Introduction: Emerging studies on the links between suboptimal oral health and multimorbidity (MM), or the co-existence of multiple chronic conditions, have raised controversy as to whether enhancing access to dental care may mitigate MM in those with suboptimal oral health. In this study, we aim to assess the extent of the association between suboptimal oral health and MM and whether access to dental care can modify this association. Methods: We conducted a cross-sectional analysis using data from the Canadian Longitudinal Study on Aging (CLSA) (N = 44,815, 45 to 84 y old). Edentulism, self-reported oral health (SROH), and other oral health problems (e.g., toothache, bleeding gums) were used as indicators of suboptimal oral health. MM was defined according to the Public Health Agency of Canada as having 2 or more of the following chronic conditions: cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. For robustness, we also used a cutoff of having 3 or more of these chronic conditions. Variables for access to dental care included (1) dental visits within the past year, (2) availability of dental insurance, and (3) cost barriers to dental care. We constructed robust Poisson regression models to estimate the association between suboptimal oral health and MM and then assessed the effect measure modification by indicators of access to dental care on a multiplicative scale. We also calculated the relative excess risk due to interaction for prevalence ratio (PR) on an additive scale. Results: Indicators of suboptimal oral health were significantly associated with MM (edentulism PR 1.17, 95% confidence interval [CI] 1.08, 1.27; poor SROH PR 1.44, 95% CI 1.33, 1.54; other oral health problems PR 1.52, 95% CI 1.44, 1.78). The magnitude of this association was higher in individuals who reported fewer dental visits within the past year, lacked dental insurance, and avoided dental care due to costs. Conclusion: The association between suboptimal oral health and MM may be exacerbated by barriers to accessing dental care. Policies aiming to enhance access to dental care may help mitigate MM in middle-aged and older Canadians with suboptimal oral health. Knowledge Transfer Statement: This study offers insights into the connection among suboptimal oral health, multimorbidity, and access to dental care factors in middle-aged and older Canadians. The findings can be of value for clinicians and policy makers aiming to enhance medical-dental integration and improve accessibility to dental care and to patients seeking information about the connections between oral health and chronic conditions. Implementation has the potential to enhance individual well-being and drive systemic improvements in health care.

To map and synthesise current evidence on how lifelong biological, environmental, and social exposures, collectively conceptualised as the exposome, interact with the human oral microbiome to influence oral disease development and progression within a One Health framework. A scoping review was conducted to identify peer-reviewed studies published in English that examined the relationships between the exposome and the human oral microbiome. The review followed the Arksey and O'Malley framework, applying its five-stage methodological approach. Comprehensive searches were performed in MEDLINE, Embase, PsycInfo, Scopus, Web of Science, and CINAHL. Study quality was assessed using the Joanna Briggs Institute (JBI) tools, and results were reported in accordance with PRISMA-ScR guidelines. A total of twenty-nine studies were included in this review. These showed that health status, non-communicable diseases, medication use, and psychosocial factors influence the biodiversity, abundance, and function of the human oral microbiome. Other studies suggested that animal interactions and physical and chemical exposures can alter host-microbiome interactions, as well as microbial community dynamics within the oral cavity. While the studies reviewed used reliable methods and standardized protocols, they were of moderate quality due to small sample sizes, potential reverse causality, and limited control for confounding and multiple testing. This review highlights the complexity of the human oral microbiome and its interactions with the various components of the exposome, emphasizing the focus on disease impact and health behaviours, while noting a gap in research on non-bacterial communities, interaction mechanisms, and long-term effects on dysbiosis.

