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Background Dental caries represents a significant global public health challenge, with particularly high prevalence rates observed among Chinese children. Pit and fissure sealing (PFS) has been established as an effective and cost-efficient preventive intervention, yet service coverage remains suboptimal in China. This study examines guardians’ preferences and preference heterogeneity regarding PFS services, with the aim of informing tailored service delivery and policy interventions to enhance PFS uptake. Methods A discrete choice experiment was conducted through face-to-face interviews with 411 guardians. Four key attributes were included: preventive effectiveness, preventive service time, distance and out-of-pocket (OOP) service cost. Data were analysed using a mixed logit model, subgroup analyses and scenario analyses were performed to examine preference heterogeneity. Results Preventive effectiveness (41.31%) emerged as the most influential attribute, followed by distance (29.23%), OOP service cost (15.85%) and preventive service time (13.61%). Female guardians and guardians of children with poor oral health status placed greater emphasis on preventive effectiveness and distance. In contrast, male guardians were more focused on OOP service cost. Guardians with higher education levels and guardians of children with better oral health status were more inclined to schedule PFS services during vacations. The scenario analysis revealed that guardians prefer PFS services with general effectiveness but higher accessibility and lower OOP costs, rather than those offering superior effectiveness but compromised accessibility and higher financial burden. Notably, medical insurance coverage boosted service uptake from 18.3% to 71.0%, with guardians willing to pay 127 Chinese yuan more for insured services. Conclusion These findings highlight substantial preference heterogeneity among guardians and underscore the transformative potential of insurance coverage in enhancing service accessibility. Policymakers should consider incorporating PFS services into medical insurance coverage and optimizing service arrangements to meet the needs of different guardian groups in order to improve the coverage and effectiveness of PFS services. Clinical trial number not applicable.

Background More than two years of the Russian-Ukrainian war have resulted in widespread human and economic tragedy. This crisis also affects health status, including oral health. Objective To carry out an exploratory analysis on the extent of caries in Ukrainian war refugee children and adolescents, and in addition to determine whether there was a statistically significant association between caries and age, gender, periodontal health status (using the Periodontal Screening and Recording (PSR) index), self-reported socioeconomic status and Italian language speaking skills. Methods This study used a cross-sectional design, was conducted in Perugia, Italy at the University Dental Clinic (COU) between November 2023 and April 2024 and included 50 children and adolescents between 3 and 18 years old (mean age 9.2 SD 4.6) with Ukrainian citizenship who had left their home country due to the war. The visits were conducted in the presence of a cultural mediator. The visits consisted of two parts: the administration of questionnaires on socio-economic status and communication skills, followed by a dental examination. A logistic regression model was used to identify the factors independently associated (age, sex, PSR, socio-economic status and level of communication) with high DMFT/dmft values. Results The refugees’ mean DMFT/dmft was 3.5 SD 2.5. The multivariate logistic regression model showed that increased PSR (OR 7.71, 95% CI 1.38–22.94, p  = 0.020) and low communication (OR 6.09, 95% CI 1.34–27.69, p  = 0.019) were independently associated with the risk of having a DMFT/dmft > 4. Conclusions The study findings were worrying in terms of the prevalence and severity of caries, especially in refugee children with a poor level of integration in the host country. This study with its preliminary data provides a starting point to reflect on the need for specific health policies adapted to a complex type of social vulnerability such as refugee children status.

Background This systematic review aimed to assess pregnant women’s knowledge, perceptions, and attitudes toward oral health changes in sub-Saharan Africa (SSA) and examine their oral health-seeking behavior during pregnancy. Methods A comprehensive search was conducted across PubMed, Google Scholar, African Journals Online (AJOL), the Directory of Open Access Journals (DOAJ), and the Cochrane Library. Both Medical Subject Headings (MeSH) and free-text terms related to oral health, knowledge, attitudes, perceptions, antenatal care, pregnancy, and Africa were used. Boolean operators (“AND,” “NOT,” and “OR”) refined the search strategy. Two independent reviewers screened studies and extracted data using Rayyan software, with a third reviewer resolving conflicts. The Robins-E tool assessed the risk of bias. Results Fifteen of seventy-five studies initially identified met the inclusion criteria after full-text screening. Most employed a cross-sectional design. Findings revealed low oral health-seeking behavior among pregnant women in Africa, attributed to factors such as negative dental experiences, concerns about harm to the unborn child, and the belief that dental care is unnecessary. Many women visited dental clinics only when they noticed significant oral health changes. Conclusions The reviewed studies demonstrated a low risk of bias and consistent findings. Pregnancy is a critical period, and poor oral health can adversely affect birth outcomes. Insufficient knowledge and misconceptions deter women from seeking dental care during pregnancy. To address this, targeted oral health education must improve awareness and overcome barriers to seeking care.

