Manu Raj Mathur

Aims To map evidence relating to repeat dental general anaesthesia (DGA) in children, describe reported repeat DGA rates and identify potentially associated factors, including treatment-planning arrangements. Methods A scoping review was conducted following Arksey and O’Malley and JBI guidance and reported according to PRISMA-ScR. Five bibliographic databases were searched, supplemented by grey literature, reference-list searching, database alerts to April 2026 and stakeholder consultation. English-language sources reporting repeat DGA in children were eligible. Results Seventy-five sources were included (72 published; three unpublished). Reported repeat DGA rates ranged from < 1% to 76%. Median rates were 4.9% with paediatric specialist-led treatment planning and 10.1% with non-paediatric-specialist-led planning. However, study period was a potential confounder; among sources published from 2010 onwards, corresponding medians were 4.9% and 3.2%. Radiographic assessment was more frequently reported with specialist-led planning (36% versus 19%). Conclusions Repeat DGA rates varied considerably. Although specialist-led treatment planning was associated with lower rates overall, this association was attenuated when study period was considered and should not imply causality. The findings highlight the potential importance of comprehensive assessment, appropriate diagnostic investigation and access to specialist expertise, and support further prospective multicentre research.

Objectives: To identify barriers for the development of evidence‐informed guidelines and propose potential methodological strategies addressing key barriers to producing trustworthy evidence‐informed guidelines in oral health (OH). Methods: Findings from a qualitative study exploring barriers in OH guideline development were used, and an international working group of experts in guideline methodology and individuals with experience in clinical and public health guidelines in OH was recruited. Through an iterative consensus approach, the following steps were followed: (1) identification of barriers related to the guideline development process itself and could be addressed through implementing or enhancing methodological strategies; (2) determination of the relevance of these challenges for guideline developers and research methodologists; and (3) agreement on the content and structure of each methodological strategy to address a particular barrier. Current methodological handbooks and publications on evidence‐informed guideline development informed this process. The nominal group technique was used to reach consensus, concluding when no further comments were raised and the participants confirmed that no additional modifications were needed. Results: Twelve experts from nine countries participated. The working group consolidated current methodology into nine strategies addressing 13 identified barriers. The document covers: defining when a document qualifies as an ‘evidence‐informed guideline’; practical approaches for defining guideline topics, scope, and questions; using pre‐existing systematic reviews; formulating recommendations with limited or indirect evidence; developing recommendations on dental products; integrating economic considerations and people values and preferences; and involving non‐dental healthcare professionals in OH guideline development. Discussion: These strategies support guideline methodologists and lead developers in producing trustworthy clinical and public health guidelines in OH at global, regional, national, and subnational levels. They aim to improve the quality, consistency, and applicability of OH guidelines, facilitating integration of reliable evidence into oral healthcare decision‐making to achieve better health outcomes and more effective health systems.

Background: Oral health literacy (OHL) plays a critical role in shaping individuals' engagement with oral health systems and their ability to translate information into effective self‐care and service use. While the Health Literacy in Dentistry (HeLD‐14) scale has demonstrated strong psychometric performance, brief and psychometrically robust instruments explicitly optimized for large‐scale surveillance remain limited. This study sought to develop a concise HeLD version that preserves sensitivity to low OHL while remaining operationally feasible for large‐scale monitoring. Methods: This cross‐sectional psychometric study was conducted among 600 adults aged 18–65 years from diverse sociodemographic backgrounds. A sequential, theory‐informed analytic approach was applied, encompassing Item Response Theory (graded response model), principal axis factoring (PAF) using polychoric correlations, and confirmatory factor analysis (CFA). Items were prioritized based on discrimination and location parameters to enhance sensitivity at the lower end of the latent OHL continuum, while structural coherence and shared variance guided further refinement. The shortened versions were recalibrated using θ estimation and their classification concordance compared with that of the original HeLD‐14. Results: IRT‐based evaluation reduced the item pool from 14 to 8 (HeLD‐8), retaining items with strong discrimination and threshold locations informative at the lower end of the oral health literacy continuum. Principal axis factoring using polychoric correlations confirmed that all eight retained items exceeded the pre‐specified communality threshold, supporting a coherent unidimensional structure; HeLD‐8 was therefore retained in full as the final candidate instrument. Confirmatory factor analysis in two independent split‐half samples supported this unidimensional structure, with acceptable‐to‐good fit indices. HeLD‐8 showed strong concordance with the full HeLD‐14 in identifying individuals with low OHL (sensitivity 92.1%, specificity 93.5%), while reducing respondent burden by more than 40% relative to the parent instrument. Conclusions: A brief oral health literacy screener, HeLD‐8, was developed and psychometrically validated to support identification of low OHL within population‐based surveillance contexts. By preserving representation across most of the original instrument's conceptual domains while substantially reducing respondent burden, HeLD‐8 may facilitate integration of OHL assessment into large‐scale oral health surveillance systems; further validation in independent and more diverse samples is recommended.

