dental research and oral health

Dental Research and Oral Health

ISSN: 2641-7413

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About Journal

Dental Research and Oral Health (PubMed NLM) is an open access peer-reviewed scientific journal dedicated to Dentists, Dental educators, Oral and dental policy-makers and Hard-tissue scientists for the dissemination of new knowledge and information about the latest research inventions relevant to dentistry and to the oral cavity and associated structures in oral health and disease.

Journal publishes all types of articles such as original research, review articles, short communications, editorials, letter to the editor, high quality clinical, and laboratory research as case series, research guidelines, techniques, and practices. The focus of this journal broadly covers, dentistry, oral pathology, epidemiology, dental implants, oral hygiene aesthetic dentistry, Gum Disease, prevention and treatment of oral diseases, geriatric dentistry, pediatric dentistry, community dentistry, cosmetic dentistry, orthodontics, TMJ disorders, implantology, cardiology, restorative dentistry, periodontology, stomatology, prosthodontics, oral and maxillofacial radiology, oral, dental and craniofacial researches and clinical trials.

Open Access:  Unrestricted visibility to the readers.

High Visibility:  Dental Research and Oral Health indexed or abstracted in    Google Scholar , Semantic Scholar ,  CrossRef , WorldCat , ResearchGate , Academic Keys , DRJI , Microsoft Academic ,  Academia.edu , OpenAIRE , Scribd , Baidu Scholar

Manuscript Submission:  Fortune Journals provides  Open Journal Systems . Authors can submit their manuscripts through online and the whole review process is being processed here with the help of Journal Editors and Reviewers.

For any kind of queries, please contact us at  [email protected]  /  [email protected]

* Impact Factor mentioned on our website is based on the Google Scholar citations.

* Impact Factor mentioned on our website is provided by Cosmos Foundation , Germany.

PubMed Indexed Articles

Research article korea.

  • Sleep analysis results of portable polysomnography in patients with acute and chronic temporomandibular disorder

Published On: 2022-10-07 --> Authors: Yeon-Hee Lee and Q-Schick Auh

dental research and oral health

  • Implications of Obstructive Sleep-related Breathing Disorder in Dentistry: Focus on Snoring and Obstructive Sleep Apnea

Published On: 2022-10-05 --> Authors: Yeon-Hee Lee

  • Investigation of Snoring and Obstructive Sleep Apnea Using Portable Polysomnography in Patients with Temporomandibular Disorder

Published On: 2022-09-30 --> Authors: Yeon-Hee Lee, Q-Schick Auh, and Eun- Jae Chung.

Latest Articles

Research article italy, use of teriparatide for the treatment of mronj in non-cancer patients refractory to the traditional conservative therapy: a systematic review.

Published On: 2022-11-30 Authors: Catalfamo Luciano, De Rinaldis Danilo, Nastro Siniscalchi Enrico, De Ponte Francesco Saverio.

dental research and oral health

Research Article Brazil

Contextual and individual factors associated with dental caries among brazilian adolescents: a multilevel study.

Published On: 2022-11-01 Authors: Cíntia Levy Matos Pedroso, Luana Leal Roberto, Alfredo Mauricio Batista De Paula, Desirée Sant’ana Haikal.

Published On: 2022-10-07 Authors: Yeon-Hee Lee and Q-Schick Auh

Published On: 2022-10-05 Authors: Yeon-Hee Lee

Research Article India

  • Assessment of Stress Levels and Oral Mucosal Changes Among Corporate Employees - An Observational Study

Published On: 2022-01-03 Authors: Shabana Shaik, Asha Venkataswamy Reddy

Research Article USA

Distribution of treatments by age of patients at an academic dental center.

Published On: 2022-05-19 Authors: Kadhium VS, Sharma P, Josan NK, Mhay S, Dault J, Nalliah RP

Reference Genes for gene expression analysis in Head and Neck Squamous Cell Carcinoma: a Data Science Driven Approach

Published On: 2022-06-17 Authors: Nehanjali Dwivedi, Sujan K Dhar, Moni A Kuriakose, Amritha Suresh, Manjula Das

Research Article Nepal

Evolution of new oral health care practices in response to covid-19 pandemic: lesson learned from national survey.

Published On: 2022-06-22 Authors: Saroj Prasad Deo, Dharanidhar Baral

Published On: 2022-09-30 Authors: Yeon-Hee Lee, Q-Schick Auh, and Eun- Jae Chung.

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Saudi Dent J PubMed Indexed Journals | Saudi Dent J Scopus Indexed Journals | Saudi Dent J Medline Indexed Journals | Saudi Dent J ESCI Indexing | Saudi Dent J PubMed Central Indexed Journals | Saudi Dent J Impact factor 2023 2024 2025

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The Oral Health in America Report: A Public Health Research Perspective

ESSAY — Volume 19 — September 8, 2022

Jane A. Weintraub, DDS, MPH 1 ( View author affiliations )

Suggested citation for this article: Weintraub JA. The Oral Health in America Report: A Public Health Research Perspective. Prev Chronic Dis 2022;19:220067. DOI: http://dx.doi.org/10.5888/pcd19.220067 .

PEER REVIEWED

Introduction

Data needed, health disparities and social determinants of health, individual and community relationships, scientific advances and equitable distribution, educational opportunities, acknowledgments, author information.

In December 2021, the National Institutes of Health, National Institute of Dental and Craniofacial Research, released its landmark 790-page report, Oral Health in America: Advances and Challenges (1). This is the first publication of its kind since the agency’s first Oral Health in America: A Report of the Surgeon General described the silent epidemic of oral diseases in 2000 (2). This new, in-depth report, an outstanding resource, had more than 400 expert contributors. Its broad scope is exemplified by its 6 sections ( Box ), each of which includes 4 chapters: 1) Status of Knowledge, Practice, and Perspectives; 2) Advances and Challenges; 3) Promising New Directions; and 4) Summary. In this essay, I provide a public health research perspective for viewing the report, identify some advances and gaps in our knowledge, and raise research questions for future consideration.

Box. Section Titles, Oral Health in America: Advances and Challenges (1)

1. Effect of Oral Health on the Community, Overall Well-Being, and the Economy

2A. Oral Health Across the Lifespan: Children

2B. Oral Health Across the Lifespan: Adolescents

3A. Oral Health Across the Lifespan: Working-Age Adults

3B. Oral Health Across the Lifespan: Older Adults

4. Oral Health Workforce, Education, Practice, and Integration

5. Pain, Mental Illness, Substance Use, and Oral Health

6. Emerging Science and Promising Technologies to Transform Oral Health

A recurring theme in the report is the need for many types of data, from microdata — the molecular, nanoparticle level — to macrodata — the population and global level. Data are needed to guide public health policies and programs at the federal, state, and local levels. Future research using big data from multiple sources (eg, community health needs assessments, surveillance systems, GIS mapping, electronic health records, practice-based research networks) will provide timely, population-based information to evaluate and drive changes to policy and delivery systems and oral health advocacy efforts.

This new report includes descriptive national data from 3 cycles of the National Health and Nutrition Examination Survey (NHANES). To continue monitoring national oral health surveillance data and trends, oral health data need to be included routinely in NHANES and in other large national studies. Too often, questions about oral health are missing from surveys, or clinical oral health data are not collected. For example, very little about oral health was included as part of the planned data collection protocol for the National Institutes of Health All of Us Research Program. This program aims to collect health information from 1 million people (3). Local and state data are often outdated, incomplete, or unavailable. Most oral health data are cross-sectional and are useful for studying trends and associations, but population-based longitudinal data to study causality and the effectiveness of interventions and policies are sparse.

How does oral health care improve other health conditions? Proprietary claims data from insurance companies (4) show the inter-relationship between treatment of periodontal disease and systemic conditions, but secondary data analysis has many limitations and confounding factors. Clinical trials show that periodontal treatment improves glycemic control among people with diabetes (5), but long-term outcome assessments are lacking. We need more answers to convince policy makers and payers about the importance of including comprehensive adult oral health services in publicly financed programs such as Medicaid, which is currently lacking in many states, and Medicare, where those services are missing altogether.

Many examples of substantial oral health disparities and inequities are presented in Section 1 of the report. For some conditions and population groups, little improvement has been made, especially among adults and seniors. Section 1 also describes the adverse social, economic, and national security effects of poor oral health, barriers to care, social and commercial determinants of oral health, and related common risk factors. More than the clinical data collected in a typical dental history is needed to understand social determinants and employ local and upstream interventions. The report suggests obtaining social histories from patients to get information about where people live, learn, work, and play. For example, to learn about socioeconomic status, diet, and medications, we want to know not only “What’s in your wallet,” (as touted in a frequent television advertisement) but what’s in your refrigerator? What’s in your medicine cabinet? Telehealth has given clinicians a look inside patients’ homes. Collaboration with social workers, home health aides, and visiting nurses could inform us even more about the home environment. With integrated electronic medical and dental patient records, oral health professionals and medical colleagues can share information. Barriers to integration and assessment of population health outcomes affect many dentists who still use paper records or software specific to dental care that lacks diagnostic codes and interoperability with other health care records systems (6).

The report highlights the need for more information about adolescents and older adults and other understudied population groups. Section 1 describes many diverse, vulnerable populations (eg, people with special health care needs, low health literacy, mental illness, substance abuse disorders; victims of structural racism) who all need to be included in oral health research. Non-English speakers and hard-to-reach populations that have physical and/or financial barriers to traditional dental care are less likely to be recruited and represented in clinical trials, making results less generalizable and interventions less applicable. The applied research agenda being developed by the American Association of Public Health Dentistry (7) and the “Consensus Statement on Future Directions for the Behavioral and Social Sciences in Oral Health,” which is based on an international summit (8), are helpful in setting research and methodologic priorities, including qualitative, implementation, and health systems research.

Knowledge about the interrelationships between oral and systemic health has greatly expanded since the 2000 report. About 60 adverse health conditions have now been shown to be associated with oral health (1), which is part of the rationale for the integration of oral health and primary care. Research will advance our understanding of the mechanisms by which oral and systemic conditions are affected by upstream environmental and social factors, epigenetic factors, and the aging process, both individually and communally. For example, how do external exposures change our microbiomes? Our oral microbiome may be exposed to air containing Sars-CoV-2, water containing protective fluoride, or many kinds of food, beverages, medications, illicit substances, smoked products, and sometimes the biome of close personal contacts. How does the health of a community’s high caries risk groups change with policies such as a tax on sugar-sweetened beverages, Medicaid reimbursement changes, or health promotion efforts to improve oral health literacy and dietary behaviors? To what extent will increased application of value-based health care reimbursement with emphasis on disease prevention, early detection, and minimally invasive care improve oral health? Will the World Health Organization’s addition of dental products (eg, fluoride toothpaste, low-cost silver diamine fluoride, glass ionomer cement) to its Model List of Essential Medicines (9) increase their use to prevent and treat dental caries for under-resourced populations without access to conventional high-cost dental care?

The report’s Section 6 describes many exciting advances in biology, biomimetic dental materials, and technology. Rapid advances in salivary diagnostics are providing information about early, abnormal changes in remote organ systems in the body. Advanced imaging techniques and artificial intelligence can be used for early diagnosis of oral lesions before they are visible to the human eye. The validity and accuracy of these techniques need careful evaluation. Can these earlier clinical end points be used to shorten the length of expensive clinical trials? Guide new preventive strategies? At what point do providers intervene with early preventive or therapeutic strategies instead of letting the body heal itself?

Will populations at greatest risk for disease and the greatest barriers to accessing dental care be able to benefit from early intervention? Every intervention has a cost. If access to new prevention and therapeutic discoveries is not equitable, will health disparities worsen? We need community engagement in the research process and the tools from many disciplines to measure and facilitate the best outcomes. The national Oral Health Progress and Equity Network’s blueprint for improving oral health for all includes 5 levers to advance oral health equity: “amplify consumer voices, advance oral health policy, integrate dental and medical [care], emphasize prevention and bring care to the people” (10).

Who will analyze all these data mined from many micro and macro sources, and who will interpret the data? Health learning systems and complex software algorithms are being developed to provide automated diagnostic information. Data analysts with knowledge of these and other sophisticated tools and modeling approaches are needed.

The dental, oral, and craniofacial research and practice communities increasingly need to be part of interdisciplinary research and educational programs with opportunities for collaboration and learning. Federally qualified health centers and look-alikes are good sites for medical–dental integration, but many of these facilities do not provide dental care.

More positions are needed for dental public health specialists who can lead advocacy efforts, interdisciplinary teams of researchers, clinicians, and community partners and conduct research. For example, the new Dental Public Health Research Fellowship at the National Institute of Dental and Craniofacial Research will provide more intensive research training to further advance dental public health and population-based research. Mechanisms are needed to promote, facilitate, and reward sharing of research and training resources across disciplines in our competitive environment.

Public health perspectives are an important part of interdisciplinary approaches to guide, conduct, and apply research and implement policies to improve oral health. Preventive approaches exist as do barriers to their dissemination and implementation. To prevent disease and improve population oral and overall health, systems change and policy reform are needed along with scientific advances across the research spectrum, more population-level data and analysis, and community participatory engagement. I am optimistic that the next Oral Health in America report will describe fewer inequities and more progress toward oral health for all.

