Noha Gomaa

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.

The fundamental cause theory posits social factors as causes of disease as they encompass access to important resources such as knowledge, wealth, and social networks. While these social factors have been consistently associated with oral and systemic diseases, causality remains unestablished. Here, we estimated the causal effect of social adversity, comprising low economic and social capital, on the development of (1) oral conditions (OC) and (2) multimorbidity including oral conditions (MIOC) in a cohort of middle-aged and older adults over a 7-y period and assessed whether effects varied by age or gender. We analyzed 2 waves from the Canadian Longitudinal Study on Aging (CLSA) (2011 and 2018). Social adversity comprised low economic (income) and social capital (community participation, social relationships). OC was defined as having 1 or more of poor self-reported oral health, lack of functional dentition (<20 natural teeth), or edentulism. Participants with an OC at baseline were excluded. MIOC was defined as having 2 or more chronic diseases and an OC. Logistic marginal structural models with inverse probability weighting estimated the causal odds ratio (OR) of developing both outcomes, controlling for sociodemographic and behavioral factors. In a total of 23,366 participants, 14% experienced social adversity at baseline, with a prevalence of 17% OC and 7% MIOC at follow-up. Social adversity significantly increased the odds of developing OC (OR = 1.9, 95% confidence interval [CI] 1.7, 2.2) and MIOC (OR = 1.7, 95% CI 1.5, 2.0) at follow-up. The observed effects were strongest in the middle-aged group, with similar odds observed in both men and women. Our findings indicate that social and economic capital are causally linked to the development of OC and MIOC over time. We suggest that policies for healthy aging should prioritize action on social and living conditions.

Background: Various studies have shown that social adversity, such as loneliness or low SES, are linked with worse cognitive outcomes, though underlying biological mechanisms remain unclear. This scoping review aims to summarize existing evidence on biological processes that may underline this association. Methods: Following PRISMA-ScR guidelines, studies measuring social adversity, cognition, and at least one biological mechanism were included. Results were summarized narratively and in tabular formats. Results: Thirteen studies examined links between social adversity, cognition, and biological mechanisms. Inflammation, allostatic load, genetics and genetic aging markers were identified as potential mediators. Conclusion: Several studies suggest that these biological mechanisms may mediate the link between social adversity and cognitive decline. However, further research is needed to clarify these complex relationships, which are crucial for developing targeted interventions, especially for socially disadvantaged populations.

Objectives: To investigate the extent of the association of adverse childhood experiences (ACEs) with co‐occurring poor self‐reported oral health (SROH) and multimorbidity in middle‐aged and older adults, and whether these associations differ by age and sex.Methods: This cross‐sectional study used data from 27 765 adults aged 45–85 years from the first follow‐up wave (2015–2018) of the Canadian Longitudinal Study on Aging (CLSA). Four categories were generated to assess co‐occurring SROH and multimorbidity: (i) good SROH, no multimorbidity; (ii) poor SROH, no multimorbidity; (iii) good SROH, multimorbidity and (iv) poor SROH and multimorbidity. Age‐and sex‐stratified multinomial logistic regressions were used to examine associations of ACEs (e.g. childhood maltreatment, neglect, parental death, serious illness or separation) with co‐occurring poor SROH and multimorbidity, adjusted for the confounders race/ethnicity, income, level of education, smoking status and alcohol consumption.Results: Over a third of participants reported having multimorbidity (35.3%), 10.4% reported poor SROH, and almost 30% of participants had experienced at least one ACE. There was a gradient in the association between higher ACEs and each of the health outcome categories, with the greater odds being for the co‐occurrence of poor SROH and multimorbidity (OR = 1.37, 95% CI: 1.30, 1.44). The associations between ACEs and adverse health outcomes in later life were significant across age groups and sexes, with middle‐aged females demonstrating the strongest associations.Conclusions: ACEs are linked to an increased non‐communicable chronic disease burden and poor oral health among middle‐aged and older Canadians, highlighting the importance of prevention in early life and the focus on psychosocial factors over the life course for healthy aging.

