periodontal prediction model (PPM) for identification of adults with diabetes varies according to participants' characteristics. BASIC RESEARCH DESIGN: The study was carried out among 250 adults attending primary care clinics in Riyadh (Saudi Arabia). The study adopted a case-control approach, where diabetes status was first ascertained, and data collection carried out afterwards using questionnaires and periodontal examinations. Variations in the performance of the PPM by demographic (sex and age), socioeconomic (education) and behavioural factors (smoking status and last dental visit) were evaluated using receiver-operating characteristic (ROC) regression. RESULTS: The PPM including 3 periodontal parameters (missing teeth, percentage of sites with pocket depth ≥6mm and mean pocket depth) had an area under the ROC curve (AUC) of 0.69 (95% Confidence Interval: 0.61-0.78), which dropped to 0.64 (95% CI: 0.53-0.75) after adjustment for covariates. Larger variations in performance were found by participants' sex, age and education, but not by smoking status or last dental visit. The PPM performed better among male (adjusted AUC: 0.76; 95% CI: 0.53 to 0.99), younger (0.67; 95% CI: 0.50 to 0.84) and less educated participants (0.76; 95% CI: 0.60, 0.92). CONCLUSIONS: The diagnostic accuracy of a novel periodontal prediction model to identify individuals with diabetes varied according to participants' characteristics. This study highlights the importance of adjusting for covariates on studies of diagnostic accuracy.

Is there a healthy migrant effect in relation to oral health among adults in England?

OBJECTIVE: The aim of the study was to assess the healthy migrant effect in relation to oral health among adults in England. STUDY DESIGN: This is a secondary data analysis of a nationally representative survey. METHODS: Data from 13,373 adults of Irish, black Caribbean, Indian, Pakistani, Bangladeshi and Chinese ethnicity, who participated in the Health Survey for England, were analysed. The proportions of edentate and dentate adults with toothache in the last 6 months in first- and second-generation migrants within each ethnic group were compared with those in the white British (reference group) ethnic group in logistic regression models after adjusting for demographic factors and socio-economic position. Among first-generation migrants, the associations of age at arrival and length of residence with each oral health outcome were assessed in logistic regression models after adjusting for sociodemographic factors. RESULTS: Compared with white British migrants, first-generation black Caribbean (odds ratio [OR]: 1.42) and second-generation Pakistani (OR: 3.16) migrants had higher odds of being edentulous, whereas first-generation Indian (OR: 0.62), Pakistani (OR: 0.62), Bangladeshi (OR: 0.41) and Chinese (OR: 0.49) migrants had lower odds. Among dentate adults, second-generation Irish (OR: 1.51) migrants, first- and second-generation black Caribbean (OR: 1.61 and 1.54, respectively) migrants, first-generation Indian (OR: 1.24) migrants and second-generation Pakistani (OR: 1.34) migrants had higher odds of having toothache in the past 6 months, whereas second-generation Bangladeshi (OR: 0.51) migrants had lower odds than white British. Age at arrival and length of residence were positively associated with being edentulous among first-generation black Caribbean, Pakistani and Bangladeshi migrants. CONCLUSION: Evidence on the healthy migrant effect was mixed, with more consistent findings seen for edentulousness among Asian groups. Black Caribbean migrants were generally the ethnic group with the worst oral health when compared with white British.

Maternal Oral Health and Early Childhood Caries amongst Low-Income Families.

OBJECTIVE: To determine the association between maternal oral health and Early Childhood Caries (ECC) and discover the role of maternal and child behaviours in explaining this association. BASIC RESEARCH DESIGN: A cross-sectional analytic study. CLINICAL SETTING: Public Healthcare Services in Pasto, Colombia. PARTICIPANTS: 384 mothers and their 2-5-year-old children. METHODS: Mothers completed a questionnaire to provide information on sociodemographic and behavioural factors and were examined for caries experience (DMFS index) and periodontal status (Community Periodontal Index, CPI). Children were examined for dental caries (dmfs index). The association between maternal dental indicators and child dmfs was assessed in negative binomial regression adjusting for confounders. RESULTS: About 96% and 33% of mothers had caries experience and periodontal disease, respectively. The mean dmfs was 7.4 (SD: 9.5, range: 0-71). Maternal DMFS, but not CPI, was positively associated with children's dmfs (Rate Ratio: 2.51, 95%CI: 1.59-3.97) after adjustments for sociodemographic and behavioural factors. CONCLUSIONS: Maternal caries experience, but not periodontal status, was positively associated with ECC in their children. Maternal and child behaviours explained little of this association.