This article is based on a presentation made in the webinar, Oral Health in America — Advances and Challenges: Reading the Report through a Research Lens , sponsored by the American Association for Dental, Oral, and Craniofacial Research. The author received no financial support for this work and has no conflicts of interest to declare. The statements made are those of the author. No copyrighted materials were used in this article.

Corresponding Author: Jane A. Weintraub, DDS, MPH, R. Gary Rozier and Chester W. Douglass Distinguished Professor, University of North Carolina at Chapel Hill Adams School of Dentistry, Department of Pediatric and Public Health, Koury Oral Health Sciences Building, Suite 4508, Chapel Hill, NC 27599-7450. Telephone: (919) 537-3240. Email: [email protected] .

Author Affiliations: 1 University of North Carolina at Chapel Hill Adams School of Dentistry and Gillings School of Global Public Health, Chapel Hill, North Carolina.

  • National Institutes of Health. Oral health in America: advances and challenges. Bethesda (MD): US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021. Accessed February 23, 2022. https://www.nidcr.nih.gov/sites/default/files/2021-12/Oral-Health-in-America-Advances-and-Challenges.pdf
  • US Department of Health and Human Services. Oral health in America: a report of the Surgeon General. Rockville (MD): US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. Accessed February 23, 2022. https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf
  • US Department of Health and Human Services. All of Us Research Hub Research Projects Directory. Updated 2/23/2022. Accessed February 23, 2022. https://www.researchallofus.org/research-projects-directory/?searchBy=workspaceNameLike&directorySearch=oral
  • Jeffcoat MK, Jeffcoat RL, Gladowski PA, Bramson JB, Blum JJ. Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions. Am J Prev Med 2014;47(2):166–74. CrossRef PubMed
  • Baeza M, Morales A, Cisterna C, Cavalla F, Jara G, Isamitt Y, et al. Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis. J Appl Oral Sci 2020;28:e20190248. CrossRef PubMed
  • Atchison KA, Rozier RG, Weintraub JA. Integration of oral health and primary care: communication, coordination and referral. Washington (DC): National Academy of Medicine; 2018. Accessed February 21, 2022. https://nam.edu/integration-of-oral-health-and-primary-care-communication-coordination-and-referral/
  • Banava S, Reynolds J, Naavall S, Frantsve-Hawley J. Introducing the AAPHD 5-year research agenda. Presentation, National Oral Health Conference, April 12, 2022; Fort Worth, Texas.
  • McNeil DW, Randall CL, Baker S, Borrelli B, Burgette JM, Gibson B, et al. Consensus statement on future directions for the behavioral and social sciences in oral health. J Dent Res 2022;101(6):619–22. CrossRef PubMed
  • World Health Organization. Executive summary: the selection and use of essential medicines 2021: report of the 23rd WHO Expert Committee on the selection and use of essential medicines, virtual meeting, 21 June–2 July 2021. Geneva (CH): World Health Organization. Accessed April 9, 2022. https:// www.who.int/publications/i/item/WHO-MHP-HPSEML-2021.01
  • Oral Health Progress and Equity Network. OPEN blueprint for structural improvement. Accessed April 22, 2022. https://openoralhealth.org/wp-content/uploads/2022/04/OPEN_FLS_BlueprintOverview_F.pdf

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  • Published: 01 March 2021

Trends and developments in oral health literacy: a scientometric research study (1991–2020)

  • Yue Sun   ORCID: orcid.org/0000-0002-1185-8091 1 ,
  • Chunying Li 2 ,
  • Yan Zhao 3 &
  • Jing Sun   ORCID: orcid.org/0000-0003-2983-8053 1  

BDJ Open volume  7 , Article number:  13 ( 2021 ) Cite this article

6096 Accesses

17 Citations

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Metrics details

  • Dental education
  • History of dentistry
  • Preventive dentistry

This study aimed to establish the current situation, intellectual base, hotspots, development trends, and frontiers of oral health literacy (OHL) from the literature.

We analyzed 1505 bibliographic records dated between January 1990 and December 2020 retrieved from the Web of Science Core Collection and the Scopus database. We used CiteSpace for word frequency analysis, co-occurrence analysis, co-citation analysis, clustering analysis, and burst analysis.

The total number of publications increased year-on-year, with the majority of publications coming from the USA. Most studies focused on the relationship between (oral) health literacy and oral health, and the development of OHL instruments. The top 10 keywords by frequency were “health literacy”, “oral health”, “attitude to health”, “dental caries”, “adult”, “children”, “dental care”, “knowledge”, “questionnaire”, and “adolescent”. The keyword with the highest burst intensity was “dental health education”.

Conclusions

OHL research is a thriving field. The field is focused on the development of an OHL instrument and health promotion practice. Strategic cooperation among countries, institutions, authors, hospitals, and communities will be important to encourage further OHL research and address oral health problems.

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Introduction

The World Health Organization (WHO) (2016) suggested that oral health is a key indicator of overall health, well-being, and quality of life. 1 It can influence people’s lives, and cause pain, discomfort, disfigurement, and even death. 2 Oral diseases are highly preventable, but remain common in many countries. 3 The Global Burden of Disease Study 2017 estimated that oral diseases affect 3.5 billion people worldwide, with untreated dental caries being among the most prevalent noncommunicable diseases. 3

Oral health literacy (OHL) is the “degree to which individuals have the capacity to obtain, process and understand basic oral health information and services needed to make appropriate health decisions”. 4 It is therefore about individual capacity to understand and use dental information to transform oral health behaviors. Low OHL limits the capacity to understand dentists’ instructions, which hinders the maintenance of oral health. 5

Many studies have shown that there is strong evidence linking oral health status with OHL. 6 , 7 Baskaradoss 6 found that more than a third of people with limited OHL had high periodontal risk, compared with about 7% of those with adequate OHL. Das et al. 8 found that 60% of research participants with periodontal pocket formation had low OHL, compared with just 36% among those with good OHL. In another study, people with limited OHL had poorer periodontal health. 5 Low parental OHL was associated with dental caries among children. 9 Improving OHL may help to increase adherence to medical instructions, and improve self-management skills and overall treatment outcomes. 6 OHL should therefore be a priority in oral health promotion programs as a determinant of oral health. 10

Since OHL was first defined by the US Department of Health and Human Services, there have been numerous publications and studies in the field, and our understanding of OHL has advanced significantly. However, there has been no review that reveals the diversified content of OHL. Therefore, it is particularly important to use bibliometric methods to quantitatively analyze the characteristics of the literature in the field of OHL and to objectively evaluate the subject’s research status and development history.

Scientometrics refers to the study of measuring and analyzing scientific literature. 11 Scientometrics is the analysis of the general characteristics of research and development (R&D) output, research hotspots, intellectual structures, and the R&D capability of countries in a certain field, using information from papers and patents such as titles, keywords, abstracts, and texts. The methods include the analysis of word frequency, citations, authorship, co-citations, co-authorship, co-words, and counts of authors, research groups, and countries. 12 CiteSpace is one of the most popular analysis tools, and plays an important role in scientometrics to explore the core structure, development history, hotspots, and overall knowledge structure of a discipline. 13 , 14

To date, no scientometrics analysis of OHL has been performed. Our study aims to generate visualized knowledge maps of OHL and analyze the current situation, intellectual base, hotspots, and development trends. We hope to provide an insight into OHL and a basis for future research.

Data sources

Literature was retrieved online through the Web of Science Core Collection (WoSCC) and the Scopus database. We used the search string in WoSCC: TS = (“oral health literacy” OR “oral health literate” OR “oral medical literacy” OR “oral medical literate” OR “oral health knowledge” OR “literacy in dentistry” OR “Estimate of Literacy in Dentistry” OR “Test of Functional Health Literacy in Dentistry” OR “Oral Health Literacy Instrument” OR “Oral Health Literacy Assessment” OR “Comprehensive Measure of Oral Health Knowledge” OR “Oral Health Literacy Adults Questionnaire”) OR (TS = (“patient medical knowledge” OR “patient understand knowledge” OR “health literacy”) AND TS = (oral OR dentistry OR dental* OR Periodont*)); and in Scopus: (TITLE-ABS-KEY (“oral health litera*” OR “oral medical litera*” OR “oral health knowledge” OR “literacy in dentistry” OR “Estimate of Literacy in Dentistry” OR “Test of Functional Health Literacy in Dentistry” OR “Oral Health Literacy Instrument”) OR TITLE-ABS-KEY (“Oral Health Literacy Assessment” OR “Comprehensive Measure of Oral Health Knowledge” OR “Oral Health Literacy Adults Questionnaire”)) OR (TITLE-ABS-KEY (“patient medical knowledge” OR “patient understand knowledge” OR “health literacy”) AND TITLE-ABS-KEY (oral OR dentistry OR dental* OR periodont*)). Document type = article; time span: January 1990 to July 2020. There were no language restrictions. The initial sample included 941 articles from WoSCC and 1314 articles from Scopus.

Data from both databases were imported into CiteSpace. Importing the Scopus data required converting ris-files to a text-file format using the software’s import features, whereas the WoSCC data were imported directly into CiteSpace from text files. Duplicate papers were eliminated, resulting in a final sample of 1505 articles.

Analysis tool

CiteSpace (7.1.R5, 64 bit) was used for analysis. This software generates node link graphs, citation network maps, and other visual results. In the CiteSpace knowledge maps, nodes reflect different elements, such as authors, countries, and cited references. The size of the nodes indicates the number of publications or frequency (i.e., citation count). A larger node shows more publications or higher frequency. The different colors within the nodes represent different times, the connection lines between the nodes reflect the relationship between them, and the color of the line reflects the date of the first cooperation or co-citation. 15 Centrality is a turning point in a field and is shown by purple on the node ring in the knowledge map. It represents the significance of nodes in a network. The thickness of the purple betweenness centrality trim shows the strength of the betweenness centrality. A key node is defined as a node with a betweenness centrality ≥ 0.1 in the network. 16 Citation bursts provide a useful means to trace the development of a research focus. Citation rings in red show the time slices in which citation bursts, or abrupt increases in citations, are detected. 17 Cluster analysis used the clustering function of CiteSpace. The modularity and mean silhouette scores of clustered co-citation networks are two indicators of the general structural properties of a research front. The modularity value ( Q ) measures the extent to which a network can be divided into independent modules, modularity Q  > 0.3 is convincing. A silhouette value ( S value) close to 1 indicates that references within a cluster contain highly consistent or similar content. 18 , 19 In this study, the parameters of CiteSpace were: time slicing (1991–2020), years per slice (1), term source (all selection), node type (choose one at a time), selection criteria (top 50), and pruning (pathfinder).

Trends in the literature

Figure  1 shows that the literature on OHL relating to published articles and citations grew significantly between 1991 and 2020. For articles, in 2019, 198 published articles were recorded in the databases, six times more than in 2009. From 2016 to 2020, 835 articles were published, 422 more than the 413 published from 2011 to 2015. Citation counts have seen a similar evolution and increase. In 2019, 2019 citations appeared in Scopus and 1543 in WoSCC, compared with 276 and 240 citations in the respective databases in 2009. From 2016 to 2020, 9004 citations appeared in Scopus and 6713 in WoSCC, compared with 3952 and 3480 citations in the respective databases from 2011 to 2015. These results show that the amount of research in this field is increasing, seemingly indicating increasing interest in the field over recent years.

figure 1

The annual number of the literature relating to published articles and citations in oral health literacy research from 1990 to 2020.

Analysis of countries

Generating a country map in CiteSpace gave 52 nodes and 107 links (Fig.  2 ). Publications on OHL came from 52 countries. The top 5 countries for co-occurrence and centrality are listed in Table  1 . The USA contributed the most publications (500), followed by Australia (111) and India (84). The top 3 countries by centrality (≥0.1) were the USA (0.68), UK (0.39), and Canada (0.20). The USA was the most important research source by publication number and centrality. Figure  2 shows extensive collaboration between the USA, Australia, UK, Canada, and Iran. The strongest collaborations were among Brazil, Sweden, and Norway.

figure 2

The network map of countries related to oral health literacy research.

Analysis of authors and co-cited authors

The co-author map showed 202 nodes and 382 links (Fig.  3 ). The 1505 articles were by 202 authors. The top 5 authors are shown in Table  2 . Three large cooperation networks had been formed. There were some collaborations among Jessica Y. Lee, A. Diane Baker, William F. Vann Jr, Kimon Divaris, and R. Gary Rozier, among Fabian Calixto Fraiz, Saul Martins Paiva, Fernanda Morais Ferreira, and Ana Flavia Granvillegarcia, and among Yan Si, ChunXiao Wang, WenSheng Rong, Xing Wang, and BaoJun Tai. No other large collaboration networks had been formed.

figure 3

The network map of active authors offered to oral health literacy research.

The author co-citation map had 460 nodes and 1614 links (Fig.  4 ). The author with the highest co-citation count was Poul Erik Petersen (161 citations), followed by Jessica Y. Lee (157 citations) and David W Baker (110 citations). Table  3 shows that the top 8 co-cited authors with centrality > 0.1 (“core strength” researchers) were Poul Erik Petersen, US Department of Health and Human Services, Miranda R. Andrus, Darren A. DeWalt, WHO, Mark D. Macek, Ruth Freeman, and Micheala Jones.

figure 4

The network map of co-cited authors offered to oral health literacy research.