Background Dental trauma constitutes the second most common cause of emergency dental care worldwide, after cavities, accounting for approximately 5% of all physical injuries across all age groups. Early intervention is crucial, especially for children and adolescents, who present a higher incidence due to their active lifestyle. This study aims to conduct a systematic review and descriptive analysis to assess the level of knowledge among non-dental healthcare professionals in the management of dental trauma, identifying gaps in their education and proposing educational interventions to improve care in this critical field. Methods This systematic review was structured according to the SPIDER strategy: population , non-dental healthcare professionals, exposure to a clinical situation , management of dental trauma and outcome knowledge, attitude and awareness. The included studies were analyzed descriptively. Mean values and other summary statistics reported in each study were extracted and organized according to the primary variables of interest, focusing on the domains of knowledge, attitudes, and practices of non-dental healthcare professionals. Due to the substantial heterogeneity in study designs, measurement tools, and response formats, no pooled or inferential analyses were performed. The articles were analyzed by the authors and summarized using a “KAP Heat Map” approach, in which colors indicated the level of knowledge (< 25%, 25–50%, 51–75%, and > 75%), and the width of the columns represented the number of studies for each question stem (QS), based on data reported in the included studies. Results Only two studies of 25 concluded that the level of knowledge was adequate, seven studies indicated a moderate level of knowledge, and sixteen studies reported an inadequate level of knowledge. Twelve of the included studies mention the need for continuing education in dental trauma for health professionals. Most included studies exhibited moderate to high risk of bias. Conclusions The studies reviewed showed that the level of knowledge of health professionals such as doctors and nurses is inadequate. This shows a lack of training during their academic training as well as a lack of training in the workplace. Trial registration This systematic review has been registered in PROSPERO with CD CRD578189 on August 9, 2024.

Objectives This study aims to provide a comprehensive assessment of the global burden of oral disorders in individuals aged 60 + , from 1990 to 2021, with projections through 2040. Methods Data on the annual prevalence and disability-adjusted life years (DALYs) for oral disorders were sourced from the Global Burden of Disease Study 2021. Temporal trends in age-standardized prevalence and DALYs rates, by age, sex, and Socio-Demographic Index (SDI), were analyzed using estimated annual percentage changes. Projections to 2040 were made using the Bayesian age-period-cohort model. Results In 2021, there were 675.8 million cases and 9.4 million DALYs due to oral disorders in older adults. While age-standardized prevalence and DALYs rates declined globally from 1990 to 2021, significant regional disparities remained. High burdens were observed in Andean Latin America and East Asia, while increasing trends were seen in Tropical Latin America and Eastern Europe. Dental caries and periodontitis were the most common disorders, with edentulism contributing substantially to DALYs. Middle-SDI countries faced the highest burdens. Projections suggest declines in dental caries and periodontitis but an increase in edentulism. Conclusions These findings underscore the need for targeted public health policies focusing on prevention, treatment, and equitable access to oral care for aging populations.

