Silvana Bettiol

Aims: Infections, including viral and bacterial agents, can trigger acute arthritis, with some potentially playing a role in the development of chronic arthritis such as osteoarthritis (OA). However, the role of pathogens in OA development remains unexplored. Therefore, this study aimed to investigate the associations between infectious agents and the risk of incident hip and knee OA. Methods: Data were analyzed from 7,352 UK Biobank participants (mean age 56.1 years (SD 8.2); 54.1% female), who were free of hip or knee OA at baseline. A multiplex serology panel measured serum immunoglobulin G antibody levels for 20 infectious agents, including herpesviruses, polyomaviruses, papillomaviruses, retroviruses, hepatitis viruses, bacteria, and protozoa. Incident hip and knee OA were identified through hospital and death registry records. Cox regression was used for the analyses, and the Hochberg method was used for multiple testing correction. Results: Over a median follow-up of 12.7 years (IQR 12.4 to 14.0), 262 participants developed hip and 311 developed knee OA. Seroprevalence rates for the infectious agents ranged from 0.2% to 95.5%. In fully adjusted model, seropositive agents (BK Virus (BKV) (HR 2.88; 95% CI 1.19 to 6.98), Human Papillomavirus type 18 (HPV-18) (HR 1.93; 95% CI 1.03 to 3.65), Kaposi’s Sarcoma-Associated Herpesvirus (KSHV) (HR 1.50; 95% CI 1.03 to 2.20), and Merkel Cell Polyomavirus (MCV) (HR 1.40; 95% CI 1.07 to 1.85)) were associated with an increased risk of incident hip OA. Cytomegalovirus (CMV) seropositivity (HR 1.39; 95% CI 1.08 to 1.78) was associated with a higher risk of incident knee OA. BKV, MCV, and CMV remained significant after multiple testing adjustments. Conclusion: This study identified specific viral pathogens associated with an increased risk of incident hip and knee OA, with differences at the knee and hip, suggesting a potential role of preceding infections in OA pathogenesis. Cite this article: Bone Joint Res 2026;15(4):412–424.

Background: Cognitive load is the mental effort required to perform a task due to demands on working memory storage and information processing. In clinical training, the cognitive load can be high due to the task complexity. Applying cognitive load management strategies may help educators support trainees’ well-being, retention, and performance. Limited research exists on the translating cognitive load management strategies with practical recommendations for enhancing clinical trainees' retention, well-being, and performance. Objectives: This scoping review aims to identify cognitive load factors and management strategies that can be used to improve trainees’ well-being, retention, and performance in clinical training and practice. Methods: We investigated the impacts of different cognitive load factors and management strategies on trainees’ well-being, retention, and performance, through a scoping review with narrative synthesis. No meta-analysis was planned. We followed PRISMA-ScR for search and screening. Databases (Embase, MEDLINE, Web of Science, CINAHL) searched 18-19 February 2025; Google Scholar and hand‑searches updated 27 February 2026. Results: We identified 8,395 records (Embase 110; Medline 124; Web of Science 188; CINAHL 66; Google Scholar and hand searches 7,907). After deduplication, screening and full-text review, 125 studies were included. Cognitive load management strategies were clustered here as (i) optimising intrinsic load via task segmentation and part-task/step-up sequencing; (ii) minimising extraneous load via de-cluttering, supportive environments and clear and concise instructions; (iii) optimising germane load via structured feedback, worked examples, and appropriately staged simulation. Conclusions: Cognitive load management strategies and institutional support may be important for trainee retention, well-being, and performance in clinical training. By using evidence-based strategies, healthcare systems may help trainees better manage cognitive load and improve learning and performance.

Objectives: Despite decades of national and global strategies, persistent inequities in oral health outcomes, access, and service provision remain. Existing frameworks often fail to integrate clinical and behavioral factors with social, cultural, and political determinants. This study aimed to map and evaluate oral health frameworks using Hodges' Health Career—Care Domains‐Model (HCM), a meta‐framework that spans clinical, behavioral, sociological, and political domains. The goal was to identify conceptual gaps and opportunities for greater integration. Methods: A structured scoping review was conducted using MEDLINE, CINAHL, EBSCO, and search engine Google Scholar (1995–2025) to identify oral health‐related conceptual frameworks. Frameworks were eligible if they addressed oral health determinants, behaviors, policies, or interventions. Two reviewers independently screened records and analyzed full‐text articles. Frameworks were categorized by theoretical orientation and mapped against the four HCM domains to identify patterns of emphasis or omission. Results: Of 226 identified records, 21 frameworks met inclusion criteria. These were classified into three thematic groups: balanced (addressing all domains), clinically led (focused on clinical/behavioral aspects), and policy/public health‐focused (emphasizing sociological/political factors). Seven cross cutting themes emerged, including health promotion, systems integration, social justice, and cultural safety. While many frameworks promoted equity and policy reform, few offered implementation guidance or had been empirically validated. Conclusions: HCM proved useful for systematically comparing frameworks and revealed consistent underrepresentation of political and structural domains. It offers a practical tool for oral health professionals, educators, and policymakers developing integrated oral health models that align with equity, sustainability, and universal health coverage goals.