Analysis of journals and co-cited journals

The co-citation journal map had 214 nodes and 872 links (Fig.  5 ). More highly cited journals included Community Dentistry and Oral Epidemiology (2019 impact factor (IF): 2.135), the Journal of Public Health Dentistry (2019 IF: 1.743), the Journal of the American Dental Association (2019 IF: 2.803), the Journal of Dental Research (2019 IF: 4.914), and BMC Oral Health (2019 IF: 1.911). Table  4 shows the top 5 co-cited journals by centrality (≥0.1). The journal with the highest centrality was Social Science & Medicine (2019 IF: 3.616), followed by the American Journal of Public Health (2019 IF: 6.464).

figure 5

The network map of co-cited journals related to oral health literacy research.

Analysis of the intellectual base

The co-citation reference map had 613 nodes and 1716 links (Fig.  6 ). Table  5 lists the top 5 co-cited references by centrality. The cited article with the highest centrality was by Jessica Y. Lee et al. 20 This study indicated that differences in OHL levels between racial groups persisted after adjusting for educational attainment and sociodemographic characteristics.

figure 6

The co-citation cluster map of references from publications in oral health literacy research.

The clustering of similar references resulted in co-citation clusters. The modularity ( Q value) was 0.7521, and the S value was 0.4228. We used the local linear regression (LLR) algorithm to label the clusters. Figure  6 shows the co-citation reference clusters. In total, 14 clusters were identified, including 6 major clusters (Table  6 ). Cluster #0, which was labeled “oral health literacy”, contained 110 references ( S value = 0.798) about OHL status and the relationships among OHL, oral health behavior, and oral health status. Cluster #1 was labeled “early childhood caries” and contained 44 references ( S value = 0.873), and was mainly about the prevention of early childhood caries and parental health literacy influence. Cluster #2 was labeled “reading ability” and contained 41 references ( S value = 0.863), and was mainly about health literacy or functional health literacy. Cluster #3 was labeled “oral health education program” and contained 39 references ( S value = 0.909), and was mainly about oral health care programs, especially for pregnant women. Cluster #4 was labeled “young children” and contained 37 references ( S value = 0.889), and was mainly about the impact of caregiver literacy on children’s oral health outcomes and the development of an OHL instrument. Cluster #5 was labeled “pediatric nonprescription liquid medication” and contained 37 references ( S value = 0.877), and was mainly about literacy and the misunderstanding of prescription labels. The top 5 co-cited references by the number of citations and centrality were mainly from these six clusters.

Analysis of hotspots

Figure  7 presents the time span of the most frequently occurring keywords and their respective co-occurrence links. “Oral health”, “health”, and “attitude to health” were three of the earliest keywords. Over time, “knowledge”, “dental caries”, “oral hygiene”, “dental care”, “adult”, “health literacy”, and other keywords developed. More recently, “impact”, “risk factor”, “internet”, “psychology”, and “surveys and questionnaire” emerged. New keywords for 2019 and 2020 included “community”, “human experiment”, and “validity”.

figure 7

The time zone view of co-occurring keyword from publications in oral health literacy research.

Table  7 shows the top 10 keywords by frequency and centrality. The keyword with the highest frequency was “health literacy”, followed by “oral health”. The keyword with the highest centrality was “controlled study”.

Figure  8 shows the co-citation keywords clusters. The modularity ( Q value) was 0.5074, and the S value was 0.4012. We used the LLR algorithm to label the clusters. There were ten keyword clusters, including three major clusters. The largest of the three major clusters, Cluster #0, included 62 keywords and a mean S value of 0.685. The literature in this cluster describes OHL and OHL assessment scales. The hotspot focused on the impact of OHL, oral health behavior, or oral health knowledge on oral health status, and the development and psychometric validation of OHL scales. The second largest cluster (Cluster #1) included 59 keywords and a mean S value of 0.826. It mainly discussed the oral health knowledge, attitudes and practice status of different populations, and dental education programs, such as information seeking behavior, available health care services, and health communication between dentist and patient. The third largest cluster (Cluster #2) included 56 keywords and a mean S value of 0.726. These studies covered factors influencing oral health and the intervention program.

figure 8

The co-citation cluster map of keywords from publications in oral health literacy research.

So-called “burst words” are words that are cited frequently over a period of time. 21 Figure  9 shows the top 24 keywords with their burst impact. The strongest citation burst keywords appeared from 1990 to 2020. “Attitude to health”, “oral hygiene”, “questionnaire”, “health behavior”, and “dental caries” were the earliest burst keywords. “Attitude to health” had the longest duration of burst, from 1990 to 2009. “Statistics and numerical data” and “psychology” were the most recent burst keywords. “Dental care” (strength: 10.3831) had the highest burst intensity.

figure 9

The keywords with strong citation bursts from publications in oral health literacy research.

OHL has become an increasingly important area of oral health research. Our study represents the first attempt to analyze the research on OHL using CiteSpace software. CiteSpace has been widely used to detect and visualize scientific knowledge, trends in the literature, and future directions of research. 16 , 19 For example, it was used to analyze publications on the relationship between betel quid chewing and oral cancer from 1998 to 2017. 22 Other researchers have used it to gain an overview of studies of traumatic dental injuries. 23 We used CiteSpace to analyze articles on OHL from 1991 to 2020 to evaluate the origin, current trends, and hotspots of research on OHL.

The time distribution and growth trends of academic papers are the most direct manifestation of academic attention and knowledge in this field. 24 Over the last 30 years, an upward trend has been observed in citations regardless of in WoSCC and Scopus database (Fig.  1 ). Besides, we identified an increasing number of research publications about OHL, which can be divided into two periods—elementary (1990–2009) and rapid development (2010–2020) (Fig.  1 )—indicating that OHL research is likely to continue to increase in the future.

An important output of research is the quantity of publications in peer-reviewed academic journals. 25 Scientific publication is considered a component of constructing a knowledge-based economy. Better economics and expenditure for scientific research in developed countries may have a positive influence on research productivity and quality. 14 The USA, an economically powerful country, is a key player in scientific research on OHL, contributing about one-third (500/1505, 33.2%) of total literature. Table  2 shows that a total of 60% of the most productive researchers were from the USA. These findings show that the USA, as a developed country, plays a leading role in the field of OHL research. This is consistent with findings showing that the level of oral health care is closely connected to economic factors. 2 This study is not the first to show the leading role of the USA in producing and publishing scientific literature. 26 , 27

Mapping the countries’ and authors’ cooperation networks revealed an essential class of scientific social networks, showing the key structures of scientific collaboration. 14 Growing global contacts and exchanges have eroded isolation. 14 However, our results showed that there was perhaps insufficient cooperation among the countries and authors in this field. For instance, in Fig.  2 , 52 nodes and 107 links are shown, meaning that 52 countries produced the literature, with 107 cooperative relationships among them—more links mean more collaboration. 25 This is consistent with other studies, 22 , 25 , 28 and suggests insufficient cooperation. Figure  3 also showed distinct clusters representing disciplines or colleges. For example, Jessica Y. Lee, Kimon Divaris, R. Gary Rozier, William F. Vann Jr, and A. Diane Baker are all from the University of North Carolina at Chapel Hill. More autonomy, international academic exchanges, and cooperation are therefore necessary to promote the development of the discipline. 28

The academic influence of authors can be determined by the number of publications and the frequency of citations. 25 Citation frequency analysis highlighted Jessica Y. Lee, who was involved in research on the development of an OHL instrument and survey, and explored the relationships among OHL, self-efficacy, and oral health status. 20 , 29 , 30 , 31 Table  3 also showed several “core strength” researchers, whose studies have had an important influence on the field. 25 However, few authors had a centrality > 0.1, indicating the lack of an influential core author group in the field of OHL. This result suggested that more research on OHL is needed and more researchers should contribute to this field. 25

We also identified the core journals publishing on OHL, reflecting the use and influence of articles published in these journals. 25 The top 5 journals had a centrality > 0.1 (Table  4 ), indicating that articles published in these journals were of higher quality and greater influence on OHL studies. By combining the citation frequency analysis and centrality analysis, we found that the American Journal of Public Health , the International Dental Journal , and Pediatrics are all highly cited and high-centrality journals. These three journals have published many high quality articles, and their academic influence was higher than other similar journals in the field of OHL.

By analyzing references, we identified the intellectual base in the field of OHL. Studies of key nodes with relatively high centrality are the foundation of the research field. 16 Articles with high centrality rankings focused on OHL levels, improvement of oral health through OHL, and relationships between health literacy and health outcomes (Table  5 ). 20 , 32 , 33 , 34 , 35 The clustering of similar references resulted in co-citation clusters, which could be used to explore the main topics. 19 By analyzing the co-cited references of the six major clusters (Fig.  6 ), we found that the intellectual base topics were relationships between health literacy/OHL and oral health, improving oral health care practice programs, and development of an OHL instrument. The 14 clusters were relatively concentrated, non-dispersed, and overlapping, indicating that the topics in the intellectual base are concentrated. The intellectual base in the field of OHL is closely related to the field of health promotion theory and health literacy.

A hotspot is a scientific issue or topic discussed in a group of documents that are linked to a period of time. 25 An analysis of high frequency keywords can be used to determine research hotspots as well as to monitor the research frontier transitions in a field. 21 The highest frequency keyword was “health literacy” (Table  7 ), indicating that OHL was closely related to health literacy. Other high frequency keywords included “oral health”, “adult”, “knowledge”, “dental caries”, “children”, “questionnaire”, and “attitude to health”. We can deduce that there is a focus in the field on the relationship between OHL and oral health in the whole population. Most publications included descriptive and cross-sectional studies, with a lack of randomized controlled intervention studies. These results suggest that there is a need in this field for more intervention research on improving OHL to enhance the oral health level of the entire population.

Detection of a citation burst indicates dramatically increasing literature citation frequencies, which can last for multiple years or a single year. 14 A stronger burst indicates that there is more focus on this research topic. 14 The emergence date of burst words shows when topics became the focus of attention. A word with high burst strength may indicate a significant turning point in the field of research. 25 Analysis of the time zone view (Fig.  7 ) and the strongest citation burst keywords (Fig.  9 ) therefore reveals the hot topics and frontiers in different periods. 17 Before 2010, the total number of keywords was relatively small. Keywords such as “oral health”, “dental caries”, “attitude to health”, “knowledge”, and “health education” appeared first. The strongest citation burst keyword was “dental health education”, a topic of early attention in this field. 36 , 37 In 2000, OHL was first defined in the US Department of Health and Human Services policy, Healthy People 2010, 38 and since then there have been more studies about the association of health literacy with oral health status. 39 , 40 , 41 Subsequently, keywords such as “health promotion”, “health literacy”, and “association” appear successively. There was rapid growth from 2010 to 2020 in several areas, including dental care and OHL instruments. “Dental care” and “word recognition instrument” had the highest burst strength during this time, demonstrating the focus of attention in this field. In 2007, researchers developed a word recognition instrument to test health literacy in dentistry: the REALD-30. 29 Reports released by the American Dental Association (ADA) and the US Institute of Medicine’s (IOM) also underpinned the importance of OHL. In 2009, the Health Literacy in Dentistry Action Plan 2010–2015 was released by the ADA, 42 and in 2011, the IOM released a report on advancing oral health in America. 43 Bursts also showed that oral health education and OHL instruments continued to develop. Keywords such as “early childhood caries”, “pregnancy”, “young adult”, “impact”, “risk factor”, “psychology”, “surveys and questionnaires”, and “validity” also appeared. This indicates that there were many studies on oral health status in different populations, and that risk factors and validation of tools remained hot topics. In the recent years, “psychology” has been a popular burst keyword, indicating that research on the development of an instrument for psychometric evaluation may be one of the frontiers in the field of OHL. The existing instruments to evaluate OHL use two main strategies: word recognition and reading comprehension. 44 However, some aspects of oral and dental health literacy are ignored by the existing tools. Further work is therefore needed on a comprehensive OHL instrument for international use, ensuring that it is both simple and brief. 45 A comprehensive, valid, and reliable scale could assist in identifying factors affecting oral health.

Strengths and limitations

To our knowledge, this is the first study to systematically analyze the research on OHL using the scientometric method. This study provided an insight into OHL and valuable information for OHL researchers to identify new perspectives on potential collaborators, cooperative countries, hotspots, and future research directions. However, this study also has some limitations. The scientometric analysis was based on papers obtained from the WoSCC and Scopus databases to meet the reference format requirements of the CiteSpace software. Although these databases embrace a relatively comprehensive range of studies, it would be better if more databases had been included for the bibliographic analysis. Furthermore, most countries in the world have their own database resources using different languages. Therefore, it is hoped that future studies will analyze and compare a range of different databases in the OHL area.

The field of OHL is currently thriving, and we expect this to continue. The development of an OHL instrument and health promotion practice are current focus areas, and the development and psychometric evaluation of a comprehensive OHL instrument may be the next frontiers in the field of OHL. Strategic cooperation among countries, core authors, institutions, hospitals, and communities should be encouraged so that resources can be shared to promote the development of OHL and address problems in the field.

