Rigorous theory-based intervention research is the bold action needed to address oral health disparities and inequities

The Consensus Statement about behavioral and social sciences in oral health encourages future research to draw on testable theories that specify causal pathways that reflect the complex nature of oral health. In this commentary, we amplify the importance of explicit and well-specified theory in oral health intervention research, acknowledging that problematic use of theory has limited its utility in developing effective public health interventions. Also, we affirm the need to focus on determinants of oral health—and health inequities—most likely to drive meaningful change, and to understand the causal pathways that connect drivers of change from the individual to the global level. We view theory-based, causal mechanisms research as a powerful approach to building successful public health interventions, and suggest resources to inspire such research, including exemplary studies, methodologies, and collaborative initiatives that facilitate strong theory-based public health research.     

Causal inference from observational data

Randomized controlled trials have long been considered the ‘gold standard’ for causal inference in clinical research. In the absence of randomized experiments, identification of reliable intervention points to improve oral health is often perceived as a challenge. But other fields of science, such as social science, have always been challenged by ethical constraints to conducting randomized controlled trials. Methods have been established to make causal inference using observational data, and these methods are becoming increasingly relevant in clinical medicine, health policy and public health research. This study provides an overview of state‐of‐the‐art methods specifically designed for causal inference in observational data, including difference‐in‐differences (DiD) analyses, instrumental variables (IV), regression discontinuity designs (RDD) and fixed‐effects panel data analysis. The described methods may be particularly useful in dental research, not least because of the increasing availability of routinely collected administrative data and electronic health records (‘big data’).     

Reflections on oral health inequalities: Theories,pathways and next steps for research priorities

Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.     

From micro to macro: Structural determinants and oral health

The structural determinants of health include social, economic and political mechanisms which generate social stratification and the socioeconomic positions of individuals within society. Despite their importance, these ‘causes of the causes’ are still relatively under-studied within oral health research. Yet it is important to assess the effects of these ‘upstream’ determinants, given that most individuals cannot influence or change them. It is also important to move beyond focusing primarily on downstream determinants and approaches at the individual or household level. This review will offer a brief overview of what is currently known about structural determinants and upstream interventions in relation to oral health. The review starts by briefly summarizing oral health focused studies of structural determinants, including welfare regimes, governance and macroeconomic, social and public policies. Current knowledge on upstream interventions associated with oral health such as community water fluoridation, sugar sweetened beverage taxes and dental payment structures will also be covered. The article will then assess gaps in the research base, including current limitations and barriers—as well as opportunities—in analysing the effects of structural determinants and upstream interventions. The review finishes by suggesting next steps for better understanding and addressing these determinants and interventions—including considerations around theory, data and approaches from other fields such as systems science—with the hope that these can help make contributions to future policy decision making processes.     

How to use mixed methods in oral health research

Wicked problems exist in the realm of oral health research. Due to their inherent complexity, using qualitative or quantitative methods alone may not be adequate for resolving them. Mixed methods approaches combine qualitative and quantitative methods, and thus, can provide a powerful tool for understanding and solving complex problems in dental public health. However, using mixed methods does not come without its challenges. This commentary outlines four main tips for researchers to consider when applying mixed methods to their research projects.     

Refugee child oral health

The number of people forced to flee their homes and move around the world is increasing rapidly. Such refugee populations are not only more likely to have poor physical, mental and social health outcomes but also to experience difficulties accessing health services in their new country. In particular, children from refugee backgrounds are at increased risk of poor oral health which in time is associated with poor adult oral health and impacts on child health (e.g. growth and development) and well‐being. To date, there is little evidence about the nature and extent of their oral health problems nor interventions to improve their oral health status. This article summarises the evidence surrounding the oral health status of children from refugee backgrounds. In addition, a systematic review of the international literature over the past 10 years is presented which identifies interventions to improve the oral health of these vulnerable paediatric populations. Based on this evidence, potential strategies available to dental service providers to optimise provision of responsive dental care are discussed.     

Measuring the impact of oral health on life quality in two national surveys - functionalist versus hermeneutic approaches

OBJECTIVES: This study compares a functionalist (quantitative) versus a hermeneutic (qualitative) approach to assessing the impact of oral health on life quality in two United Kingdom national surveys. METHODS: The vehicles for this study were two Office for National Statistics' Omnibus Surveys completed in 1998 and 1999. In both studies a random probability sample of 3000 household addresses was selected from the British Postcode Address File (PAF). The data were collected by face-to-face interviews with respondents in their homes about how their oral health status affected their quality of life employing a qualitative, hermeneutic approach (1998) and a functionalist, quantitative approach using a battery of questions (1999). RESULTS: Irrespective of study design, in both studies it was apparent that the majority of the public perceived their oral health as affecting their life quality (P > 0.05). Likewise, both approaches identified that oral health affected life quality most frequently through physical aspects of oral health rather than social or psychological. However, using the hermeneutic approach, respondents were less likely to cite that their oral health affected specific aspects of their oral health compared to when a battery of questions were used (P < 0.01). Furthermore, socio-demographic variations in oral health-related quality of life were more apparent when a battery of questions were employed compared to an open-ended approach. CONCLUSIONS: Different approaches to assessing oral health-related quality of life yield similar findings in terms of prevalence of oral health's impact and affected ways (domains). However, the different methods influenced the ability to identify socio-demographic disparities.     