Ethnic Disparities in Oral Health Related Quality of Life among Adults in London, England.

OBJECTIVE: To explore ethnic disparities in oral health related quality of life (OHQoL) among adults, and the role that socioeconomic factors play in that association. RESEARCH DESIGN: Data from 705 adults from a socially deprived, ethnically diverse metropolitan area of London (England) were analysed for this study. Ethnicity was self-assigned based on the 2001 UK Census categories. OHQoL was measured using the Oral Health Impact Profile (OHIP-14), which provides information on the prevalence, extent and intensity of oral impacts on quality of life in the previous 12 months. Ethnic disparities were assessed in logistic regression models for prevalence of oral impacts and negative binomial regression models for extent and intensity of oral impacts. RESULTS: The prevalence of oral impacts was 12.7% (95% CI: 10.2-15.1) and the mean OHIP-14 extent and severity scores were 0.27 (95% CI: 0.20-0.34) and 4.19 (95% CI: 3.74-4.64), respectively. Black adults showed greater and Asian adults lower prevalence, extent and severity of oral impacts than White adults. However, significant differences were only found for the extent of oral impacts; Black adults reporting more and Asian adults fewer OHIP-14 items affected than their White counterparts. After adjustments for socioeconomic factors, Asian adults had significantly fewer OHIP-14 items affected than White adults (rate ratio: 0.28; 95%CI: 0.08-0.94). CONCLUSION: This study found disparities in OHQoL between the three main ethnic groups in South East London. Asian adults had better and Black adults had similar OHQoL than White adults after accounting for demographic and social factors.

Perceived learned skills and professional development of graduates from a master in dental public health programme.

INTRODUCTION: Assessing the impact of a training programme is important for quality assurance and further development. It also can helps with accountability and marketing purposes. This study evaluated the impact of King's College London (KCL) Master of Science programme in Dental Public Health in terms of graduates' perceived learned skills and professional development. METHODS: An online questionnaire was sent to individuals who completed successfully the KCL Master of Science programme in Dental Public Health and had a valid email address. Participants provided information on demographic characteristics, perceived learned skills (intellectual, practical and generic) and professional development (type of organisation, position in the organisation and functions performed at work before and after the programme). Learned skills' scores were compared by demographic factors in multiple linear regression models, and the distribution of responses on career development was compared using nonparametric tests for paired groups. RESULTS: Although all scores on learned skills were on the favourable side of the Likert scale, graduates reported higher scores for practical skills, followed by intellectual and generic skills. No differences in scores were found by sex, age, nationality or time since graduation. In terms of career development, there were significantly higher proportions of graduates working in higher education institutions and taking leadership/managerial roles in organisations as well as greater number and variety of functions at work after than before the programme. CONCLUSION: This online survey shows that the programme has had a positive impact on graduates in terms of perceived learned skills and professional development.

Attitudes and practices regarding preventive dentistry among Libyan dentists.

PURPOSE: To assess the attitudes towards and practices related to preventive dentistry among Libyan dentists. METHODS: A cross-sectional, questionnaire-based survey was conducted among dentists working in Benghazi. All dentists registered with the Dental Association of Benghazi and with two or more years of practice were invited to participate. The questionnaire enquired about dentists' demographic (gender and age) and professional characteristics (practice sector and years of service), attitudes towards preventive dentistry using nine semantic differential scales and the frequency with which they performed eight preventive measures to patients. Non-parametric tests were used to compare attitudes towards and practices related to preventive dentistry by participants' demographic and professional characteristics. RESULTS: Of the 175 dentists returning questionnaires (response rate 79%), 166 had complete information on all the variables needed for analysis (75%). Dentists felt preventive dentistry was useful and essential to the community as well as of scientific merit for dentists. As for practices, oral hygiene instruction and recommending fluoridated toothpaste were the most commonly reported preventive measures performed by dentists whereas the application of topical fluoride and fissure sealants were the least reported. Attitudes towards and practices related to preventive dentistry varied by professional but not demographic characteristics. CONCLUSION: Dentists showed a generally positive attitude towards preventive dentistry. However, certain preventive measures, particularly those that incur costs, were less frequently practised.