Data availability

All data sets generated for this study are included in the paper.

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The authors thank for the librarians for their assistance in document retrieval and collation. We thank dentist Jun Hong-Zhou, from Zhong Guan Cun Hospital, Beijing, China, for participating in discussion and analysis results of the research.

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Y.S. conceived and designed the study, collected the data and performed software analysis, and drafted the first vision. J.S. conceived and the study, interpreted and discussed the findings, and provided important feedback regarding the paper. C.L. made substantial contributions to literature retrieval and data analysis. Y.Z. made extra contributions to the data processing and paper revising. All authors approved the final paper as submitted.

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Sun, Y., Li, C., Zhao, Y. et al. Trends and developments in oral health literacy: a scientometric research study (1991–2020). BDJ Open 7 , 13 (2021). https://doi.org/10.1038/s41405-021-00066-5

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Challenges to conducting research on oral health with older adults living in long-term care facilities

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The challenges to conducting oral health studies involving older people in long-term care facilities (LTCFs) must be debated.

This study aimed to investigate researchers’ perceptions and experiences while conducting an epidemiological survey on oral health among older individuals residing in LTCFs.

A qualitative study was conducted involving six researchers who utilized field diaries to record their impressions during data collection through interviews (older individuals (or their proxies), caregivers, and LTCF coordinators) and oral examinations of the older people participants. Additionally, researchers responded to open-ended questions about their experiences. The collected material was subjected to content analysis by two researchers.

The themes that emerged from the analysis were institutional context, aspects affecting the operationalization of the study, and data collection oriented by the clinical-functional profile of the older people. According to the researchers’ perceptions, LTCF coordinators demonstrated concern for the study’s benefits for older adults and the preservation of institutional routines during the research process. Caregivers emerged as vital sources of information, guiding researchers in navigating the challenges posed by the physical and mental complexities of the older people participants, necessitating empathy, sensitivity, and attentive listening from the researchers. The organization of materials and a streamlined data collection process proved essential for optimizing time efficiency and reducing stress for participants and researchers.

The researchers recognized the important role played by LTCF coordinators and formal caregivers, underscoring the significance of empathetic methodologies and streamlined data collection processes in mitigating the challenges inherent to research conducted within LTCFs.

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Population aging is a global phenomenon presenting significant challenges to healthcare systems worldwide due to the burden of chronic age-related conditions [ 1 ]. The aging process often leads to frailty and increased functional dependence, resulting in a notable rise in institutionalization [ 2 ]. In Brazil, as observed in other countries like the United States, France, and China, the age pyramid has undergone an inversion, contributing to a higher prevalence of chronic diseases and functional dependence among older individuals. Consequently, the population residing in long-term care facilities (LTCFs) has grown substantially [ 3 , 4 , 5 ].

Older adults living in LTCFs generally depend more on daily activities than their non-institutionalized counterparts, and oral health is a prominent concern [ 6 , 7 ]. Institutionalization can negatively impact older individuals eating habits, cognition, and overall functioning, resulting in deteriorating health conditions [ 6 , 8 ]. Furthermore, significant barriers to oral health care exist within nursing home settings [ 9 , 10 ]. The oral health of this group is characterized by severe tooth loss, oral diseases, and biofilm accumulation [ 11 , 12 , 13 ]. These conditions have been associated with adverse outcomes in terms of general health, quality of life, and mortality [ 14 ]. In Brazil, the operations of LTCFs are regulated by the National Vigilance Agency. However, despite the recognized need to improve oral health care provision in these institutions, the regulations do not explicitly address oral health. Therefore, research in LTCFs is imperative to generate robust scientific evidence concerning the oral health needs of older individuals. Such evidence is essential for enhancing standards of care and making informed decisions that prioritize the overall health and well-being of older populations. A recent review analyzing barriers to translating research into oral healthcare policy and practice for older adults stressed the need for increased efforts to undertake research involving older adults, including frail older adults living in residential care, to develop an evidence-informed paradigm for oral health care and expand policies and care practices for this age group [ 15 ].

However, conducting studies involving older people in LTCFs poses numerous challenges, demanding meticulous planning, considerable time, and ample resources to overcome these obstacles [ 16 ]. Nevertheless, there is a lack of research discussing these challenges [ 17 , 18 , 19 ], particularly strategies to include older individuals with dementia in studies [ 20 , 21 ]. Although health research may share similar challenges, none of these studies have discussed research experiences, including oral health assessment. The previously reported challenges were related to obtaining consent, conducting interviews, engaging caregivers and family members, maintaining privacy, addressing participant attrition, obtaining sufficient sample sizes, accounting for intra-institution cluster effects, dealing with incomplete data, and navigating rigid LTCF practices and routines [ 16 , 17 , 18 , 19 , 20 , 21 ]. For older individuals with dementia, researchers emphasize the need for inclusive strategies, considering their communication difficulties, memory loss, diminished autonomy in decision-making, and emotional disposition [ 20 ]. The only identified systematic review on methods for involving older people in health-related studies highlights the viability of studies involving older adults, emphasizing the importance of clear communication, building good relationships, and employing flexible approaches [ 22 ].

This study aimed to investigate researchers’ perceptions and experiences while conducting an epidemiological survey of oral health among older individuals residing in LTCFs. The findings of this study can provide a valuable understanding of the challenges faced during the study and identify effective strategies to improve the quality and efficiency of future research in this context. Furthermore, understanding researchers’ perspectives makes it possible to develop specific recommendations to enhance research methods for this vulnerable population. By addressing these challenges and designing effective strategies, this research can improve the quality of studies focusing on older populations living in LTCFs and promote evidence-informed oral healthcare policies and practices for this age group.

This study employed a qualitative method with a phenomenological approach to explore the experiences of researchers during data collection with older individuals residing in LTCFs and their perceptions of the execution of this work. The phenomenological approach, centered on language, seeks to capture the essence of the lived experience and the emergent meanings from that experience. Previous knowledge of the phenomenon is disregarded to explore how the subjects experience events [ 23 , 24 ]. Field diaries and an online form with open-ended questions were used to explore the researchers’ experiences.

Context of study

The research was conducted at philanthropic LTCFs in Belo Horizonte, Brazil, during a cross-sectional study between August 2022 and March 2023. In 2022, there were 28 philanthropic LTCFs in the city. The sample planning aimed to include all older individuals residing in these facilities, irrespective of their cognitive status. The study participants were coordinators of the LTCFs, formal caregivers of older people, and individuals aged 60 years or older residing in these facilities. The formal caregivers of the older adults were remunerated professionals with employment ties in the LTCFs, having received specific training as elderly caregivers or being nursing technicians. During data collection, they assisted and cared for the older adults. Epidemiological data were collected through interviews with the coordinators, formal caregivers, and older individuals or their proxies (caregivers). The collected variables followed the model of the International Classification of Functioning, Disability, and Health (Fig.  1 ), which included anthropometric measures and physical and oral examinations conducted at the LTCFs.

figure 1

Model adapted from International Classification of Functioning, Disability and Health

The six researchers involved in the study had undergone prior training for conducting interviews, and four of them received calibration exercises for the oral examinations. All six researchers participated in the data collection process for the epidemiological research. These researchers consisted of both undergraduate dental students and master’s degree graduate students, who formed pairs to serve as interviewers, examiners, and/or assistants (annotators).

A pilot study was carried out at one of the LTCFs participating in the research to ensure the smooth execution of the study. This pilot study allowed for testing the digital data recording tools and refining the sequence and dynamics for conducting interviews and examinations. The pilot study served as a preparatory phase, ensuring the research procedures were well-coordinated and optimized before the main data collection phase.

Procedure and participants

The research utilized a field diary as the primary method to record informal conversations, observations of the behavior of older people and formal caregivers during data collection, reflections on the examination process and methods employed, as well as the researchers’ impressions regarding the data collection process within the LTCF setting [ 25 , 26 ]. Researchers independently and freely made digital-format entries in their respective field diaries.

All six researchers independently and freely made digital-format entries in their respective field diaries. Criterion sampling was the method utilized for selecting this sample, which encompassed all researchers who have shared an experience, yet exhibit variations in characteristics and individual experiences [ 27 ]. In addition to the field diary, an online form with open-ended questions was employed to collect individual feedback from each researcher about their feelings and experiences as a researcher during the fieldwork. The form included the following guiding questions: (1) How was your experience collecting data at the LTCFs, considering the older people, caregivers, and LTCF context? (2) What was the most striking aspect during the days you collected data at the LTCFs? (3) If you were to advise a researcher about beginning data collection at a long-term care facility through interviews with older people, what observations would you share to ensure their success? (4) what is the main aspect that should be considered for satisfactory data collection with older people similar to those encountered at the LTCFs? The responses to these questions contributed to the researchers’ reflections and perspectives. They were considered part of the corpus of analysis for the study.

Data analysis

The contents of the field diaries and open-ended questions were independently submitted to exhaustive readings by two researchers with experience in qualitative studies for a more in-depth capturing of the information. Subsequently, the data underwent content analysis, following the approach proposed by Graneheim and Lundman [ 28 ]. The researchers identified units of meaning within the records and extracted the essence of each unit, resulting in the creation of condensed units of meaning. Through this process, categories and themes that emerged from the analyzed content were identified. Reliability was ensured through continual discussion of the data with the team. Consensus meetings were held to ensure agreement on the themes that emerged. In the final analysis, codes such as R1, R2, and so forth were used to represent each of the interviewees, allowing for a systematic and organized representation of the participants’ contributions.

Ethical aspects

This study received approval from the Human Research Ethics Committee of the Universidade Federal de Minas Gerais. The participants signed a statement of informed consent.

Results and discussion

The data collection for the epidemiological study on oral health assessment in 14 LTCFs, 311 older people, and 164 formal caregivers involved six researchers. They recorded their observations in field diaries and responded to open-ended questions. Through content analysis of the field diaries and open-ended questions, three main themes emerged: (1) institutional context, (2) aspects affecting the operationalization of the study, and (3) data collection oriented by the clinical-functional profile of the older people. The categories under each theme are presented in Table  1 .

Institutional context

Results regarding the institutional context are presented in Table  2 , showcasing the units of meaning that illustrate the categories within this theme. The researchers recognized the crucial social role played by LTCFs in reintegrating older people, particularly those who have experienced neglect or loneliness, perceiving these institutions as mandated by Brazilian legislation to care for and support older individuals [ 29 ]. Regarding the ambience of LTCFs , the study revealed a wide variation in the activities and services offered to residents across different institutions. As stipulated by the Brazilian Resolution, LTCFs should provide a welcoming environment that upholds older people’s human rights and dignity, including aspects such as identity, freedom of beliefs, freedom to come and go, privacy, and respect [ 30 ]. The ambience also encompasses fostering family and community involvement in caregiving, the coexistence of residents with different degrees of dependence, supporting residents’ autonomy, promoting leisure opportunities, and preventing violence or discrimination against residents [ 29 ]. The Brazilian regulation also standardizes structural aspects of the LTCFs, human resources, health care, nutrition, washing, processing, and storage of clothing, and cleaning facilities [ 29 ]. The researchers’ perceptions indicated the importance of establishing systematized assessment processes to reveal the different levels of quality of the LTCFs, indicating the need for policies that favor achieving the principles of ambience and the well-being of the older people who reside in these facilities.

The profile of the older people living in the LTCFs , as recorded by the researchers, was characterized by high frequencies of cognitive impairment, clinical-functional frailty, mental and behavioral disorders, and dependence in performing basic and instrumental activities of daily living. These characteristics posed challenges during the data collection process, as many participants exhibited refusal, resistance, and low levels of cooperation with the study due to their health conditions. This clinical-functional profile is similar to that described for older people living in long-term care facilities worldwide [ 8 , 14 ]. The researchers also observed rapid functional decline among the older people during the data collection period when the same individuals were visited on different occasions from one week to the next. As a cross-sectional study, the researchers sought to conclude data collection in the first and only approach to older people, whenever possible.

Moreover, fluctuating interest in participation necessitated additional attempts to secure their involvement due to emotional and health-related fluctuations. A previous study involving older people with dementia found that verbal communication varied between weeks, from one day to another, and even within the same day [ 20 ]. Another challenge was dealing with the losses of individuals. Data collection began with mapping all residents at the institution by consulting the records. When seeking older people for interviews, there were cases of death – either recent or longer ago. In the latter case, it was perceived that the LTCFs did not perform regular updating and the separation of records.

Regarding oral health , the researchers identified a precarious situation among older people, with a high frequency of tooth loss, caries, and periodontal disease in the remaining teeth, along with unsatisfactory dental prostheses and accumulation of biofilm and dental calculus. This oral health profile aligns with previous studies in different countries, highlighting the substantial burden of oral diseases among institutionalized older individuals [ 13 , 31 , 32 ]. This researchers perception reflects the oral health profile of older people living in LTCFs in Belo Horizonte for more than a decade and a half [ 12 ], demonstrating that this population is a special needs group requiring oral care improvements [ 11 , 31 ].