Theoretical explanations for social inequalities in oral health

Social inequalities in health and oral health continue to present a major challenge to public health. Progress towards the development of interventions to reduce health inequalities is currently being hampered by an incomplete understanding of the causes of inequalities in health. This paper aims to provide oral health researchers with an overview of four current explanations for inequalities in oral health and to suggest further areas of research needed to advance our understanding of the causes of social inequalities in oral health.     

Oral health promotion interventions on oral reservoirs of staphylococcus aureus: a systematic review

The oral cavity serves as a reservoir of Staphylococcus aureus for infection of the lower respiratory tract and cross-infection to other patients. This systematic review was designed to examine the effectiveness of oral health promotion interventions on this pathogen. The PubMed, ISI Web of Science, and Cochrane Library databases were searched for clinical trials assessing the effect of oral health promotion interventions on oral and oropharyngeal carriage of S. aureus. Oral health promotion interventions on oral reservoirs of S. aureus in both systemically healthy and medically compromised groups consisted of oral hygiene interventions only. There was a lack of evidence pertaining to the effectiveness of mechanical oral hygiene interventions against this pathogen. Chlorhexidine delivered in oral hygiene products such as mouthrinses, gels, and sprays appeared to have some utility against S. aureus, although some studies found equivocal effects. There was a dearth of studies investigating the efficacy of other chemical agents. Although many chemical agents contained in oral hygiene products have proven in vitro activity against S. aureus, their clinical effectiveness and potential role as adjuncts or alternative therapies to conventional treatment remain to be confirmed by further high-quality randomized controlled trials.     

Evolution and development of methodologies in social and behavioural science research in relation to oral health

The aim of this introductory paper is to provide an overview of key methodological developments in social and behavioural research in oral health. In the first section, we provide a brief historical perspective on research in the field. In the second section, we outline key methodological issues and introduce the seven papers in the theme. Conceptual models can contextualize research findings and address the ‘why’ and ‘how’ instead of ‘what’ and ‘how many’. Many models exist, albeit they need to be evaluated (and adapted) for use in oral health research and in specific settings. The increasing availability of big data can facilitate this with data linkage. Through data linkage, it is possible to explore and understand in a broader capacity the array of factors that influence oral health outcomes and how oral health can influences other factors. With advances in statistical approaches, it is feasible to consider casual inferences and to quantify these effects. There is a need for not only individual efforts to embrace causal inference research but also systematic and structural changes in the field to yield substantial results. The value of qualitative research in co-producing knowledge with and from human participants in addressing ‘the how’ and ‘the why’ factors is also key. There have been calls to employ more sophisticated qualitative methods together with mixed methods approaches as ways of helping to address the complex or Wicked Problems in population oral health. In the final section, we outline possible future methodological directions in social and behavioural oral health research including participatory approaches and the development of core outcome sets. Our overriding goal in the paper is to facilitate a critical debate in relation to methodological issues which can be used to improve understanding and generate knowledge in population oral health and that this, in turn, will help inform oral health policy and practices.     

Models for individual oral health promotion and their effectiveness: a systematic review

Background:  There is a recognized need to deliver oral health information to people during clinical encounters to enable them to develop personal skills in managing their own oral health. Traditional approaches to individual oral health education have been shown to be largely ineffective and new approaches are required to address personal motivations for preventive behaviour. This systematic review aims to identify and assess the effectiveness of behaviour models as a basis for individual oral health promotion.
Methods:  Electronic databases were searched for articles evaluating the effectiveness of health behaviour models in oral and general health between 2000 and 2007. Eighty-nine studies were retrieved and data were extracted from the 32 studies that met the inclusion criteria.
Results:  Thirty-two studies were identified in the fields of clinical prevention and health education, motivational interviewing (MI), counselling, and models based interventions. MI interventions were found to be the most effective method for altering health behaviours in a clinical setting.
Conclusions:  There is a need to develop an effective model for chairside oral health promotion that incorporates this evidence and allows oral health professionals to focus more on the underlying social determinants of oral disease during the clinical encounter. There is potential to further develop the MI approach within the oral health field.     