Objetivos: El objetivo fue evaluar la asociación entre las dinámicas individuales del entorno familiar y la experiencia de caries de aparición temprana (CAT), así como determinar si estas asociaciones varían según el grado de afectación del tejido dental. Materiales y métodos: Se analizaron datos de 210 niños de 3 a 5 años en Callao, Perú, a partir de cuestionarios y exámenes dentales. Las dinámicas familiares evaluadas incluyeron la propiedad de la vivienda, la convivencia parental, la estructura familiar y el tamaño de la familia. La experiencia de CAT se evaluó mediante el examen clínico de los dientes primarios cariados, obturados o ausentes, diferenciando las lesiones cavitadas y no cavitadas. Las covariables fueron demográficas, socioeconómicas, conductas de salud y acceso a los servicios odontológicos. Para el análisis, utilizamos modelos de regresión multivariable por bloques, estimando cocientes de prevalencia e intervalos de confianza al 95%, y reportamos nuestros hallazgos de acuerdo con las directrices STROBE. Resultados: Los modelos totalmente ajustados indicaron que la prevalencia de experiencia de CAT fue mayor en niños que residían en viviendas alquiladas (RP 1,29; IC 95% 1,17; 1,41), en hogares monoparentales (RP 1,75; IC 95% 1,61; 1,91), en familias extensas además de la familia nuclear (RP 1,19; IC 95% 1,08; 1,29) y en aquellos que compartían el hogar con al menos cuatro miembros adicionales (RP 1,05; IC 95% 0,94; 1,14). El análisis de subgrupos de acuerdo con el grado de afectación del tejido dental mostró que la estructura familiar y el tamaño del hogar estaban significativamente asociados con lesiones no cavitadas, mientras que la asociación con lesiones cavitadas fue más pronunciada en relación con la convivencia parental, después de ajustar por todas las covariables. Conclusiones: Los indicadores relacionados con las dinámicas individuales del entorno familiar están asociados con la experiencia de caries de aparición temprana (CAT) en niños pequeños en el Perú. Sin embargo, se requieren análisis adicionales para comprender plenamente los mecanismos subyacentes y otros determinantes que contribuyen al desarrollo de la caries en esta población de estudio.

To assess the effectiveness of an intervention on caregivers' assisted toothbrushing techniques and oral health maintenance for preschool-aged children, and to determine whether these effects differ by age. A single group pre/post intervention study was conducted among children aged 3-5 years and their caregivers in Callao, Peru. Eligible caregivers were trained on assisted toothbrushing using large and real-scale typodonts, along with practical demonstrations by a dentist. Additionally, they were instructed on healthy practices and oral health in children. Children's oral hygiene status (OHS) was assessed using the Simplified Oral Hygiene Index (OHI-S) at baseline and three months postintervention. To assess the effectiveness and quantify the magnitude of the difference between the OHI-S before and after the intervention, we used Wilcoxon signed-rank test and the Cliff's Delta test, respectively. Results were stratified by age group to examine potential differences. The sample (n = 210) predominantly comprised 3-year-old Peruvian females, primarily cared for by their mothers, who identified as single mothers who had not previously received instruction in oral hygiene practices. We found improvement in children's OHI-S in most age groups. Specifically, among 3-year-olds, the OHI-S score improved significantly from 'fair' (m = 2.6, ± 0.2, range 2.4-2.8) to 'good' (m = 1.1, ± 0.2, range 0.9-1.3). The intervention showed a moderate effect size (δ = -0.15, 95% CI -0.18, -0.10) in the 3-year-olds and a moderate effect size (δ = -0.05, 95% CI -0.08, -0.01) in the 4-year-olds. No significant improvements were observed in the 5-year-old group. A caregiver-focused intervention significantly improved OHS among preschool-aged children, particularly in younger age groups. Substantial improvements in OHI-S scores were noted for 3- and 4-year-olds, while age-specific factors may have limited efficacy in the 5-year-old group. These findings highlight the importance of early, targeted oral health education for caregivers.

INTRODUCTION: Emerging research on the links between sub-optimal oral health and multimorbidity (MM), or the co-existence of multiple chronic conditions, has raised queries on whether enhancing access to dental care may mitigate the MM burden, especially in older age. Here, we aim to assess the association between sub-optimal oral health and MM and whether access to dental care can mitigate the risk of MM in individuals with sub-optimal oral health. METHODS: We conducted a cross-sectional analysis using data from the Canadian Longitudinal Study on Aging (CLSA) (n=44,815, 45-84 years old). Edentulism, self-reported oral health (SROH), and other oral health problems (e.g., toothache, bleeding gums), were each used as indicators of sub-optimal oral health. MM was defined according to the Public Health Agency of Canada as having 2 or more chronic conditions out of cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. Variables for access to dental care included the number of dental visits within the last year, dental insurance status, and cost barriers to dental care. We constructed multivariable step-wise logistic regression models and interaction terms with 95% confidence intervals and estimated prevalence ratio (PR) to assess the associations of interest, adjusting for a priori determined sociodemographic and behavioural factors. RESULTS: Each of the sub-optimal oral health indicators were significantly associated with MM (edentulism PR=1.48, 95%CI 1.31, 1.68; poor SROH PR=1.81, 95%CI 1.62, 2.01; other oral health problems PR = 1.91, 95%CI 1.78, 2.06). The magnitude of this association was exacerbated in individuals who lacked dental insurance, could not afford dental care, and those who reported fewer dental visits within the last year. CONCLUSION: The association between sub-optimal oral health and MM may be exacerbated by the lack of access to dental care. Policies aiming to enhance access to dental care may help mitigate the risk of MM.