The researchers recorded the difficulty of older people accessing routine oral care, as many depend on caregivers who have an excessive workload, have little time available to perform oral hygiene, do not prioritize it, or are unaware of its importance. A daily routine of oral hygiene during bathing was often observed, as reported in a previous study, in which nurses reported that the teeth of the majority of residents were brushed at least once a day [ 13 ]. The researchers’ findings underscore the pressing need for improved oral care for this special needs population, emphasizing the importance of incorporating oral hygiene into routine healthcare practices, promoting oral care initiatives, and providing training for caregivers [ 13 , 33 ].

Aspects affecting the operationalization of the study

The researchers encountered various challenges related to the operationalization of the study, particularly in gaining the acceptance and cooperation of LTCFs. Results regarding the operationalization of the study are presented in Table  3 . The signing of informed consent by the LTCF coordinators proved to be a complex process, with many expressing resistance and skepticism about the study’s potential impact and benefits for the older residents. Some questioned the importance of a study involving individuals at the end of life. The researchers faced concerns about interrupting institutional routines and potential risks to the residents without any direct return. Similar challenges have been observed in studies conducted in the United Kingdom, where the presence of researchers was perceived as intrusive [ 17 ]. In compliance with Brazilian legislation on research involving human beings, participation must be consented to clearly and voluntarily with no financial compensation. As experienced by other researchers, flexibility and creativity were needed to justify the importance of the project to generate evidence that reinforces the importance of oral health for this group. It was also essential to emphasize the low risk associated with the participation of older individuals [ 17 ]. Establishing a trusting relationship with the coordinators of the LTCFs proved vital for their willingness to participate in the study. The researchers tried to showcase the study’s potential in generating valuable knowledge, organizing academic extension activities tailored to this specific population, and the potential benefits it could bring to enhance resident care. The presence of researchers might have encountered increased resistance during the pandemic, leading to visit cancellations due to concerns about the higher risk of mortality and morbidity from the coronavirus among older people [ 34 ].

The study planning at LTCFs should include the time spent on recruitment and the need for different approaches for contact: repeated telephone calls, personal visits, the presentation of documents/written projects, and the joint determination of a data collection timeframe. Researchers should also be prepared to deal with refusals, as occurred in this study when coordinators vehemently refused to participate, stating that they did not have the authorization or that the LTCF was part of a network that did not permit study participation. This challenge shows that building collaborative relationships with LTCFs is essential to understand research concerns clearly and to plan a project involving vulnerable adults jointly [ 15 ]. In contrast, the researchers also recorded situations in which the coordinators were receptive to the study, recognizing that it is important to demonstrate the needs of this population, which could result in programs and policies for older people who reside in LTCFs.

The process of obtaining informed consent from the older residents themselves was also challenging, especially for those with severe cognitive impairment. In such cases, consent was given by caregivers or LTCF coordinators acting as guardians of the older people. The issue of consent by proxy and the ability of the proxy to represent the wishes of cognitively impaired adults has been a subject of debate [ 15 ]. Several researchers have highlighted the challenges of obtaining informed consent and respecting the autonomy of individuals with dementia [ 16 , 17 , 18 , 19 , 20 , 21 , 35 ]. Hubbard and Maas emphasized the importance of continually monitoring the individual’s desire to participate, even when a proxy provides consent through the interpretation of verbal and nonverbal signs. They asserted that consent is an ongoing process rather than an a priori one-time event, as Crossan & McColgan (1999) mentioned. We encountered similar situations where residents could not provide direct consent. In such cases, the researchers took great care to explain the study and obtain their assent while interpreting their facial expressions and behavior to respect their autonomy and wishes. Despite these efforts, 15 invited older people chose not to participate.

The institutional routines of LTCFs significantly impacted the study execution. Researchers had to consider and respect the schedules and activities of the older residents, leading to adjustments in the data collection timeframe. Additionally, finding suitable times for interviews and examinations was challenging due to the residents’ mobility problems and caregivers’ availability. The researchers had to collaborate with LTCF coordinators to find mutually agreeable time slots while ensuring minimal disruption to the institution and its residents. Finding suitable time slots to conduct interviews was also a significant challenge, as observed in a previous study exploring the perception of dignity among older people residing in LTCFs [ 19 ]. The authors of that study emphasized the need to avoid peak activity times, such as meals or regular visits by physicians, and to avoid conducting interviews immediately after an activity, such as lunch, as participants often displayed weariness and lethargy during such periods [ 19 ]. To overcome this challenge, the research team collaborated with the LTCF coordinators to agree on appropriate data collection times that did not disrupt the institution’s routines or inconvenience the residents. This required a significant consideration of each location’s availability and the staff’s workload. Other researchers have noted these challenges [ 17 , 19 , 20 , 21 , 35 ], especially considering that caregivers are crucial as proxies for older people. Researchers also had to contend with the unavailability of caregivers to answer questions due to their multifaceted responsibilities in caring for many residents. Introducing the study could thus be an additional burden for them, which many might perceive as unwanted.

In addition to respecting the institutional dynamics, the execution of data collection required careful organization by the researchers regarding the selection of data collection location and methods . Many residents faced mobility issues, making moving from one place to another challenging. In some instances, caregivers were unavailable to assist in this task, requiring additional time to reach the most suitable location for the interview or oral examination. Factors such as lighting, privacy, and participant comfort had to be considered during this process. Adapting the data collection process to the specific situation encountered at each LTCF was necessary. Some facilities had designated spaces for the study, while others lacked appropriate areas, leading to examinations being conducted wherever possible, such as in TV armchairs or beds. Previous studies have discussed the need for such adaptations [ 17 , 20 ]. According to Hall, Longhurst and Higginson, these field situations also posed challenges to maintaining privacy during data collection, which became especially sensitive during oral examinations [ 19 ]. The proximity required for oral examinations could generate discomfort, mainly when conducted in the presence of colleagues and staff. Efforts were made to ensure privacy in such situations. Consequently, conducting studies in this context demanded considerable flexibility and reciprocity, considering the limitations and demands of the LTCFs [ 19 ]. The researchers were also concerned about biosafety and cross-infection prevention [ 36 ], mainly due to the vulnerability of older people to the COVID-19 pandemic. Adhering to strict protocols and protective measures during data collection became essential to safeguard the health of both residents and researchers.

Various measures can be employed to ensure standardization and successful data collection. Providing proper training and ongoing supervision for the researchers is essential. This training should cover all aspects of the data collection process, including interview techniques, oral examination protocols, and ethical considerations. Additionally, it is crucial to ensure that the researchers have access to the minimum necessary resources required for data collection, such as sterilized clinical kits, personal protective equipment, and appropriate data recording tools. A comprehensive manual of norms and standard procedures should be prepared to maintain consistency and adherence to established protocols. This manual should outline step-by-step instructions for each stage of the data collection process, from participant recruitment to data recording and analysis. Regular reference to this manual will help researchers follow standardized procedures and minimize the risk of errors or deviations during the study [ 37 ].

The high proportion of older people with cognitive impairment created additional complexities. Variables related to subjective aspects, such as quality of life and self-perception of health, posed challenges since some residents had limited discursive capacity. The researchers utilized validated instruments designed for older adults with adequate cognitive levels but recognized the need for more context-specific tools for individuals with dementia. Challenges to assessing subjective aspects of the lives of older people with dementia have been discussed, considering the lack of validated instruments for this population. There is a debate in the literature on whether data collected from individuals with dementia are reliable due to cognitive impairment [ 38 ]. However, more recently, there has been growing recognition that such individuals can express perceptions, needs, and concerns [ 38 , 39 ], and their subjective experiences should be considered and investigated in studies [ 20 , 39 ]. Approaches such as structured observation focused on nonverbal communication (facial expressions and body language) and nonstructured observation within the ethnographic tradition have been employed in previous studies to understand the social world of older people [ 20 ]. A study assessing quality of life among older people with dementia combined observation with interviews using open-ended questions, and older people were included based on their capacity to communicate verbally in a conversation rather than based on the diagnosis of dementia [ 20 ]. The literature describes the need to use multiple (qualitative and quantitative) methods in studies involving individuals with dementia with different levels of verbal communication skills to promote a contextualized, multidimensional assessment [ 39 ]. Such approaches should also be considered strategies to understand the quality of life in the context of oral health assessments in future studies and to guide care strategies considering the experiences and wishes of individuals with dementia.

Data collection oriented by the clinical-functional profile of the older people

The researchers revealed that the clinical-functional profile of older people requires differentiated approaches for data collection, particularly the use of relational skills, such as empathy, active listening, patience, sensitivity, and flexibility to deal with different behaviors – ranging from cooperative to resistant individuals. Results regarding the data collection oriented by the clinical-functional profile of the older people are presented in Table  4 . Cognitive impairment and levels of cooperation were identified as obstacles to the data collection process, with frequent resistance to the study. The progression of cognitive decline leads to a deterioration of cognitive functions and behavior and mood disorders, including depression, irritability, and aggressiveness [ 40 , 41 , 42 ].

This profile of the older people also required communication strategies on the part of the researchers, who needed to be direct and clear, often involving the participation of the caregivers. The researchers manifested insecurity, feeling unprepared to understand and deal with older people in some situations. Hubbard, Downs, and Tester [ 20 ] suggest that researchers dealing with dementia should be trained as skilled verbal and nonverbal communicators, sensitive to how dementia impacts memory, decision-making capacity, and emotions. Developing strategies tailored to each participant’s unique experiences and listening to their voice is essential. Hall, Longhurst, and Higginson [ 19 ] add that researchers must be particularly patient, and the extra time and training for this must be built into the research design. Establishing set protocols for handling various responses ensures uniformity and consistency [ 19 ]. Researchers also had to contend with parallel conversations,” where older people spoke about other subjects and extended the conversation. This required employing different communication strategies and striking a balance between listening to the older person and returning to the assessment without causing discomfort [ 16 , 20 ].

Sensory impairments, such as low visual and hearing acuity, also compromise communication. Hearing impairment is common among older people [ 43 ], and there are also high proportions of blindness and vision impairment among residents of LTCFs [ 44 , 45 ]. Interviews involving older people with hearing impairment were found to be draining, as the researchers needed to raise their voices and repeat questions. This limitation can negatively impact the quality of dialogue and create discomfort for the older person [ 20 ].

The researchers highlighted the caregivers’ knowledge in guiding the data collection process according to the clinical-functional profile of the participants. Being familiar with older people and their physical and mental status, caregivers served as valuable mediators, offering insights into effective communication and strategies for dealing with each case. Caregivers of older people perform the functions of accompaniment and care, offering emotional support as well as support in their social interactions, assisting and accompanying routines of personal and environmental hygiene, nutrition, preventive health care, the administration of medications and other health procedures, and assisting and accompanying the mobility of older people in activities of education, culture, recreation, and leisure [ 46 ]. Moreover, caregivers also acted as a proxy for older adults with cognitive impairment, providing information about health and daily activities. The researchers recognized caregivers as a source of support during data collection, contributing to a more efficient and enjoyable data collection process by helping identify older people and guiding them to data collection locations.

The research techniques proved suitable and valuable for understanding the researchers’ experiences. The records of these experiences revealed various challenges and strategies in conducting studies involving older people residing in LTCFs, considering the diversity of residents’ profiles and the institutional context. Table  5 presents a synthesis of the main challenges and the strategies employed to deal with them during the data collection process. Additionally, practical aspects have been listed as recommendations for future studies involving this population.

The main limitation of this study was to have restricted the researchers’ records to field diaries and a form with open-ended questions. Verbal manifestations during the interviews could have revealed new or different perceptions from what was recorded. However, all material obtained was analyzed. The information on the forms at the end of the data collection period had similar content to that recorded during the process but was more synthesized and systematized. Thus, these were complementary methods that demonstrated consistency in the perceptions of the researchers’ experiences.

The researchers recognized the important role played by LTCF coordinators and formal caregivers, underscoring the significance of empathetic methodologies and streamlined data collection processes in mitigating the challenges inherent to research conducted within LTCFs. The institutional context significantly influences the planning and execution of research involving older adults residing in LTCFs, particularly those with clinical-functional profiles that necessitate specific tailored approaches. Respecting older adults’ autonomy and establishing effective and respectful communication are fundamental for building trust. Recognizing the caregivers’ knowledge provides valuable understanding for the data collection process. The LTCF willingness to participate in the research reflects their commitment to advancing knowledge in the field while upholding institutional routines and residents’ well-being. Beyond methodological considerations, such as selecting appropriate variables, defining the sample, and employing valid measures, social and cultural aspects of the LTCFs can impact costs, required human resources, and the execution timeline. In conclusion, conducting studies in LTCFs demands careful planning, effective communication, and flexibility to address institutional and residents’ diverse profiles. Collaborating closely with LTCF staff and caregivers is essential for successful data collection and ultimately benefiting this vulnerable population.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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This research was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (001), Fundação de Amparo à Pesquisa do Estado de Minas Gerais (PPM-00603-18), and Conselho Nacional de Desenvolvimento Científico Tecnológico (CNPq: 310938/2022-8).

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Ramos, T.M.C., da Silva Alves, Á.A., Apolinário, T.A. et al. Challenges to conducting research on oral health with older adults living in long-term care facilities. BMC Oral Health 24 , 422 (2024). https://doi.org/10.1186/s12903-024-04204-x

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The Department emphasizes the responsibility of the dentist to see problems affecting the oral region in the context of overall health status. The department’s curriculum includes assessment of patients’ overall health status and its impact on oral health care, identifying problems affecting the teeth and supporting structures, understanding and identifying oral mucosal and salivary gland disorders, orofacial neurological and chronic pain disorders, oral manifestations of systemic diseases and dental management of patients with complex medical problems and disabilities.