Recent years have seen significant positive changes and developments in oral health–related policy and data on oral health and oral health care in Canada. Simultaneously, on the international stage, the momentum for oral health and related research continues to build. These changes have led to an initiative to create Canada’s first National Oral Health Research Strategy (NOHRS), which was recently published by the Canadian Institutes of Health Research–Institute of Musculoskeletal Health and Arthritis (Allison and Rock 2024). In this communication, we describe the process that was used to undertake this work. We present the resulting guiding principles, the research priority areas, and the framework that emerged, which included 6 strategic priorities grouped into 3 themes: (A) Leading Issues: (1) access to care, (2) inequities, identities, and oral health; (B) Emerging Methods: (3) artificial intelligence, (4) omics; and (C) Overarching Approaches: (5) environmental sustainability, (6) knowledge mobilization and implementation science. In addition, NOHRS includes a series of proposed goals and a timeline over the coming years. The point is to encourage a broad range of individuals and groups of people to engage with this high-level strategy and create plans to implement it. This strategy directly answers the call by the World Health Organization for countries to establish a national oral health research strategy (World Health Organization 2024). We have engaged in an extensive, broad consultative process, resulting in a Canadian NOHRS that is tailored to the needs of our community. Its aim is to galvanize our community into action to address the priorities we have identified. By engaging in this process, we build upon multiple oral health–related initiatives in Canada and on the international stage. We hope to inspire and facilitate similar, much-needed work elsewhere.

Dental attendance is important for the prevention, diagnosis, and treatment of oral diseases. In this study, we aimed to assess the extent of the association between dental visits, inadequate oral health, and multimorbidity (MM), and whether this association differs by age and sex. We conducted a cross-sectional analysis of the first follow-up wave (2018) of the Canadian Longitudinal Study on Aging (CLSA). Poor self-reported oral health (SROH), oral health problems, and edentulism were used to indicate inadequate oral health. MM was defined as having 2 or more chronic conditions out of cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. Dental visiting was determined as the number of visits to a dental professional within the past 12 months. Covariates included socioeconomic, behavioural factors, and the availability of dental insurance. We constructed multivariable Poisson and logistic regression models with interactions terms and estimated the relative excess risk due to interaction prevalence ratio (RERIPR) to assess the effect measure modification of age and sex on the associations of interest. We conducted sensitivity analyses and estimated E-values for unmeasured confounding. In this sample (n = 44,815), dental visiting was inversely associated with inadequate oral health and MM in adjusted models, reducing the odds/prevalence of poor SROH (OR 0.41, 95% CI 0.34, 0.51), oral health problems (PR 0.89, 95% CI 0.79, 0.94), edentulism (OR 0.10, 95% CI 0.06, 0.15), and MM (PR 0.86, 95% CI 0.79, 0.92). These associations were stronger in older age and females. Dental visiting may contribute to better oral health and reduced chronic diseases in the middle-aged and older population. Our findings suggest the need for age and sex-specific targeted interventions to optimize oral and overall health.

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.

Studies on the -omics of child neurodevelopmental outcomes, e.g. genome, epigenome, microbiome, metabolome, and brain connectome aim to enable data-driven precision health to improve these outcomes, or deliver the right intervention, to the right child, at the right time. However, evidence suggests that neurodevelopmental outcomes are shaped by modifiable socioenvironmental factors. Everyday exposures including family and neighbourhood-level socioeconomic status, housing conditions, and interactions with those living in the home, are strongly associated with child health and have been suggested to alter -omics. Our aim was to review and understand the biological pathways by which home factors contribute to child neurodevelopment outcomes. We review studies suggestive of the home factors contributing to neurodevelopmental outcomes that encompass the hypothalamic-pituitary-adrenal axis, the brain, the gut-brain-axis, and the immune system. We thus conceptualize home-ics as the study of how the multi-faceted living environment can impact neurodevelopmental outcomes through biology and highlight the importance of targeting the modifiable aspects of a child’s home to optimize outcomes. We encourage clinicians and health care providers to routinely assess home factors in patient encounters, and counsel families on modifiable aspects of the home. We conclude by discussing clinical and policy implications and future research directions of home-ics. Impact Home-ics can be conceptualized as the study of how home factors may shape child neurodevelopmental outcomes through altering biology. Targeting modifiable aspects of a child’s home environment (e.g. parenting style, early intervention, enriched environment) may lead to improved neurodevelopmental outcomes. Clinicians should routinely assess home factors and counsel families on modifiable aspects of the home.