Objectives To develop and design the Defensive Dentistry Attitude Scale (DDAS) to evaluate the relationship between defensive dentistry and fear of malpractice among dentists in Türkiye. Methods The Defensive Dentistry Assessment Scale (DDAS) questions were determined based on expert opinions and a literature review. Based on these results, a questionnaire including the 13-item DDAS and the malpractice fear scale was sent to 3513 dentists in Türkiye by email between 3.11.2023 and 10.1.2024. A total of 369 dentists returned. The questionnaire consisted of 26 questions with two VAS scales related to the frequency of complications and detailed anamnesis. During the development of DDAS, the Content Validity Index (CVI), Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA) were utilized. The Mann–Whitney U and Kruskal–Wallis tests were employed for group comparisons. In examining the relationships between variables, path analysis within the structural equation modeling (SEM) framework was conducted. Results The DDAS developed in the study was a valid and reliable measure with two dimensions and eight items. DDAS (Median = 29) and malpractice fear scores (Median = 21) were high in dentists. Malpractice fear scores of dentists aged 29–35 years (Median = 21) were found to be statistically significantly higher than those of dentists aged 36 years and older ( p  < 0.05). The levels of malpractice fears (Median = 22) and defensive dentistry attitudes (Median = 31) of dentists with 6–10 years of experience were statistically significantly higher than those of dentists with 11 years of experience and over (respectively (Median = 20), (Median = 28), p  < 0.05). A statistically significant and high-level positive correlation was found between dentists' fear of malpractice and their tendency to adopt defensive dentistry practices (β = 0.56, p < 0.001). Conclusions According to the results of this study, the DDAS was found to be a valid and reliable measure of negative and positive defensive dentistry. Specifically, a significant and strong positive correlation was identified between dentists' fear of malpractice and their engagement in defensive dentistry practices. This finding indicates that the tendency to adopt defensive dental behaviors increases as malpractice fear increases.

Background Oral and systemic health are closely linked. Chronic diseases like diabetes mellitus, cardiovascular diseases, and hypertension increase the risk of dental caries, periodontal disease and tooth loss. Moreover, poor oral health can worsen the status of systemic diseases. Despite this, oral health is often overlooked in chronic disease management. This study aimed to evaluate the oral health status of patients with chronic diseases (PWCD) compared to healthy controls using DIMF-T and DMF-S indices. Methods This retrospective study included 205 participants (106 PWCD and 99 healthy controls) attending the Oral Diagnosis & Radiology outpatient clinic at Bahçeşehir University Dental Hospital. Comprehensive intraoral and radiological examinations assessed caries lesions, missing teeth, filled teeth, periodontal disease, denture usage, and the prevalence of apical osteitis, soft tissue lesions, and intraosseous lesions. Oral health status was quantified using DIMF-T and DMF-S indices. Statistical analyses were conducted to identify differences between groups. Results The study group (PWCD) exhibited significantly higher median values for missing teeth (MT), decayed surfaces (DS), missing surfaces (MS), DIMF-T, and DMF-S indices compared to the control group ( p  < 0.001). Chronic periodontitis was more prevalent in PWCD (76.42%) than in controls (45.45%), while gingivitis was more common in the control group (52.53%, p  < 0.001). Medication use for systemic diseases was strongly associated with poor oral health outcomes ( p  < 0.001). However, no significant differences were observed between the groups for decayed teeth (DT), hopeless teeth (IT), or filled teeth (FT). Conclusions PWCD demonstrated worse oral health outcomes compared to healthy controls, highlighting the need for integrated oral and systemic healthcare strategies. Dental professionals should be careful in identifying oral conditions that may signal underlying systemic diseases. Future research should explore the integration of oral health evaluations into routine medical screenings and examine the global practices of oral health management in PWCD.

Introduction This study aimed to compare the self-reported oral health status, knowledge, and habits of individuals living with diabetes mellitus and healthy controls. To achieve this, the modified version of the World Health Organization’s Oral Health Questionnaire for Adults (ANNEX 7; Google Forms) was employed for data collection. Methods The study included 99 diabetes patients (33 with type 1 and 66 with type 2 diabetes mellitus) and 102 non-diabetic controls. Logistic regression models, adjusted for demographic factors, were applied to examine associations between oral hygiene practices, dietary habits, and the number of natural teeth. Results Individuals with diabetes exhibited a greater frequency of oral pathological conditions. Despite 74% of people with diabetes mellitus (PwDM) brushing their teeth twice daily, they had fewer natural teeth compared to the control group (20 or more teeth: DM: 54.5%, controls: 70.6%). In our study, there is no evidence that number of teeth is dependent on HbA1c levels, and we found that neither age nor gender influenced the change in HbA1c levels. Lower interdental cleaning habits and frequent fruit consumption were identified as significant risk factors for severe tooth loss. Conclusion and clinical relevance This study highlights significant oral health disparities in diabetes patients, particularly those with T2DM, who reported poorer oral health, more frequent denture use, and fewer natural teeth. These findings underscore the need for integrating oral health education, preventive care, and interdisciplinary collaboration into diabetes management to improve overall health outcomes.