CLINICAL CARE

Biopsy service.

Diagnostic Pathology Laboratory

Patient Admissions

Oral medicine / pathology.

Cone Beam Computed Tomography

Orofacial and Head Pain

Clinical management of special needs patients, oncologic dental care, predoctoral curriculum: omprm, preclinical radiology.

In this radiographic technique preclinical laboratory course, the student is scheduled to spend a total of 4 hours in learning the fundamentals associated with the discipline of dental radiography. This instructional experience is designed to provide the student with the practical skills and knowledge necessary to manage the digital radiographic computer system, and to expose digital periapical and bitewing radiographs while following the acceptable infection control and radiation health and safety protocols.

General Pathology

This course covers the molecular, cellular, tissue, and organ changes that underlie disease. The general pathology component of the course covers cellular responses to injury, cell death, immunology, inflammation, wound healing, immunopathology, developmental and genetic disorders, neoplasia and an introduction to oral precancer and environmental and radiation induced pathology. The fundamental elements of how the body reacts to disease are explored and examples are given to show the link between pathology and the oral cavity.

Introduction to Oral and Maxillofacial Radiology

The first part of this course provides the fundamental knowledge in Radiology as it relates to x-ray generation, image formation, imaging systems, radiobiology, and radiation protection. The students will be introduced to different radiographic modalities (e.g., intraoral radiographs, panoramic images, extraoral radiographs, and advanced imaging systems) as well as the radiographic anatomy of intraoral radiographs, panoramic images and cone beam CT scans. The second part of the course (i.e., after the first exam) focuses on the interpretation of radiographic imaging and radiographic appearances of common dental findings such as caries, periodontal disease, inflammatory diseases, and dental and developmental anomalies.

Body and Disease I and II

Body and Disease I and II is a course jointly run with the Department of Molecular Pathobiology. This course emphasizes basic mechanisms in systemic physiology, pathology, and therapeutics and the integration and implications for dental practice. This course is divided into vertical integrated units (VIUS) by organ system. Each VIU contains sessions for discussion giving students the unique opportunity to incorporate medicine directly into a dental context and to create a framework that they can learn to apply to their patients and beyond. The physiology component of the course presents, sequentially, key physiological concepts related to the organ systems of the body, including reference to relevant basic anatomy and histology. The systemic pathology focuses primarily on prevalence and incidence and pathogenesis (cause and effect relationships) or mechanisms of disease. These mechanisms are taught not only within an individual system (e.g., cardiac) but also between systems (e.g., cardiac and pulmonary). The course thus covers common diseases within the range of the major organ systems: cardiovascular, hematology, pulmonary, endocrine, gastrointestinal, infectious diseases, reproductive pathology, renal, skeletal, neuropathology, and common diseases of the skin. The pharmacology / therapeutics component of the course describes the mechanisms of action of principal classes of pharmacological agents, discusses the impact of pharmacokinetic parameters on the onset, duration, intensity and termination of drug action, as well as proper usage, possible interactions with other medication / factors and commonly encountered adverse effects. A special focus is placed on the indications of drugs used in dentistry, the non-dental indications for drugs most commonly used by other health providers and the impact of commonly used drugs on the dental treatment of patients. Faculty and physician guest lecturers present the most current concepts in their field. The application of pathologic principles to dental treatment, particularly of medically complex patients, is discussed, and oral manifestations related to systemic disease are included in clinical cases. There is a significant emphasis on case-based learning.

Oral and Maxillofacial Pathology and Radiology

This course provides an overview of oral pathology including the clinical, microscopic and radiographic presentation of oral diseases and pathogenesis. Soft tissue lesions including oral premalignant and malignant lesions, infectious diseases, soft tissue tumors and salivary diseases as well odontogenic cysts and tumors, non-odontogenic bone diseases and bone tumors are discussed covers with emphasis on etiology, clinical presentation and management. Diagnostic procedures and treatment of oral disease will be introduced in relationship to the clinical and radiographic presentation and pathogenesis. 

Care of the Medically Complex Patient

This course will build upon prior course knowledge that was presented in General Pathology, Body and Disease courses, as well as other basic science courses. It will focus on the clinical presentation and natural history of selected medical disorders, as well as present the scientific evidence available in how to manage and approach the selected medical disorders. The practical information needed to arrive at a medical risk assessment in order to develop management strategies in the delivery of dental care will be reviewed. The course will focus on how to obtain and interpret desired information through medical and other consultation; recognition of oral consequences / manifestations of selected medical illnesses; the relevant practical pharmacology of the management of common medical problems and its impact on oral/dental disease and therapy; drug mechanisms, interactions and adverse effects of commonly prescribed medications and how to incorporate evidence-based decisions into the dental treatment plan.

Clinical Pathologic Correlations

This course builds upon prior course knowledge that was presented in General Pathology, Body and Disease I and II, and Oral and Maxillofacial Pathology, as well as basic science courses. The course provides an integrative approach to the diagnosis and management of patients presenting with pathology of the oral soft and hard tissues. Students are expected to use foundational knowledge to develop a differential diagnosis, determine the most likely diagnosis based on patient presentation, demographics and current evidence and develop a management of the disease or disorder. The course is predominantly case based and includes written description of clinical/radiographic findings.

Orofacial Pain-Neurosensory Disorders

This course builds upon foundational knowledge of somatosensation, nociception, and the complex interaction between neural and immune systems following tissue injury. Emphasis is placed on practical concepts that illustrate how to interpret clinical manifestations of integrated somatosensory neurobiology. Neuropathic pain is extensively examined with emphasis on neuroplasticity and the origins of perception. These applied concepts of a dynamically-maintained CNS become the foundation for understanding chronic pain as well as pain that persists in the absence of tissue injury. Extensive use of cases then explores the presentation, diagnostic features and criteria, and contemporary therapeutics for selected chronic musculoskeletal, neuropathic and mixed orofacial neurosensory / pain disorders. Throughout the course the unique experience of suffering and the biopsychosocial factors that influence it are explored.

Oral Medicine, Diagnosis, and Radiology Clinic

This clinical rotation spans the third year and takes place in the Patients’ Admissions Clinic. It builds on foundation knowledge presented by courses across the department. Students will show proficiency in collecting and recording patient information to include chief complaint, vital signs, medical, dental and social histories, as well as category, side effects and interactions of medications. Reviewing these segments of the patient record, students will show competency in developing a medical risk assessment based on the patient’s oral health needs. Ability to develop an appropriate medical consult is also assessed. Proficiency in performing and recording the findings of an extraoral and intraoral examination to include variations of normal, anomalies, as well as pathology is also a part of this course skill set. Radiographic proficiencies of prescribing, acquiring and interpreting diagnostic radiographs will be demonstrated. Students will be expected to recognize and develop a simple differential diagnosis for common oral mucosal lesions or conditions.  

Senior Comprehensive Care

This course will draw upon the senior dental student's knowledge and skill across all clinical disciplines and upon her/his understanding of evidence-based and biomedical-dental-based principles, to demonstrate in a variety of interactive, clinical scenarios a capacity for comprehensive patient assessment, diagnosis, and interdisciplinary treatment planning. The course will be concentrated in the fall semester to facilitate early assessment of comprehensive care critical thinking as well as preparation for national board examination. The format will include summary and strategy sessions that also involve an interactive case session that will require consideration inside and outside the classroom. The course will concentrate on the review and practice of diagnosis criteria, radiology interpretation skills, hard and soft tissue findings, dental management of medically complex patients, pharmacology, evidence-based dentistry and critical thinking skills. An additional course section for Geriatrics is included in this course to complete the learning experience.

Oral Medicine/Diagnosis Clinic

Through this course, the student will broaden his/her diagnostic skills, the understanding of treatment of medically complex patients, and radiographic interpretation skills. Students will build on their D3 oral medicine clinical experiences in the following ways: further experience in diagnosis of new patients during the Oral Diagnosis rotation, radiographic interpretation exercises, radiographic technique skills assessments. Based on the patient's pre-existing systemic status and the dental needs, the student will implement appropriate strategies to minimize chances of systemic complications from the therapy of oral diseases and further practice the identification of relevant interaction and side effects of medications.

In this course, the student applies the knowledge and skills previously acquired in didactic and clinical courses to the management of patients with congenital, developmental and acquired disabilities, undergoing oncology treatment and with medical complexity. Students will adapt the foundational knowledge to address the dental treatment needs of these unique populations of patients and development management skills to allow for optimal and safe dental care. The student will enhance skills for developing a medical management plan based on patient’s oral health needs and if needed, write a medical consult accurately.

Oral Medicine and Orofacial Pain Clinic

Students are assigned rotations to the Oral Medicine and Orofacial Pain Clinic, where they will evaluate patients by conducting a thorough history and physical exam, review of diagnostic data, and create a differential diagnosis and a list of treatment plan options. Students will also be evaluating follow-up patients for monitoring of disease progression. Additionally, students will engage in didactic learning through case presentations and journal article reviews as well as in depth discussions on the diagnosis and management of oral mucosal diseases and orofacial pain disorders.  

Honors & Electives Programs: OMPRM

Oral & maxillofacial radiology honors program.

The honors in Oral & Maxillofacial Radiology is a one-half-day session per week throughout the academic year clinical experience in which the D3 student will gain additional training in the practice of Oral & Maxillofacial Radiology. Students will be exposed to radiographic normal anatomy and interpretation of conventional and advanced imaging systems and gain experience on interpretation of complicated radiographic findings and reading and interpreting cone beam CT scans. This course will focus on the interpretation of different types of head and neck imaging, especially cone beam CT and advanced imaging. The students will understand the technique and indications of different types of radiographs, proper and systematic evaluation of different types of radiographs and accurate description of the radiographic findings and adequate differential diagnosis and appropriate follow-up.

Oral & Maxillofacial Pathology Diagnostics Honors Program

This course allows D3 students the ability to see and learn the pathologic findings of common oral lesions. Students learn to recognize histopathologic characteristics of neoplastic, infectious and reactive lesions of the head and neck. Weekly microscopic sessions with boarded oral and maxillofacial pathologists help students correlate basic science with clinical practice. This course is especially applicable to students who have an interest in attending specialty training in oral surgery, endodontics, periodontics and oral medicine/oral pathology.

Oral Medicine and Pathology Honors Program

This program is dedicated to the diagnosis and management of patients with a wide range of oral lesions. Students will develop their diagnostic skills, learn how to manage chronic oral mucosal diseases with a number of pharmacologic therapies, take intraoral photographs and perform various diagnostic tests including mucosal biopsies. Microscope sessions provide students with the opportunity to review the microscopic appearance of the tissue they have removed by biopsy. Students will learn the process involved in presenting in a "grand rounds" format with two of their most interesting patients. This will include learning how to put together a PowerPoint presentation with digitized pictures, how to perform a Medline search, and how to critically review the scientific literature.

Orofacial Pain Elective

This clinical concentration program provides the participant with the opportunity to gain experience in the diagnosis and management of the patient with orofacial pain — including some of the most challenging disorders faced in practice resulting in great impact on the patient’s quality of life. The program includes regular and intensive "hands-on" clinical experience under the supervision of well-trained attending faculty. Participants will receive training which specifically addresses relevant craniofacial anatomy and neurophysiology as well as diagnostic classification criteria / systems and the full spectrum of medical, procedural, physical, and behavioral therapeutic modalities.

Special Patient Care Elective Program

This clinical concentration program provides the participant with the opportunity to gain experience in the diagnosis and management of patients with medical complexities and developmental, intellectual, behavioral, physical, and mental/cognitive disabilities. The program provides the student exposure to the types of patients whom they may encounter during their hospital-based general practice residency. Additionally, it will prepare students to manage and treat patients with medical issues in private practice. The program includes intensive "hands-on" clinical experience under the supervision of well-trained attending faculty along with a discussion of cases. The students will be responsible for an assigned roster of patients and will have the opportunity to provide comprehensive dental treatment throughout the academic year as their schedules allow. The students will be encouraged to engage in scholarly activity, including publications and presentations at the annual meetings of the Special Care Dentistry Association (SCDA) and American Dental Education Association (ADEA). Credit for procedures performed during the clinic sessions will be awarded toward graduation requirements.  

Patient Admissions (Suite 1A)

Faculty from the Department welcome new patients to the professional and caring environment of the Patient Admissions suite. Initial visits include a medical history/medication review and a comprehensive head and neck examination, which includes a cancer screening. X-rays will also be assessed at this visit and taken if needed.

Information for PATIENTS »

Information for students:.

Second, third- and fourth-year students will be assigned 6-10 days of rotation each year.

You will see new patients.

You will gain hands-on clinic experience in reviewing the patient’s chief concern, acquiring vitals, collecting a thorough medical history, list of medications and social history. You will receive training in how to manage medically complex patients and request consultation from other health professionals.  Additionally, you will acquire skills in performing a comprehensive extra-oral and intra-oral exam, assess findings and determine the need for referral.  Imaging skills will include prescribing, acquiring and interpreting radiographs. 