Comparing lifecourse models of social class and adult oral health using the 1958 National Child Development Study.

OBJECTIVE: To identify the lifecourse model that best describes the association between social class and adult oral health. METHODS: Data from 10,217 participants of the 1958 National Child Development Study were used. Social class at ages 7, 16 and 33 years were chosen to represent socioeconomic conditions during childhood, adolescence and adulthood, respectively. Two subjective oral health indicators (lifetime and past-year prevalence of persistent trouble with gums or mouth) were measured at age 33. The critical period, accumulation and social trajectories models were tested in logistic regression models and the most appropriate lifecourse model was identified using the structured modelling approach. RESULTS: The critical period model showed that only adulthood social class was significantly associated with oral health. For the accumulation model, a monotonic gradient was found between the number of periods in manual social class and oral health; and four out of eight social trajectories were found to be distinctive. Finally, the social trajectories model was not significantly different from the saturated model indicating that it provided a good fit to the data. CONCLUSION: This study shows the social trajectories model was the most appropriate, in terms of model fit, to describe the association between social class and oral health.

Relationship between family characteristics and children's regular toothbrushing with fluoride toothpaste.

OBJECTIVE: To examine the association between toothbrushing habits of 8-9 year-olds and maternal behaviours and attitudes towards oral health in a sample of Japanese population. METHODS: Cross-sectional data on mothers' behaviours and attitudes towards oral health and children's toothbrushing habits were collected from 378 mother-child pairs by self-administered questionnaires. Logistic regression examined the association of children's daily brushing with fluoride toothpaste with family characteristics, mother's behaviour (toothbrushing frequency, use of interdental aids and supervision of children's toothbrushing), and mother's attitudes towards oral health (priority for toothbrushing and dental fear). RESULTS: Children's favourable brushing habits were positively associated with child's gender (female) (OR 1.29; 95%CI:1.09,1.53), child's order of birth (first) (OR 1.53; 95%CI:1.05,2.23), maternal brushing habits (OR 2.42; 95%CI:1.73,3.40), and maternal dental fear (OR 1.45; 95%CI:1.10,1.90). None of the other examined factors were significantly associated with child toothbrushing behaviour. CONCLUSIONS: Matemal oral hygiene practice and attitude towards dentists appear to be important predictors of children's toothbrushing habits in this Japanese community sample.

Socioeconomic inequalities in dental caries among 5-year-olds in four Chinese provinces.

OBJECTIVE: To explore socioeconomic inequalities in dental caries among 5-year-olds in four Chinese provinces. METHODS: This study used data from 1,732 children living in Guangxi, Hubei, Jilin and Shanxi who participated in the Third National Oral Health Survey in 2005. Questionnaires were completed by parents to collect information on family socioeconomic position (parental education and household income) and children's dental behaviours (toothbrushing frequency, sugar intake frequency and last dental visit). Children were clinically examined for dental caries, which was reported using the dmft index. Socioeconomic inequalities in children's caries experience were assessed in negative binomial regression models. RESULTS: There were significant gradients in children's dmft by household income. Children's dmft increased from 2.63 in the highest income group to 4.70 in the lowest income group. However, parental education was not significantly related to childhood dental caries. CONCLUSION: Clear social gradients in caries experience of deciduous teeth were found by household income but not parental education.

Caries experience among Romanian schoolchildren: prevalence and trends 1992-2011.