The global burden of oral diseases and shocking inequalities highlight the failure of current oral health systems and policies. One of the limitations with existing approaches is that they rely almost exclusively on professional perspectives with minimal input from communities, and in particular disadvantaged populations. As a consequence, interventions often fail to achieve sustained improvements and have limited impact in reducing inequalities. Within global health, there is growing recognition of the importance of meaningful community engagement in all aspects of policy, practice and research. The CORE global oral health research programme is being conducted in four middle‐income countries (Brazil, India, Colombia and Kenya) and an innovative element is that the planned research will be informed by community engagement with disadvantaged communities. Through a process of co‐design, local communities will be actively involved in designing, implementing and evaluating interventions. The planned community engagement activities include community mapping, establishment of community forums, appointment of community link workers and community outreach activities including visual and performing arts events. The aim of this commentary is to critically review the policy context and principles of community engagement, and to reflect on insights gained through the initial engagement activities undertaken as part of the CORE programme.

Objectives: To evaluate health system readiness for UHC for oral health in ageing populations, using a cross‐country analysis of eight countries (Japan, India, Colombia, Rwanda, the UK, Nigeria, Australia, Canada). The analysis encompasses health system organisation, financing and service delivery; dental workforce volume and distribution; oral health policies and provisions for older adults; and age‐based differences in oral disease burden. Methods: A narrative review was conducted across eight countries, purposively selected to represent diverse health system financing and governance arrangements using three established health system frameworks, by Böhm et al., Mackintosh et al. and Karan et al. Data were sourced from the WHO Global Oral Health Status Report and supplementary country‐specific sources, and findings were organised thematically across four domains. Age‐based differences in oral disease burden were quantified using disability‐adjusted life years (DALYs) rates per 100 000 population, comparing adults aged ≥ 65 years with those aged < 65 years over the period 2001–2021, with both absolute and relative differences calculated. Results: Considerable variation in readiness towards achieving UHC for oral health in ageing populations was observed. High‐income countries nominally included essential dental services under UHC but often with shallow coverage, significant co‐payments and limited rehabilitative services, leading to substantial out‐of‐pocket spending (notably Australia and Canada). Lower‐income countries provided minimal public financing for oral health, leaving most dental care to private out of pocket expenditure (as observed in India and Nigeria). Dental workforce shortages and maldistribution were pronounced in low‐resource settings (Rwanda and Nigeria recorded dentist‐to‐population ratios of approximately 1:57000 and 1:35000 respectively). Few countries had specific policies or programmes targeting oral healthcare for older adults (Japan and the UK). In most countries, adults ≥ 65 years had a higher oral disease burden than younger adults, especially in contexts with lower overall disease levels and greater longevity. Conclusions: Health systems are largely underprepared to deliver adequate coverage for oral health services for ageing populations. Strengthening financial protection, broadening coverage of preventive and restorative dental services, enhancing workforce capacity and embedding oral health in general health and ageing policies are critical to achieving equitable oral health outcomes for older adults.