There are usually 14-18 dental students in the clinic with 3 – 5 faculty per session.

Approximately 32 – 36 patients are seen in the Admissions Clinic every day.

Oral Medicine/Pathology

Mondays & Wednesdays 345 E. 24th Street, Suite 2S, New York, NY 10010

Phone: (212) 998-9743 Fax: (212) 995-4767

We provide care to patients with a range of complaints including, but not limited to:

  • abnormal swellings involving the head and neck (jaw/oral region),
  • oral sores or lumps and bumps inside the mouth,
  • severe dry or burning mouth or other neurosensory disorders, and
  • abnormal/pathological x-ray findings unrelated to common dental issues.

After a complete history and oral exam, we use imaging, perform tissue biopsies and other chairside diagnostics, and manage a wide range of patients with oral mucosal diseases, salivary gland disorders and other diseases affecting the jaws and oral structures. Our faculty are trained in the specialties of Oral Medicine or Oral and Maxillofacial Pathology.

The rotation is four consecutive days, Monday though Thursday, from 9:00 am to 6:00 pm. You will be in the Oral Medicine clinic for two days and the Orofacial Pain clinic for two days.

You will see patients with various types of pathologies that you learned about in your didactic courses.

You will work on patients hands-on and learn to take a good medical history, perform a comprehensive extra-oral and intra-oral exam, make an appropriate clinical or differential diagnosis, write prescriptions, and learn to perform soft tissue biopsies.

There are usually eight senior dental students in the clinic with two faculty per session.

Approximately 15 to 20 patients are seen in the Oral Medicine clinic per day on Monday or Wednesday.

Information for Faculty:

Please fill out an internal referral form for oral medicine. Then the student or resident can bring the patient or the patient can come straight to the oral medicine clinic (1A) and schedule an appointment directly with the patient service representative.

Certainly. Please either call (212) 998-9743 to make an appointment, visit the clinic on the first floor, or e-mail one of the oral medicine faculty.

Yes, you are always welcome to participate in the care of your family member.

There are usually 8–9 senior dental students per weekly rotation.

Cone Beam Computed Tomography (CBCT)

Schedule an appointment for CBCT: Cone Beam CT Imaging Service 345 E. 24th Street, Suite 1A, New York, NY 10010 Phone: (212) 998-9430 Fax: (212) 443-1347

Complete a Cone Beam CT Prescription »

Fully digitized radiology service provides intraoral, panoramic, and 3D imaging (cone-beam computed tomography) to patients of NYU Dentistry and those referred from outside providers. There are four (4) cone beam CT scan machines. Faculty from the Department of Oral & Maxillofacial Pathology, Radiology and Medicine also provide radiographic interpretation and radiographic consults on different types of radiographs.

The Office of Academic Affairs sends an email regarding the honors courses, including eligibility criteria, in the spring semester. After submitting your application, you will be invited for an interview and later notified if you are selected. Currently, two students per year are accepted.

The course will help to improve radiographic interpretation skills and knowledge of the technical aspects of cone beam computed tomography. This is very beneficial for students interested in a number of specialty residencies, including Oral and Maxillofacial Radiology, Oral and Maxillofacial Surgery, Periodontics, Endodontics, and Prosthodontics.

Orofacial & Head Pain

Tuesdays & Thursdays 345 E. 24th Street, Suite 2S, New York, NY 10010 Phone: (212) 998-9743 Fax: (212) 995-4767  

The Orofacial and Head Pain clinic provides highly specialized diagnostic and treatment modalities for complex orofacial pain disorders. A large number of acute and chronic pain disorders are treated, including but not limited to:

  • temporomandibular disorders (TMD, TMJ),
  • musculoskeletal disorders,
  • neuropathic (nerve) disorders such as trigeminal neuralgia and post-traumatic neuropathies,
  • movement disorders (dystonia), and
  • sleep apnea.

Our specialty trained and board certified clinical faculty bring the highest level of multimodal treatment, care and pain relief for individuals dealing with these diagnoses.

Information for PATIENTS   »  

Requirements and responsibilities are outlined by your course director and will be emailed to you.

Yes, patient consult and follow-up visits will be conducted by students along with attending guidance.

Apply for the Orofacial Pain Elective in your D3 year.

Complete the in-house referral form in Axium, and then give your patient instructions to call 212-998-9743 to make an appointment.

Every effort is made to reply to the in-house referral form in Axium. You may also call the clinic directly and ask to speak to an attending.

Yes, you may call the clinic to reach any of our orofacial pain faculty to discuss a patient.

Under the supervision of experienced faculty, fourth-year dental students attend to the dental needs of individuals with disabilities at the NYU Dentistry Oral Health Center for People with Disabilities . Among the patients presenting to the Center are individuals with intellectual, developmental, physical, mental, cognitive, and behavioral impairments along with patient undergoing complex medical therapy like transplants and oncologic care who require dental clearance before their treatment.

There are four full-time licensed dental assistants that assist with treatment throughout the day. In addition, all third-year students assigned to a concurrent 3-week rotation play a role in the assistance of care.

Yes, students have the opportunity to provide all dental treatment. Oral surgery, prosthodontics, endodontics, and restorative dentistry are just some of the many realms of procedure we do within the program. We complete all procedures within the scope of general dentistry.

Patients with all types of mental and physical disabilities and medically complex patients are seen in the program.

The facility provides several accommodations for patients: The rooms are larger than typical operatories and have soothing, adjustable, multi-colored lighting to help create a relaxing environment; one room accommodates the treatment of bariatric patients; a wheelchair tilt is affords patients the ability to receive care without transferring out of their wheelchair; the multisensory room is designed to accommodate patients who require sensory modulation.

Yes, once a medical and dental assessment of the patient's needs have been completed, options for sedation (ranging from mild to deep sedation) are considered.

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Faculty of Dental Medicine and Oral Health Sciences 2024 Research Day

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The 2024 Research Day will take place on April 24, 2024, at Centre Mont Royal, 2200 Mansfield. 

For more information: www.mcgill.ca/dentistry/research-and-graduate-students/events/research-day

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Oral Health in America - November 2022 Bulletin

Section 5 summary, pain, mental health, substance use, and oral health.

A word cloud highlighting pain, mental illness, and substance abuse and how they impact oral health.

Section 5 of the oral health report reflects a growing understanding of the relationship between pain, mental health concerns, substance use, and oral health.

Pain can signal the presence of mental or physical (including dental) problems, or a combination of these, and may occur as a consequence of correcting or treating those problems. Managing orofacial pain is a common responsibility of oral healthcare providers, and understanding pain is essential for caring for patients with both mental illness and substance use disorders.

Substance use disorders that occur alongside mental illnesses are also much more common than previously assumed. Of the 19.3 million Americans with substance use disorders, nearly half also had a distinct mental illness. There is extensive evidence of a strong association between psychiatric disorders and poor oral health; people with severe mental illness have particularly high rates of periodontal disease and tooth decay, often as a consequence of their medications and potential challenges for self-care.

Status of Knowledge, Practice, and Perspectives

In 2016, an estimated 20% of U.S. adults experienced chronic pain, and about 8% had high-impact chronic pain. The prevalence of chronic orofacial pain is not as well documented, but a 2016 prospective study reported an annual incidence of nearly 4%. The high prevalence of pain in the population poses a major societal burden, indicating a need to better understand the impact of pain and its biological mechanisms.

Better understanding of the problem can also alter prescribing practices of dentists and other medical professionals. Eighty percent of the world’s prescription opioid analgesics are consumed in the United States. Since opioids suppress pain, people using these drugs can miss the warning signs of tooth decay and progression to abscess. In 2011-2016 opioid use was associated with a higher number of missing teeth, with 26.3% of long-term opioid users missing 20 or more teeth. Beyond their indirect effect on oral health, opioids also directly impact oral health by reducing salivary flow.

Advances and Challenges

Because so many addictions—especially opioid addictions—begin with the experience of pain, researchers have focused their efforts on elucidating the underpinnings of chronic pain and distress. Understanding the mechanisms involved in pain development has led to the creation of more effective modes of treatment. Additionally, more attention has been placed on dental prescribing practices, particularly after third molar (wisdom tooth) extraction, which is frequently a first-time exposure to opioids for younger patients. Major interventions to curtail opioid prescribing are ongoing, and recognition of the equivalent or superior performance of alternative pain medications is growing. People with mental or substance use disorders are often stigmatized or marginalized, and health care providers—including dentists—are not immune to social biases shared by the public at large. Patients are more likely to return if they feel their providers are kind, caring, patient, gentle, helpful, and fair. Stigma around a patient’s mental or substance use disorder can hinder the development of clinical relationships that are important to optimal care.

Promising New Directions

Recent research has increased our understanding of the neurobiological mechanisms that link mental illness and substance use. Substance use disorders are now understood as a form of mental illness, and three major hypotheses have been developed to explain the comorbidity of substance use and other mental illnesses. Researchers are working to determine whether substance use alleviates symptoms of mental illness or leads to changes in the brain that promote mental illness, or whether both mental illness and substance misuse share neurobiological mechanisms that increase vulnerability.

Scientists are also exploring the role of the oral microbiome in the interplay of substance use, mental health, and oral disease. The degree to which smoking and other substance use impacts the composition of microbial communities in the oral cavity is emerging as a particularly significant area of research. Microorganisms do not stay in the oral cavity but can translocate to other parts of the body, causing infection and inflammations at non-oral sites. Oral bacteria in non-oral sites have been linked to conditions like atherosclerosis, Alzheimer’s disease, and rheumatoid arthritis and more work is being done to determine what relationship the oral microbiome might have with these conditions.

Additional Takeaways

Taken together, substance use disorders and mental illness are common, recurrent, and treatable. However, these conditions can directly worsen oral health, alternatively, medications used to treat these conditions can have adverse side-effects on a patient’s oral health. Overcoming these challenges will require greater integration of mental, oral, and general healthcare. In particular, dental professionals must acquire new competencies related to the behavioral health aspects of substance use and mental illness to provide optimal care including disease prevention and appropriate referrals for patients with substance use disorders and mental health problems.

Q&A With Senior Editor

Q&A with Section Editor

Q&A with Christian S. Stohler, DMD, DrMedDent, senior editor Section 5: Pain, Mental Illness, Substance Use, and Oral Health.

What are some important takeaways about this section? Complex clinical presentations call for collaborative practice of medical, behavioral, and dental health care providers.

Section V represents the first report issued by the U.S. oral health community and NIDCR about the comorbidity of oral health, pain, and behavioral health and substance use conditions. It zeroes in on a blind spot of the dental profession, focusing on a subject that intersects with the U.S. opioid crisis.

Without even considering their interrelationship, oral disease, pain, and behavioral and substance use conditions all remain undertreated in vulnerable populations. The healthcare environment within which these health conditions are addressed is highly fragmented. Given that oral disease, pain, and behavioral and substance use conditions feed on each other, novel programs are called for that offer an overarching perspective for the millions of impacted Americans to improve their physical and mental well-being and employability. The magnitude of the problem has reached a level of gravity that puts the effectiveness of current care practices into question.

Major investments in the workforce and technology are needed in support of interprofessional collaborative practice. Moving from a fragmented system of care to an environment that offers coordination between medical, mental, and dental care delivery necessitates a patient-centered and accountable patient management platform.

What was a surprising finding? Oral health, pain, and behavioral health and substance use conditions represent a blind spot for the dental profession.

It is surprising how much is known about the prevalence of mental health and substance use among the U.S. population, including the special vulnerability of adolescents with respect to mental health and substance use. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 55.1 million U.S. adults were impacted by mental illness in 2019; 19.3 million U.S. adults had a substance use disorder (SUD). Of those with SUD, 9.5 million adults also had a mental health condition. These disease demographics emphasize the current environment within which oral health services are currently administered.

Another area of concern is opioid prescriptions for adolescents. Because alveolar and orthognathic surgeries are common among adolescents, dental professionals have an obligation to responsibly manage postoperative pain without inflicting harm. The assumption that opioids are the most effective postoperative pain medications is wrong; combinations of ibuprofen and acetaminophen should be considered as the first choice of treatment. Regarding risk, persons with depressive preoccupation are more likely to extend use of opioid prescriptions after wisdom tooth removal than those without depression. Given the vulnerability of the human brain between the ages of 18-25 years, published data make it difficult to justify the prescription of opioids to adolescent patients following dental and maxillofacial surgeries.

What should the American people know about this section of the report? Mental health and substance use conditions as well as persistent pain are associated with above average levels of compromised oral health.

With multimorbidity on the rise in the U.S., the working interface between the oral health community and the healthcare community needs to be defined in operational terms.

Insufficient attention is given to the oral health of individuals with mental illness, substance use conditions and persistent pain. The fact that persons with these conditions are stigmatized, marginalized, and often poor make matters worse. Public opinion regarding persons with mental illness, substance use conditions, and persistent pain have not changed much in the past two decades.

Focusing on oral health, psychotropic medications as well as licit and illicit drugs contribute to oral health issues, including dental caries, periodontal disease, oral abscesses, mucosal dysplasia, xerostomia, and tooth wear. Eating disorders are associated with tooth erosions and decay. Compromised personal hygiene, notably inadequate oral hygiene, is common among persons with mental health and substance use disorders. Broad awareness of these relationships will accelerate the integration of the oral needs of those patients.