Oral health promotion evaluation – time for development

Increasing emphasis is now being placed upon the evaluation of health service interventions to demonstrate their effects. A series of effectiveness reviews of the oral health education and promotion literature has demonstrated that many of these interventions are poorly and inadequately evaluated. It is therefore difficult to determine the effectiveness of many interventions. Based upon developments from the field of health promotion research this paper explores options for improving the quality of oral health promotion evaluation. It is essential that the methods and measures used in the evaluation of oral health promotion are appropriate to the intervention. For many oral health promotion interventions clinical measures and methods of evaluation may not be appropriate. This paper outlines an evaluation framework which can be used to assess the range of effects of oral health promotion programmes. Improving the quality of oral health promotion evaluation is a shared responsibility between researchers and those involved in the provision of programmes. The provision of adequate resources and training are essential requirements for this to be successfully achieved.     

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龋病是儿童和成人常见的口腔疾病,从公共卫生角度着手才能较大限度地防治龋病的发生、发展。近几年在卫生部和中华口腔医学会倡导下开展了一系列口腔公共卫生项目,包括:监测儿童口腔健康状况及危险因素、进行学龄前儿童乳牙龋综合干预、加强儿童口腔疾病综合防治、开展全国爱牙日主题活动、探索"健康口腔微笑中国"口腔健康教育模式等,这些项目的开展将有效促进我国人群的口腔健康。     

上海市社区口腔公共卫生人力资源及工作满意度调查

目的:调查上海市社区口腔公共卫生人力资源现状及其工作满意度,为完善社区口腔公共卫生服务能力建设提供依据.方法:采用普查方法,对上海市246家社区卫生服务中心参与口腔公共卫生服务的人员进行问卷调查,内容包括人员基本情况和工作满意度.采用SPSS 20.0软件包对工作满意度及人员基本情况进行统计学分析.结果:上海市有759...     

Oral health therapists: what is their role in Australian health care?

The aim of this report was to examine the role of the oral health therapist (OHT) in the contemporary Australian context. The original intent of the OHT role was to address unmet community oral health need in a cost‐effective manner. Although it was recognized that OHTs would need to deliver clinical treatment, particularly restorative services for children, the core of their education and their knowledge and proficiency is in oral health and public health promotion. Unmet oral health need persists, and this is especially urgent for the most disadvantaged. Some may argue that this provides evidence that OHTs should provide an expanded range of clinical services, including adult restorative treatment, and that additional training should be provided to enable this to occur. This report counters that view by showing that the current health system does not avail itself of the health promotion services that OHTs are already educated to deliver. Improved health outcomes within the Australian health system are achievable by bringing oral health into the general health system, by introducing models of care aimed at the early detection of risk and disease and by recognizing the importance of public health measures designed to prevent disease.     

Oral health and quality of life

Over the past two decades an increasing body of research has been devoted to exploring the links between oral diseases and disorders and quality of life outcomes. As with similar studies in medicine, this work was stimulated by changing concepts of health, the development of theoretical models linking biological and psychosocial variables and the development and testing of measures that allowed those linkages to be investigated. This area of research is now referred to by the rather cumbersome term 'oral health-related quality of life'. This research addresses two important questions: 1) To what extent do oral disorders compromise aspects of daily living that individuals value? 2) What interventions mitigate their effects and restore the individual's quality of life? This presentation provides an overview of this field of research and a brief summary of some of the work that has been conducted to date along with the implications for clinical and public health practice of what that research has found.     

Emerging theories into the social determinants of health: implications for oral health promotion

In recent years public health research has increasingly focused upon exploring the social determinants of health. This interest has partly arisen through an acknowledgement of the limitations of educational preventive approaches in improving population health and reducing health inequalities. Many health education interventions have been influenced by health behaviour research based upon psychological theories and models. These theories focus at an individual level and seek to explore cognitive and affective processes determining behaviour and lifestyle. Current psychological theories have only a limited value in the development of public health action on altering the underlying social determinants of health. New theoretical approaches have however, emerged which explore the relationship between the social environment and health. This paper aims to review and highlight the potential value to oral health promotion of three important public health theoretical approaches: life course analysis, salutogenic model and social capital. It is important that an informed debate takes place over the theoretical basis of oral health promotion. As the field of oral health promotion develops it is essential that it is guided by contemporary and appropriate theoretical frameworks to ensure that more effective action is implemented in the future.     

Methodological aspects of a computer-assisted telephone interview survey of oral health

Despite the reported benefits of computer-assisted telephone interview (CATI) methods, experiences from their use in Australian oral health surveys have not been described. This report aimed to present methodological aspects of a CATI survey conducted in the five mainland states. A response rate of 66 per cent was obtained, yielding 4050 completed interviews. Analysis revealed generally small levels of non-response bias: persons who avoided or delayed dental treatment because of cost and non-health card holders were harder to contact, while non-English speakers and persons aged 20–29 years were less likely to participate. A total of 1770 person hours of interview time was spent on the survey: 64.5 per cent of that time was spent on the telephone with an average of 10 minutes 17 seconds per call (13 minutes 37 seconds per completed call). Only seven questions had missing data for more than 1 per cent of respondents. Comprehension of questions and cooperation with the interview was rated by interviewers as 'good' or 'very good' for more than 90 per cent of respondents. The CATI method was highly efficient and yielded good quality data for the survey.