Background: Dental caries remains one of the most prevalent noncommunicable diseases worldwide despite decades of clinical and behavioural interventions. Persistently high prevalence suggests that current approaches are better organised for ongoing disease management than for preventing new disease occurrence. This commentary examines whether an elimination framework could provide a more coherent and outcome‐oriented direction for oral health policy and practice. Methodology: We apply the Dahlem Framework to assess whether dental caries meets established criteria for disease eradication. We then position caries within the classical continuum of control, elimination, and eradication, drawing on current evidence on caries aetiology, fluoride exposure, dietary environments, primary care integration, surveillance, and the social and commercial determinants of oral health. Results: Dental caries does not meet the criteria for eradication. It has no single causal agent, no interruptible transmission cycle, no immunising intervention, and no global surveillance architecture capable of detecting incidence. Eradication is therefore conceptually impossible. Elimination, however, defined as the stable disappearance of dental caries as a public health problem within a defined population, is biologically plausible and operationally achievable. An elimination frame shifts expectations from managing recurrence to preventing occurrence and reframes caries as a system outcome rather than solely an individual behavioural or clinical problem. Conclusion: Caries elimination is not the promise of biological absence, but a realistic and measurable population health objective. Adopting an elimination framework could strengthen policy coherence, surveillance, implementation research, professional education, and accountability, while reorienting oral health systems toward prevention, equity, and sustained population‐level impact.

Understanding the factors that support sustained smoking cessation is essential for evaluating the effectiveness of tobacco control measures and improving quit outcomes at the population level. This study investigates successful quitting smoking (SQS), defined as abstinence for at least six months, using two waves of the Global Adult Tobacco Survey (GATS), and explores the factors associated with and contributing to changes in SQS over time. We conducted a secondary analysis of GATS India Wave 1 (2009-2010) and Wave 2 (2016-2017). Adults who smoked either currently or in the past 12 months were included, and SQS was assessed among those who reported quitting and remaining abstinent for six months or more. Chi-squares and z-tests were used to examine the difference in characteristics of included participants between two waves and the change in prevalence of SQS among them. Multivariate logistic regression was used to examine associations between SQS and explanatory or tobacco control-related factors within each wave. Multivariate decomposition analysis was conducted to quantify the contribution of each factor to the change in SQS between waves. While the prevalence of smoking decreased significantly from 17.18% in Wave 1 to 13.18% in Wave 2, the prevalence of SQS remained unchanged at 0.70%. Higher education and the presence of indoor smoking restrictions at home were consistently associated with greater odds of SQS. Receiving cessation support other than physician advice was associated with higher SQS in Wave 2. However, no significant change in SQS was observed among individuals who received advice from healthcare professionals. The decomposition analysis revealed no statistically significant contribution of individual factors to the overall change in SQS, although smoke-free home rules showed a high positive contribution within the sample. The findings suggest that while India has made strong policy gains in reducing smoking, these have not translated into improvements in sustained quitting. Strengthening evidence-based cessation support, particularly beyond routine provider advice, and leveraging digital platforms and household-level interventions could be key to improving SQS rates. Continued monitoring and targeted policies are essential to ensure quit attempts result in lasting success.