OBJECTIVES: To assess the caries experience of 6-8- and 11-13-year-olds in Romania and to compare their caries levels with those from a previous study conducted in 1992. METHODS: A cross-sectional pathfinder survey was conducted in five major cities of Romania (Iasi, Timisoara, Cluj-Napoca, Tirgu Mures and the capital, Bucharest) in 2011. Cities were purposively chosen for comparability with the 1992 study. Children were clinically examined by one trained dental examiner using the International Caries Detection and Assessment System (ICDAS II). RESULTS: Among the 548 6-8-year-olds, 84.3% had caries experience (82.7% when carious lesions at stages 1-2 were excluded) with mean d1-6mft and d3-6mft of 4.76 (sd 3.46) and 4.43 (sd 3.35) respectively. Among the 592 11-13-year-olds, 83.1% had caries experience (76% when carious lesions at stages 1-2 were excluded) with mean D1-6MFT and D3-6MFT of 4.52 (sd 4.01) and 3.39 (sd 3.35) respectively. Advanced carious lesions were the main contributors to children's caries experience. There were significant differences by cities, with the lowest caries levels seen in Bucharest. High caries levels have persisted in Romania over the last decades in spite of a small but significant decrease in d3-6mft and D3-6MFT values between 1992 and 2011. Variations in caries trends were found by city. CONCLUSION: These findings show that high caries levels still exist among schoolchildren in the five cities included in the study. Romania has not yet achieved the WHO target for 2000 of an average DMFT lower than 3 at 12 years of age.

Big Data in Epidemiology: Brave New World?

Epidemiology is experiencing a significant shift toward the utilization of big data for health monitoring and decision-making. This article discusses the recent example of the World Health Organization (WHO) global oral health status report and regional summaries, which faced criticisms due to its reliance on big data from the Global Burden of Disease (GBD) study. We address the arguments for and against the use of big data in epidemiology and provide an assessment of the value and limitations of big data epidemiology. Moreover, we provide recommendations as to how the oral health community should reconcile traditional epidemiologic approaches with big data and advanced data analytics. This Perspective article highlights the challenges of the current epidemiologic landscape, the potential of big data, and the need for a balanced approach to data utilization in epidemiology.

Caries clusters at lesion-severity thresholds: A Sierra Leone case study.

OBJECTIVES: Despite being almost entirely preventable, globally, dental caries is extremely prevalent. Moreover, dental caries will continue to present an even larger challenge for lower income countries, particularly those in the African context, as they transition to a more Western diet. Hence, epidemiological data providing insight into disease patterns and trends is critical to inform public health action. The purpose of this study was to examine dental caries clusters by caries detection threshold among 15-year-old adolescents in Sierra Leone, using data from the latest national survey, and to explore associated sociodemographic factors. METHODS: This paper presents a secondary analysis of oral health data on 490 15-year-olds from the Sierra Leone national oral health survey of schoolchildren. Hierarchical cluster analysis of dental caries experience was conducted across all surfaces at four decay detection thresholds using the International Caries Detection and Assessment System (ICDAS) (clinical: ICDAS 2-6, cavitated: ICDAS 3-6, obvious: ICDAS 4-6 and extensive obvious: ICDAS 5-6 decay) across the four regions of Sierra Leone. Ordered logistic regression was used to estimate the association of sociodemographic factors with generated clusters relating to clinical and obvious decay experience. These are of both clinical and epidemiological relevance. RESULTS: A 3-cluster decay pattern representing a 'low' to 'high' decay experience distribution was observed under each decay detection threshold across surfaces. For clinical decay (including visual enamel caries), 28.8% had low, 55.1% medium and 15.9% high caries status. In the adjusted model, the only significant risk factor across obvious and clinical decay thresholds was region, with adolescents outside the Western region more likely to experience decay. CONCLUSION: This study suggests that adolescents in Sierra Leone fall into three distinct caries clusters: low, medium to high decay experience distribution, regardless of decay threshold. It reinforces the importance of recognizing dental caries detection thresholds and the use of contemporary epidemiological methodology. This suggests that adolescents outside the Western region are likely to have higher caries experience. The data also provides insight to the nature of adolescents in each cluster and should help to inform policy and planning of the integration of oral health into primary care and school systems.

Family income and tooth decay in US children: does the association change with age?