Tasmania faces ongoing challenges in providing equitable oral health care across its geographically dispersed and ageing population. Tasmania has the lowest dental practitioner-to-population ratio in Australia, alongside long wait times and limited access to care in rural and regional areas. This perspective explores the demographic and workforce distribution trends that influence oral health service delivery in Tasmania using Census data, regulatory records, and key public sector audits. We highlight critical gaps in service provision and policy, reflect on the implications of the workforce maldistribution, argue for expanding the oral health therapy workforce and explore the transdisciplinary approaches currently implemented that prioritise sustainable, community-integrated oral health care. Such models align with the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), but also encompass SDGs 4, 5, 6, 8, 9, 10, 13 and 17, which respond to environmental and social contexts. This perspective highlights the intersections of planetary health, oral health, and community well-being, arguing that sustainable, health-centred solutions must address both human and environmental health outcomes.

Objectives: Oral health is an important aspect of quality of life for older people, especially those with dementia. The impact of an active oral hygiene program on the oral microbiome was explored in a group of older participants (average age 84 years old) with dementia against a separate control group whose oral hygiene followed the status quo.Materials and Methods: The oral cavity bacteriomes and mycobiomes were assessed from swabs of cheek, gum, and tongue surfaces. Samples were collected at the beginning and end of a 6‐week study period, and bacterial and fungal community profiles were determined by short‐read metabarcode sequencing of 16S and 18S ribosomal RNA (rRNA) genes, respectively.Results: The predominant bacteria were found to be in order of abundance: Streptococcus, Cellulosimicrobium, Rothia, Veillonella, Prevotella, Actinomyces, and species that belonged to the families Lactobacillaceae and Gemellaceae. Similarly, common fungal species belonged to Saccharomyces and the Candida‐Lodderomyces clade. The intensive oral hygiene program did not affect bacterial or fungal taxa distributions. A minor reduction in bacterial species richness (15%–20%) was observed post‐intervention in both groups. Mycobiome outcomes varied by sampling sites, unlike bacterial communities, which were relatively homogenous. Participant differences, potentially individual health status, genetics, and other personal factors, explained most data set variations (70%–78% of the variance), with the experimental design accounting for about 2%.Conclusions: To enable an alteration of oral cavity communities that may improve overall oral health and mitigate infectious disease risks in older people, especially those in residential care, targeted and specific hygiene approaches may be needed for the purposes of assessing effectiveness at the microbiological level. Future research should focus on developing and testing such targeted strategies to mitigate infectious disease risks and enhance the quality of life for older individuals, particularly those in residential care settings.

Objective: The current Australian Pregnancy Care guidelines recommend that antenatal care providers discuss oral health, provide advice and refer women to dental professionals as needed. However, the delivery of oral health recommendations in antenatal settings appears substandard. This study aimed to identify the barriers and enablers influencing antenatal care providers' adoption of the oral health guidelines.Methods: A qualitative study was conducted using semi‐structured interviews with a purposive sample of antenatal care providers in Tasmania, Australia. Data analysis followed a thematic coding method using the Capability, Opportunity, Motivation ‐ Behaviour (COM‐B) model and Theoretical Domains Framework to identify implementation barriers and enablers and to inform recommendations.Results: Twenty‐five antenatal care providers participated (midwives n = 14, general practitioners n = 10 and obstetrician‐gynaecologist n = 1). Thirty‐two explanatory themes were identified and mapped directly to six COM‐B constructs and 11 Theoretical Domains Framework domains. Eight main themes were identified as both impeding and enabling when viewed in different contexts: (1) perceived patient knowledge and awareness; (2) professional oral health knowledge, training and skills; (3) awareness of the guidelines on oral health; (4) patient education and professional resources; (5) interprofessional collaboration and support; (6) streamlined referral processes and access to dental services; (7) perceived outcomes of oral health interventions; and (8) perceived professional responsibility related to oral health.Conclusions: Key strategies include improvements to the promotion and dissemination of relevant guidelines, professional education and training, and development and adoption of oral health‐centred models of care to support interprofessional collaboration. Future research should focus on developing brief and sustainable interventions that address antenatal care providers’ practice behaviours.