Introduction: Oral health is a crucial yet neglected aspect of the global health and development agenda. Although oral diseases affect almost half of the world’s population, they receive little attention and public investment by policymakers, undermining progress toward the Sustainable Development Goals (SDGs). Objective: The study aimed to 1) analyse the SDG framework through an oral health lens, identifying links across goals and targets, and 2) quantify the reduction in oral disease burden required by 2030 under a counterfactual status quo projection and 2 policy benchmark scenarios: one-third reduction of noncommunicable disease prevalence aligned with SDG target and 10% reduction based on the World Health Organization Global Oral Health Strategy & Action Plan (GOHAP) target. Methods: A systematic content analysis was conducted on the UN resolution “Transforming Our World: The 2030 Agenda for Sustainable Development.” Linkages were categorised across 4 dimensions: disease burden, determinants, system integration, and policy alignment. The Global Burden of Disease data were used to model a counterfactual status quo projection using the compound annual growth rate (CAGR) (2015–2019), disaggregated by World Bank income groups. “Improvement ambition,” representing potential preventable disease burden, was calculated as the difference between the status quo projection and each target. Results: Oral health was directly or indirectly linked to all 17 SDGs and 37 of 169 SDG targets, particularly SDGs 3, 4, 6, and 10. Achieving the SDG-aligned target could avert 981 and 649 million cases of caries of permanent teeth and periodontal disease, respectively, by 2030. Even with the GOHAP target of a 10% reduction, 373 and 272 million cases could be averted, respectively. Conclusion: Oral health is linked to the SDGs through shared risk factors and determinants with implications for equity and global development. The “improvement ambition” metric provides a practical tool for policymakers to benchmark progress and guide investments during this decisive decade. Knowledge Transfer Statement: Integrating oral health into SDG-aligned policy could avert up to 981 million cases of permanent caries and 649 million cases of periodontal disease by 2030. Even achieving the WHO Global Oral Health Action Plan target would prevent hundreds of millions of cases globally. Our “improvement ambition” metric helps policymakers and researchers benchmark progress toward Universal Health Coverage, noncommunicable disease prevention, and health equity, highlighting that excluding oral health results in losses in health, productivity, and social progress.

Background: The increasing burden of oral diseases in low‐ and middle‐income countries (LMICs) and limited access to and affordability of oral care disproportionately impact disadvantaged groups. Oral health research has been dominated by professional academic perspectives with limited contribution from the communities involved. The aim of this commentary is to provide a broad overview of the aims and objectives, principles, values, and study design of the CORE programme. Programme Aims: The CORE (Community focused Oral health Research for Equity) programme is a multinational research initiative which aims to reduce oral health inequalities and improve access to dental services through collaborations between disadvantaged communities and academic and community partners in Brazil, Colombia, India and Kenya. Public health research interventions will be co‐created and tested with local communities through a participatory action research approach and active community engagement and involvement. In addition, the programme aims to strengthen local oral health research capacity and advocacy. General Programme Design: The CORE programme is comprised of three elements: (1) Programme management and governance; (2) Research components focused on oral health inequalities, commercial determinants and oral health system reform; (3) Overarching components including (i) community engagement and involvement, (ii) training and capacity building, (iii) monitoring, evaluation and learning. Through a collaborative community‐based approach, the CORE programme will undertake high‐quality research in LMICs to inform future pro‐equity and health system reform policies.

Background: Vitamin B ₁₂ deficiency is common in populations with limited animal-source foods and has been linked to delayed infant neurodevelopment and adverse pregnancy outcomes. Evidence on the benefits of maternal B ₁₂ supplementation for improving infant neurodevelopment remains mixed, particularly in low-income and middle-income countries where deficiency is prevalent. Methods: This double-blind, randomised controlled trial was conducted in two tertiary maternity care centres in India and Nepal. Pregnant women in their first trimester, following a vegetarian diet, were enrolled and randomised to receive either a daily oral supplement of 250 µg (group A) or 50 µg (group B) of methyl-cobalamin from enrolment to 6 months post partum. The primary outcomes were infant neurodevelopment assessed at 9–12 months using the Development Assessment Scale of Indian Infants and biochemical B ₁₂ status in mothers and infants measured through blood tests. Results: 531 mothers completed the study (group A n=255; group B n=276). There were no significant differences in baseline characteristics between mothers at both centres or in groups A and B. Mental developmental quotients (DQs) were higher in the infants of group A: 103.7 (7.7) than group B: 101.7 (8.8); p=0.008). This corresponds to a mean difference of 7.8 centiles (p=0.007). Mean motor DQs were not significantly different between the groups. Maternal vitamin B ₁₂ levels rose from the first to third trimester in both groups, with a larger increase in group A (104.9 pg/mL (SD 159.1)) than group B (47.5 pg/mL (SD 118.0)), p0.05). Conclusions: Daily supplementation with 250 µg of vitamin B ₁₂ during pregnancy in vegetarian mothers significantly improved infant mental DQ and maternal B ₁₂ status compared with a 50 µg dose.