This study explored whether the association of family income with tooth decay changes with age among children in the United States. A second objective was to explore the role of access to dental health care services in explaining the interrelationships between family income, child age and tooth decay. Data from 7,491 2- to 15-year-old children who participated in the 1999-2004 National and Health and Nutrition Examination Survey were analyzed. The association of family income with the prevalence of tooth decay in primary, permanent and primary or permanent teeth was first estimated in logistic regression models with all children, and then, separately in four age groups that reflect the development of the dentition (2-5, 6-8, 9-11 and 12-15 years, respectively). Findings showed that the income gradient in tooth decay attenuated significantly in 9- to 11-year-olds only to re-emerge in 12- to 15-year-olds. The age profile of the income gradient in tooth decay was not accounted for by a diverse set of family and child characteristics. This is the first study providing some evidence for age variations in the income gradient in tooth decay among children in the United States.

Sense of coherence and four-year caries incidence in Finnish adults.

This study assesses whether sense of coherence (SOC) predicts incidence of tooth decay over 4 years and the role of dental behaviours in explaining the effect of SOC on incidence of tooth decay. Data from 994 adults who participated in both the Health 2000 survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed for this study. At baseline, participants provided information on demographic characteristics, education level, the SOC scale and dental behaviours (tooth brushing frequency, dental attendance and sugar intake frequency). The 4-year incidence of tooth decay was calculated using data from baseline and follow-up clinical oral examinations. Baseline SOC was significantly related to 4-year incidence of tooth decay after adjustment for demographic factors and education (relative risk: 0.79, 95% CI: 0.63-0.98). This effect was fully attenuated after further adjustment for the three dental behaviours. Tooth brushing frequency and dental attendance were the only dental behaviours significantly related to incidence of tooth decay. This prospective study suggests that SOC predicts incidence of tooth decay and that dental behaviours may help explaining why adults with strong SOC have lower risk of developing tooth decay than those with weak SOC.

Roles of different sources of social support on caries experience and caries increment in adolescents of East london.

Evidence on the contribution of social support to oral health is scarce. We first explored the association of social support with caries experience and the relative roles of support from family, friends and a special person on caries experience in 15-16-year-old adolescents. We then explored whether social support at 11-12 years of age predicts caries increment in second permanent molars over 4 years and the relative roles of different sources of support on 4-year caries increment. Data from phases 1 and 3 of the Research with East London Adolescents Community Health Survey (RELACHS), a school-based prospective study of a representative sample of adolescents in East London, were used for cross-sectional (phase 3) and longitudinal analyses (phases 1 and 3). Data were collected by questionnaires including the same questions on demographic characteristics, socioeconomic measures and the Multidimensional Scale of Perceived Social Support at phases 1 and 3. A questionnaire section on dental behaviours and an oral clinical examination were also included in phase 3. Social support was negatively related to both caries experience and increment independently of demographic characteristics, socioeconomic measures and dental behaviours. Furthermore, only support from a special person was significantly related to caries experience and increment in unadjusted and adjusted regression models. In conclusion, adolescents who perceived higher levels of social support had lower caries experience and increment. However, support from a special person was more relevant for these adolescents than support from family and peers.

Role of Dentistry in Global Health: Challenges and Research Priorities.

Despite some improvements in the oral health of populations globally, major problems remain all over the planet, most notably among underprivileged communities of low- and middle-income countries but also in high-income countries. Furthermore, essential oral health care has been a privilege, instead of a right, for most individuals. The release of the Lancet issue on oral health in July 2019 built up some momentum and put oral conditions and dental services in the limelight. Yet, much work is still needed to bridge the gap between dental research and global health and get oral health recognized as a population health priority worldwide. Using the framework proposed by Shiffman, we argue that a global health network for oral health must be harnessed to influence global health policy and drive health system reform. We have identified challenges around 4 key areas (problem definition, positioning, coalition building, and governance) from our experience working in the global health arena and with collaborators in multidisciplinary teams. These challenges are outlined here to validate them externally but also to call the attention of interested players inside and outside dentistry. How well our profession addresses these challenges will shape our performance during the Sustainable Development Goals era and beyond. This analysis is followed by a discussion of fundamental gaps in knowledge, particularly in 3 areas of oral health action: 1) epidemiology and health information systems; 2) collection, harmonization, and rigorous assessment of evidence for prevention, equity, and treatment; and 3) optimal strategies for delivering essential quality care to all who need it without financial hardship.