Introduction As the global demand for emergency health services continues to expand, the role of paramedics persists and grows alongside the expansion of ambulance services. The need to explore alternative pathways for enhancing service efficiency and alleviating hospital demands is increasingly evident, particularly for low-acuity cases. Non-traumatic dental conditions (NTDC) can be ongoing and have far-reaching health implications if not treated correctly. This scoping review aims to explore what is known about the incidence of NTDC cases attended by paramedics internationally. Methods Three electronic databases (Medline, Scopus, CINAHL) were searched between 1 Jan 2000 and 30 April 2023, using the primary search terms “paramedics,” “prehospital,” and “dental emergency.” In addition, grey literature was examined using Google Scholar. Studies were included if they investigated NTDC as the primary treatment condition in the prehospital setting (excluding clinical settings) and were written in English. Results Of 1755 articles identified only four studies met the inclusion criteria. Three were quantitative descriptive surveys, and one study included interview data. Studies originated in Poland, the United States, Turkey, and India. Paramedics who reported attending an NTDC case varied between 28% and 72%. Two papers reported on the demographics of patients most affected by NTDC, including young children aged 7-15 and older individuals between the ages of 45-64. Despite limitations and bias across all studies, results indicated insufficient knowledge and education of paramedics regarding dental anatomy or proper management of NTDC. Conclusion This scoping review identified a paucity of robust research and publications investigating the paramedic role in initial treatment and referral pathways of dental injuries. There was limited information on the paramedic’s knowledge, attitude, and training in dental injuries. Further research is required to determine paramedics’ preparedness to manage and improve patient outcomes to reduce the growing burden on emergency departments.

ObjectiveTo explore women's oral health experiences and barriers to dental care and identify potential strategies to improve oral health during pregnancy. MethodsA qualitative descriptive study design was used. Purposively elected antepartum and postpartum women & GE;18 years of age from Tasmania, Australia, were recruited using maximum variation sampling. Semi-structured interviews were conducted, and all qualitative data were analysed using an inductive thematic approach. ResultsFifteen women were interviewed with a mean & PLUSMN; SD age of 32.3 & PLUSMN; 4.5 years. Three key themes were generated from the data that described women's perceived changes in their oral health during pregnancy; barriers to oral health care during and after pregnancy; and perceived strategies to improve access to care. Most women acknowledged the importance of maintaining good oral health but reported a decline in their oral health status during pregnancy. Women also identified several barriers to dental care, including treatment costs, competing maternal priorities, limited oral health knowledge and negative perceptions towards dentistry. The provision of preventative oral health care by ANC providers was also limited. Community awareness, patient education resources and assessment tools could support the promotion of oral health care. Women also perceived that interprofessional collaboration between antenatal and dental providers played a key role in promoting oral health. ConclusionThis study explored women's varied oral health experiences and perceptions during pregnancy and highlighted critical barriers and enablers to dental care. Policy-level strategies that promote interprofessional collaboration between antenatal and dental providers and expand dental care access are suggested to overcome barriers to oral health for women during pregnancy.

Introduction: This study examines the main characteristics of dental informatics research using bibliometric analysis of articles in the online journal database PubMed, to identify the main trends of research in dental informatics. The study aims to identify trends, geographic distribution of papers and authors, rates of collaboration, and performances of journals and institutions. Methods: Information on dental informatics was extracted solely from the PubMed online journal database from January 1989 to September 2019. A three-phase search approach was employed. Bibliometrics was used to examine the growth and progress of dental informatics over time. Results: A total of n=236 papers on dental informatics were identified, with an average of 7.9 papers per year. The trend of papers published increased over time with 41 countries represented in this study. There were only 15 countries which had 10 or more representatives, seven of which came from Europe. North America produced the most research in dental informatics, with 149 paper affiliations and ten were cross regional, in 61% of the total papers. Discussion: The topic of dental informatics began in the mid to late 1980s, with the most productive years in the last decade, reaching a high point in the mid 2010s. There was a low level of international collaboration, and few conducted across different continents. Conclusion: There is steady increase in the pace of research in dental informatics, with growing interest in exploring various implementation methods. Collaboration has become a product of a globalised world, with the potential to share data and exchange ideas using cutting-edge technologies. As these trends continue, the field of dental informatics may see further growth and development, with more technology available to provide communication and share data points and methods becoming widespread.

Objective: To explore the water fluoridation status of rural Victorian towns over 1000 population and document the oral health profile in the local government areas (LGAs) currently with no water fluoridation. To assist/inform future LGA planning, we describe a case study of a community‐based co‐design approach to increase access to fluoridated water in rural communities.Design: A descriptive design and a case study.Setting: Rural Victorian towns over 1000 population.Participants: Twenty‐nine LGAs in rural areas.Main Outcome Measure(s): LGA water fluoridation status and oral health profiles.Results: Sixty‐six (33%) of the 203 Victorian rural towns with >1000 population, representing 149 251 people, did not have access to fluoridated water. Towns in 29 rural LGAs were included with 62% without water fluoridation with many having higher than the Victorian average of preventable hospital admissions due to dental conditions in children aged 0–9 years. Over 50% of children aged 0–12 years living in these rural nonfluoridated LGAs had above‐the‐state average rates of decayed, missing and filled teeth (dmft/DMFT). In those aged 0–5 years, this was the highest with 78% above‐the‐state average. In the case study, meetings were well attended, and the group resolved to lobby for water fluoridation, which was successful.Conclusion: Many Victorian rural towns do not have access to fluoridated water. A community‐based co‐design approach can dispel ill‐informed concerns about dangers of water fluoridation to successfully lobby the state government to fluoridate the local water supply.