What is the main call to action? Improving the lives of people with mental health, addictive disorders and persistent pain by addressing their oral health needs.

Integrating care for mental illness, addictive disorders, and conditions of persistent pain within the U.S. health system remains a challenge. For such integration to occur, oral healthcare professionals must acquire competencies in interprofessional practice. Recent additions to U.S. Dental Accreditation Standards, calling for dental students’ training in interprofessional practice are expected to develop a dental workforce capable of navigating across the “medical-mental-dental” divide. Dental practitioners’ attitudes toward people with persistent pain, mental illness and substance use disorders can be stigmatizing, necessitating changes in dental education and practice.

Christian S. Stohler

Christian S. Stohler, DMD, DrMedDent, is the Dean of the Columbia University College of Dental Medicine. He received his DMD and DrMedDent degrees from the University of Bern, Switzerland, where he also received certificates in oral surgery and prosthodontics. He is an expert on pain management and jaw disorders.

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Peer Reviewed

The oral health in america report: a public health research perspective, jane a. weintraub.

1 University of North Carolina at Chapel Hill Adams School of Dentistry and Gillings School of Global Public Health, Chapel Hill, North Carolina

Introduction

In December 2021, the National Institutes of Health, National Institute of Dental and Craniofacial Research, released its landmark 790-page report, Oral Health in America: Advances and Challenges ( 1 ). This is the first publication of its kind since the agency’s first Oral Health in America: A Report of the Surgeon General described the silent epidemic of oral diseases in 2000 ( 2 ). This new, in-depth report, an outstanding resource, had more than 400 expert contributors. Its broad scope is exemplified by its 6 sections ( Box ), each of which includes 4 chapters: 1) Status of Knowledge, Practice, and Perspectives; 2) Advances and Challenges; 3) Promising New Directions; and 4) Summary. In this essay, I provide a public health research perspective for viewing the report, identify some advances and gaps in our knowledge, and raise research questions for future consideration.

Section Titles, Oral Health in America: Advances and Challenges ( 1 )

1. Effect of Oral Health on the Community, Overall Well-Being, and the Economy

2A. Oral Health Across the Lifespan: Children

2B. Oral Health Across the Lifespan: Adolescents

3A. Oral Health Across the Lifespan: Working-Age Adults

3B. Oral Health Across the Lifespan: Older Adults

4. Oral Health Workforce, Education, Practice, and Integration

5. Pain, Mental Illness, Substance Use, and Oral Health

6. Emerging Science and Promising Technologies to Transform Oral Health

Data Needed

A recurring theme in the report is the need for many types of data, from microdata — the molecular, nanoparticle level — to macrodata — the population and global level. Data are needed to guide public health policies and programs at the federal, state, and local levels. Future research using big data from multiple sources (eg, community health needs assessments, surveillance systems, GIS mapping, electronic health records, practice-based research networks) will provide timely, population-based information to evaluate and drive changes to policy and delivery systems and oral health advocacy efforts.

This new report includes descriptive national data from 3 cycles of the National Health and Nutrition Examination Survey (NHANES). To continue monitoring national oral health surveillance data and trends, oral health data need to be included routinely in NHANES and in other large national studies. Too often, questions about oral health are missing from surveys, or clinical oral health data are not collected. For example, very little about oral health was included as part of the planned data collection protocol for the National Institutes of Health All of Us Research Program. This program aims to collect health information from 1 million people ( 3 ). Local and state data are often outdated, incomplete, or unavailable. Most oral health data are cross-sectional and are useful for studying trends and associations, but population-based longitudinal data to study causality and the effectiveness of interventions and policies are sparse.

How does oral health care improve other health conditions? Proprietary claims data from insurance companies ( 4 ) show the inter-relationship between treatment of periodontal disease and systemic conditions, but secondary data analysis has many limitations and confounding factors. Clinical trials show that periodontal treatment improves glycemic control among people with diabetes ( 5 ), but long-term outcome assessments are lacking. We need more answers to convince policy makers and payers about the importance of including comprehensive adult oral health services in publicly financed programs such as Medicaid, which is currently lacking in many states, and Medicare, where those services are missing altogether.

Health Disparities and Social Determinants of Health

Many examples of substantial oral health disparities and inequities are presented in Section 1 of the report. For some conditions and population groups, little improvement has been made, especially among adults and seniors. Section 1 also describes the adverse social, economic, and national security effects of poor oral health, barriers to care, social and commercial determinants of oral health, and related common risk factors. More than the clinical data collected in a typical dental history is needed to understand social determinants and employ local and upstream interventions. The report suggests obtaining social histories from patients to get information about where people live, learn, work, and play. For example, to learn about socioeconomic status, diet, and medications, we want to know not only “What’s in your wallet,” (as touted in a frequent television advertisement) but what’s in your refrigerator? What’s in your medicine cabinet? Telehealth has given clinicians a look inside patients’ homes. Collaboration with social workers, home health aides, and visiting nurses could inform us even more about the home environment. With integrated electronic medical and dental patient records, oral health professionals and medical colleagues can share information. Barriers to integration and assessment of population health outcomes affect many dentists who still use paper records or software specific to dental care that lacks diagnostic codes and interoperability with other health care records systems ( 6 ).

The report highlights the need for more information about adolescents and older adults and other understudied population groups. Section 1 describes many diverse, vulnerable populations (eg, people with special health care needs, low health literacy, mental illness, substance abuse disorders; victims of structural racism) who all need to be included in oral health research. Non-English speakers and hard-to-reach populations that have physical and/or financial barriers to traditional dental care are less likely to be recruited and represented in clinical trials, making results less generalizable and interventions less applicable. The applied research agenda being developed by the American Association of Public Health Dentistry ( 7 ) and the “Consensus Statement on Future Directions for the Behavioral and Social Sciences in Oral Health,” which is based on an international summit ( 8 ), are helpful in setting research and methodologic priorities, including qualitative, implementation, and health systems research.

Individual and Community Relationships

Knowledge about the interrelationships between oral and systemic health has greatly expanded since the 2000 report. About 60 adverse health conditions have now been shown to be associated with oral health ( 1 ), which is part of the rationale for the integration of oral health and primary care. Research will advance our understanding of the mechanisms by which oral and systemic conditions are affected by upstream environmental and social factors, epigenetic factors, and the aging process, both individually and communally. For example, how do external exposures change our microbiomes? Our oral microbiome may be exposed to air containing Sars-CoV-2, water containing protective fluoride, or many kinds of food, beverages, medications, illicit substances, smoked products, and sometimes the biome of close personal contacts. How does the health of a community’s high caries risk groups change with policies such as a tax on sugar-sweetened beverages, Medicaid reimbursement changes, or health promotion efforts to improve oral health literacy and dietary behaviors? To what extent will increased application of value-based health care reimbursement with emphasis on disease prevention, early detection, and minimally invasive care improve oral health? Will the World Health Organization’s addition of dental products (eg, fluoride toothpaste, low-cost silver diamine fluoride, glass ionomer cement) to its Model List of Essential Medicines ( 9 ) increase their use to prevent and treat dental caries for under-resourced populations without access to conventional high-cost dental care?

Scientific Advances and Equitable Distribution

The report’s Section 6 describes many exciting advances in biology, biomimetic dental materials, and technology. Rapid advances in salivary diagnostics are providing information about early, abnormal changes in remote organ systems in the body. Advanced imaging techniques and artificial intelligence can be used for early diagnosis of oral lesions before they are visible to the human eye. The validity and accuracy of these techniques need careful evaluation. Can these earlier clinical end points be used to shorten the length of expensive clinical trials? Guide new preventive strategies? At what point do providers intervene with early preventive or therapeutic strategies instead of letting the body heal itself?

Will populations at greatest risk for disease and the greatest barriers to accessing dental care be able to benefit from early intervention? Every intervention has a cost. If access to new prevention and therapeutic discoveries is not equitable, will health disparities worsen? We need community engagement in the research process and the tools from many disciplines to measure and facilitate the best outcomes. The national Oral Health Progress and Equity Network’s blueprint for improving oral health for all includes 5 levers to advance oral health equity: “amplify consumer voices, advance oral health policy, integrate dental and medical [care], emphasize prevention and bring care to the people” ( 10 ).

Educational Opportunities

Who will analyze all these data mined from many micro and macro sources, and who will interpret the data? Health learning systems and complex software algorithms are being developed to provide automated diagnostic information. Data analysts with knowledge of these and other sophisticated tools and modeling approaches are needed.

The dental, oral, and craniofacial research and practice communities increasingly need to be part of interdisciplinary research and educational programs with opportunities for collaboration and learning. Federally qualified health centers and look-alikes are good sites for medical–dental integration, but many of these facilities do not provide dental care.

More positions are needed for dental public health specialists who can lead advocacy efforts, interdisciplinary teams of researchers, clinicians, and community partners and conduct research. For example, the new Dental Public Health Research Fellowship at the National Institute of Dental and Craniofacial Research will provide more intensive research training to further advance dental public health and population-based research. Mechanisms are needed to promote, facilitate, and reward sharing of research and training resources across disciplines in our competitive environment.

Public health perspectives are an important part of interdisciplinary approaches to guide, conduct, and apply research and implement policies to improve oral health. Preventive approaches exist as do barriers to their dissemination and implementation. To prevent disease and improve population oral and overall health, systems change and policy reform are needed along with scientific advances across the research spectrum, more population-level data and analysis, and community participatory engagement. I am optimistic that the next Oral Health in America report will describe fewer inequities and more progress toward oral health for all.

Acknowledgments

This article is based on a presentation made in the webinar, Oral Health in America — Advances and Challenges: Reading the Report through a Research Lens , sponsored by the American Association for Dental, Oral, and Craniofacial Research. The author received no financial support for this work and has no conflicts of interest to declare. The statements made are those of the author. No copyrighted materials were used in this article.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.

Suggested citation for this article: Weintraub JA. The Oral Health in America Report: A Public Health Research Perspective. Prev Chronic Dis 2022;19:220067. DOI: https://doi.org/10.5888/pcd19.220067 .

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Michigan Minds Podcast: The Interrelation of Dental Hygiene and Medical Care

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Romesh Nalliah, PhD , joins Michigan Minds to discuss his research on the impact oral care has on serious heart conditions, indicating how closely related medical and dental health are. Nalliah is a Clinical Professor of Dentistry and the Associate Dean for Patient Services at the U-M School of Dentistry. In recognition of Dental Hygiene Month, Nalliah outlines the importance of including dental care in routine medical care and explains why dentists should be notified of family dental history.

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dental research and oral health

Oral health behaviors associated with mental health disorders

A study that examined oral hygiene self-care behavior among patients with self-reported mental health disorders was presented at the 102nd General Session of the IADR , which was held in conjunction with the 53rd Annual Meeting of the American Association for Dental, Oral, and Craniofacial Research and the 48th Annual Meeting of the Canadian Association for Dental Research, on March 13-16, 2024, in New Orleans, LA, U.S..

The abstract, "Oral Health Behaviors Associated with Mental Health Disorders," was presented during the "Oral Health and Systemic Conditions" Oral Session that took place on Thursday, March 14, 2024, at 2 p.m. Central Standard Time (UTC-6).

The study, by Gracie Groth of the Arizona School of Dentistry and Oral Health, Mesa, U.S., reviewed electronic dental records for patients treated in an academic advanced care dental clinic between 2018 and 2021 to identify the presence of self-reported anxiety, dental anxiety, depression, bipolar disorder, PTSD, and oral hygiene self-care behaviors (OHB).

Specific OHB included self-reported frequency of daily toothbrushing (TB), interdental cleaning (ID), use of fluoride toothpaste (FTP) and mouthwash (MW), and recommended preventive recare interval and frequency of returning for recare visits within a 2-year period.

Descriptive statistics, Mann-Whitney U, and Wilcoxon rank-sum tests were used for data analysis. ATSU Mesa IRB #2023-136 Exempt. 854 charts were reviewed, with 250 records identified with self-reported MHD.

Age of included patients ranged from 18 to 95 years, with mean age = 53.82 ±18.943. Most were females (n=145, 58.2%). Anxiety was the most common MHD (n=156, 62.4%), followed by depression (n=154, 61.6%), dental anxiety (n=64, 25.6%), bipolar disorder (n=37, 14.8%), and PTSD (n=22, 8.8%).

There were no significant differences in OHB, recare intervals or frequency of recare visits by MHDs. Most did not use ID (n=152, 60.8%) or MW (n=183, 73.2%). A Mann-Whitney U test showed there was a statistically significant difference between men and women for TB (W=11546.000, p=0.004) and FTP (W=11599.000, p=0.007), with women showing greater frequency of use.

The mean recommended recare interval was 5 months, with < 2 attended recare visits reported by sex and all types of MHD. Frequency of performing OHB, except for daily brushing with fluoride toothpaste, and returning for recare at recommended intervals was low for patients with self-reported MHD.

Provided by International Association for Dental, Oral, and Craniofacial Research

Credit: CC0 Public Domain

[On the anniversary of the Moscow City Research-and-Practical Center for Tuberculosis Control, Department of Health Care of the city of Moscow]

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Personal name as subject

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