Background Periodontal complications are frequently reported in youth with type 1 diabetes (T1DM), yet evidence linking continuous glucose monitoring (CGM) metrics to pediatric periodontal status is limited. We assessed periodontal health in T1DM versus healthy peers and examined associations of HbA1c and CGM-derived metrics—including coefficient of variation (CV), time in range (TIR), and time below range (TBR)—with periodontal indices, alongside sociodemographic determinants. Methods In this single-center cross-sectional study (age 7–12 years), T1DM participants ( n  = 52) were compared with healthy controls ( n  = 26). Periodontal outcomes were Plaque Index (PI), Gingival Index (GI), and simplified Basic Periodontal Examination (s-BPE). CGM summaries (preceding 14–30 days) were obtained for T1DM only. Caries experience (dmft/DMFT) was recorded as an oral-health descriptor. Group comparisons used Kruskal–Wallis/Dunn tests; associations used Spearman correlations and multivariable linear regression adjusting for age, sex, parental ages, education, and household income. Results Compared with controls, T1DM showed higher PI, GI, and s-BPE (all p  < 0.001). Xerostomia was more frequent in T1DM (30.8% vs. 0%; p  = 0.004). Periodontal indices did not differ between HbA1c (< 7% vs. ≥ 7%) or CV (< 36% vs. ≥ 36%) strata. Within T1DM, TBR < 70 mg/dL correlated weakly but positively with PI (ρ = 0.312; p  = 0.024) and GI (ρ = 0.316; p  = 0.022). In adjusted analyses restricted to the T1DM cohort, time below range < 54 mg/dL (TBR < 54) was positively associated with the plaque index. For the gingival index, small associations were observed with time in range (TIR) and glycemic variability (CV); however, these were directionally inconsistent with biological expectations and should be interpreted cautiously. No predictors were identified for the s-BPE screening outcome. dmft/DMFT did not differ across groups; maternal education associated with lower DMFT ( p  < 0.05). Rural–urban residence showed no differences. Conclusions Children with T1DM exhibit poorer periodontal health than healthy peers. An exploratory link between higher hypoglycemia burden (TBR) and greater plaque/gingival inflammation suggests a modifiable behavioral conduit—hypoglycemia management and night-time hygiene—superimposed on salivary dysfunction and social determinants. Findings support integrating CGM-informed counseling on free-sugar exposure and oral hygiene into pediatric diabetes care and align with SDG-3 goals to strengthen prevention within routine services.

Background Oral diseases and poor oral hygiene are prevalent among frail older adults in nursing homes. Despite well-known organizational barriers such as low prioritization, time and staff shortages, and lack of routines and training, research on the perspective of nursing home management remains limited in this area. Purpose To investigate the views and experiences of professionals in leadership roles regarding oral health needs and routines as well as barriers and facilitators in providing effective oral care for frail older adults in nursing homes. Methods A web-based survey was sent to 1,526 nursing home professionals (managers, coordinators and registered nurses) in Sweden. The survey comprised a 52-item questionnaire covering oral health needs, oral care barriers and facilitators, routines, education, collaboration with dental care services, and the use of the quality register Senior Alert, designed to support a preventive approach in nursing care and the Revised Oral Assessment Guide-Jönköping (ROAG-J). Results Responses were received from 166 managers, 55 coordinators and 243 nurses, yielding a 32% response rate. About half of the respondents perceived residents’ oral health as poor, and 83% reported that most residents required assistance with oral care. The main barriers were difficulties for nursing staff to perform oral care and residents’ unwillingness to participate, often due to dementia. Increased and regular training in oral care for nursing staff was viewed as the most important facilitator; however, only 41% of respondents reported that their staff had received training regularly. The Senior Alert register and the ROAG-J were widely used and generally perceived as effective. Oral health was also frequently discussed during regular Senior Alert team meetings, with a high level of management involvement. Conclusions The significant and complex oral care needs of older adults in nursing homes, coupled with the fact that nursing staff often lack adequate training, stress the importance of management allocating resources, ensuring regular staff training and strengthening collaboration with dental care services. Senior Alert’s structured approach seems to have the potential to enhance the engagement of nursing home professionals in managing residents’ oral health.