The etiology of dental caries reflects a complex interplay of biochemical, microbial, genetic, social and physical environmental, and health-influencing behavioral factors. This review updates the literature on the efficacy of behavioral approaches to caries prevention for children up to 18 y of age. Included were studies of behavioral interventions implemented at individual, family, and community levels that assessed results in terms of reductions in caries increments. Only those reports published since 2011 were considered. Outcomes were variable, although motivational interviewing, which involves individuals in decisions about oral health within the context of their respective life circumstances, proved effective in 3 of 4 reported studies, and more definitive trials are underway. Recommendations for future research include examinations of the cost-effectiveness of interventions, as well as work focused on understanding the mechanisms underlying oral health behavior change and variables that may mediate or moderate responses to interventions.

We describe development of the Early Childhood Caries (ECC) Basic Research Factors Questionnaire (BRFQ), a battery of measures assessing common potential predictors, mediators, and moderators of ECC. Individual-, family-, and community-level factors that are linked to oral health outcomes across at-risk populations are included. Developing standard measures of factors implicated in ECC has the potential to enhance our ability to understand mechanisms underlying successful prevention and to develop more effective interventions. The Early Childhood Caries Collaborating Centers (EC4), funded by National Institute of Dental and Craniofacial Research, developed the BRFQ, which was used across four randomized trials to develop and test interventions for reducing ECC in at-risk populations. Forty-five investigators from across the centers and NIDCR were involved in the development process. Eight “measures working groups” identified relevant constructs and effective measurement approaches, which were then categorized as “essential” or “optional” common data elements (CDEs) for the EC4 projects. Essential CDEs include 88 items, with an additional 177 measures categorized as optional CDEs. Essential CDEs fell under the following domains: oral health knowledge, oral health behavior, utilization/insurance and cost, parent/caregiver dental self-efficacy, quality of life, caregiver and family characteristics, and child characteristics. The BRFQ makes available a battery of measures that support efforts to understand population risk factors for ECC and to compare oral health outcomes across populations at risk. The BRFQ development process may be useful to other clinical research networks and consortia developing CDEs in other health research fields. All the trial that used the BRFQ were registered at Clinicaltrial.gov NCT01116726 , April 29, 2010; NCT01116739 , May 3, 2010; NCT01129440 , May 21, 2010; and NCT01205971 , September 19, 2010.

Background: By midcentury, the US population will be remarkably more racially and ethnically diverse, with a dramatic increase in the proportion of older adults. This report addresses ongoing oral health disparities and inequitable access to care related to these changes, with emphasis on implications for the workforce, taking note of effects of the COVID-19 pandemic. Relevant Considerations: Considering that social determinants shape health behaviors, reflection on the most effective type of dental workforce should take into account population characteristics and the relationship of oral health with overall health and general well-being. The dental workforce composition will need to mirror changing demographics, and effective dental health teams will be characterized by cultural competence, humility, readiness, and capacity to adapt to changes. In addition, the influence of social histories and the pandemic on health and dental care utilization is important. Equally important are the inclusion of oral health literacy in treatment planning and disease prevention, as well as oral health–related quality of life in considering outcomes of care. Providing patient-centered care for a diverse population requires tailored treatment modalities, as well as intra- and interprofessional approaches. In this way, the whole person can be cared for, including those with special health care needs, whether related to chronic disease, mental health conditions, or behavioral, physical, and social differences. Conclusions: Changing demographics will affect the delivery of oral health care, including who can best provide care and how, what the needs are, and in what ways prevention and treatment can most effectively be accomplished. The education of dentists must address unmet population needs, including for those with special health care concerns and older adults. These population groups are influenced by a variety of social determinants, and provision of services may need to occur in alternative care delivery settings. Identifying and addressing the needs of every patient within this broad array of new requirements will challenge dental professionals to redefine what it means to be a health care practitioner. Knowledge Transfer Statement: This article describes how sociodemographic changes in the United States will challenge the dental workforce in new ways and points to research and practice needs to address these challenges. Oral health disparities and the changing oral health care needs of patients from diverse and underserved groups are discussed, with a focus on the implications for delivery of care and policies that are needed to improve oral health outcomes for all.