Gustavo Hermes Soares

Inequitable utilization of regular dental care is known to be a key driver for inequalities in oral health outcomes. The aim of this study was to investigate inequalities in adolescent dental care, at the intersections of sex, race and ethnicity, and sexual identity. We analyzed pooled data from the 2021 to 2023 national Youth Risk Behavior Survey, comprising 27,692 participants. A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was performed, defining 20 intersectional strata by sex, race and ethnicity, and sexual identity. Two binary outcomes pertaining to dental service utilization were assessed: (i) not having visited a dentist in past 12 months, and (ii) never having visited a dentist. There was evidence of modest between-stratum heterogeneity with regards to dental visits in the past 12 months, and substantial heterogeneity for never having visited a dentist. The fixed effects of sex, race and ethnicity, and sexual identity explained approximately 93% to 97% of the between-stratum variance. The median odds ratio indicated that, depending on intersectional identity, the odds increased by 35% for not having visited a dentist in the past 12 months and 108% for never having visited a dentist. Discriminatory accuracy was poor for both outcomes. Inequalities in adolescent dental attendance may be substantial, particularly among Black and sexual minority individuals. Under specific MAIHDA modeling assumptions, we find that the inequalities across intersectional strata appear to be largely additive in nature.

Background/Objectives: This study aimed to explore perceived changes in the eating behavior of children with overweight and obesity following a nutritional intervention, considering the perspectives of children and their families participating in a specialized health promotion program. Methods: This qualitative study included five children aged 7 to 12 years and four family members enrolled in the ProSaúde Kids Program in southern Brazil. The study comprised three stages: initial semi-structured interviews; nine interactive nutritional workshops conducted from July to November 2024 with active family participation; and final interviews after the intervention. Recordings were transcribed and analyzed in ATLAS.TI^® using the collective subject discourse approach, guided by Bronfenbrenner’s Ecological Systems Theory. Results: The intervention was associated with reported changes in perceptions and eating practices. Families described greater involvement of children in food decisions, perceived reductions in consumption of ultra-processed foods, and reported reorganization of eating routines. Children expressed increased critical awareness of food-related media content and greater appreciation of body diversity. Improvements in the quality of homemade school snacks suggested meaningful family engagement, even in the absence of direct school involvement. Conclusions: The workshops were described as encouraging reflection and supporting changes in attitudes and practices. Overall, the findings indicate potential positive shifts in eating behavior, greater awareness of food choices, and enhanced family participation in the behavior-change process.

This study uses an intersectional framework to examine how race, gender, and sexual orientation jointly influence access to dental care in the United States. Leveraging cross-sectional data from the All of Us Research Program, we applied multilevel analysis of individual heterogeneity and discriminatory accuracy to assess disparities in dental service use and affordability across 30 intersectional strata. Results showed substantial inequities, with racialized, gender-diverse, and sexual minority individuals facing greater barriers to care. While most disparities were explained by additive effects, the findings highlight the importance of intersectionality in revealing how layered disadvantage shapes oral health outcomes. This study contributes to a more nuanced understanding of oral health equity by integrating gender and sexual orientation into intersectional health research.

Introduction: Silver diamine fluoride (SDF) is an effective cariostatic agent that has reemerged globally in recent years. Its resurgence is timely as dental caries remains prevalent, necessitating an affordable and simple treatment option. Its implementation in Australia has been slow, with inconsistent views on its use among practitioners, but is likely imminent given the recent global uptake. There is currently no literature examining Australian dental stakeholder views on SDF’s implementation. Objectives: This study aims to investigate Australian dental stakeholder views on the use of SDF and to identify the challenges and facilitators to its implementation for managing dental caries. Methods: Qualitative semi-structured interviews were conducted with Australian dental stakeholders. The analysis was carried out using Braun and Clarke’s reflexive thematic analysis framework and NVivo14 software. Results: Ten participants were interviewed (7 dentists, 2 hygiene therapists, and 1 hygienist) from 4 Australian states. The barriers and facilitators to Australia’s use of SDF were found within the themes of policy, research, manufacturer, teaching and exposure, and clinical setting. Major barriers to SDF adoption include insufficient training in the undergraduate setting, lack of a standardized Australian guideline detailing use, no Therapeutic Goods Administration approval for caries, and the manufacturer’s product design. Facilitators included continual professional development on SDF, manufacturer marketing of the product, and ample research supporting SDF’s effectiveness for dental caries. Conclusions: This study highlights both barriers and facilitators to SDF use in Australia, providing insight into factors that may influence its future integration into dental practice. Knowledge Transfer Statement: The results of this study show that successful implementation into Australia will require effort and changes by policymakers, universities, and manufacturers to support clinician use.

Background: Racism arrived in Australia with colonization and its intentionally oppressive policies and actions toward Aboriginal and Torres Strait Islander Peoples. To a large extent, colonial and biomedical agendas are maintained by Australia’s health system that underlies much of the racialized health inequities in the country. Dentistry significantly lags behind medicine and other health care areas in the uptake of antiracism, with the dental accreditation body only acknowledging racism as a determinant of oral health in 2022. Objective: This project will comprehensively co-design strategies for an antiracist dental health system in Australia through the following objectives: (1) development of an antiracist curriculum for dental students; (2) workforce strategies that support the attraction, retention, and well-being of the Aboriginal and Torres Strait Islander dental workforce; and (3) oral health promotion training for Aboriginal Health Workers/Practitioners. Methods: This project is grounded in decolonizing and Indigenous methodologies, which guide our ways of working at the knowledge interface. Co-design Yarning sessions will inform the development and implementation associated with each of the objectives through tabulation and narrative synthesis of sessions. Objectives will be evaluated with both quantitative and qualitative measures and analyzed accordingly with inverse probability of treatment weighting, content analysis, or reflexive thematic analysis. Results: The study received ethical review approval in February 2024 and received funding in June 2024. The co-design phase for each objective will run from July 2024 to February 2025. The dental curriculum will be developed in 2025 and delivered to the 2026 student cohort. Evaluation data will be collected from the comparator student cohort in 2025 and the implementation cohort in 2026. Data collection for the development of workforce strategies will be collected from October 2024 to July 2025; the framework will be developed from August to December 2025 and disseminated in 2026. Oral health promotion training will be developed from August to February 2024, implemented from March to June 2025, and qualitative evaluation data will be collected between July and September 2025. Conclusions: The proposed research will develop an antiracism curriculum for dental students, a tailored Aboriginal and Torres Strait Islander dental workforce framework, and an oral health promotion training program for Aboriginal Health Workers/Practitioners. The processes and final outcomes of this research will be scalable and able to be tailored to different contexts. Together, these strategies will build oral health knowledge at the Community level, in turn supporting Aboriginal and Torres Strait Islander self-determination of oral health. International Registered Report Identifier (IRRID): PRR1-10.2196/69012

Objective: To develop and validate two age‐specific, strength‐based measures of social and emotional well‐being (SEWB) for Aboriginal and Torres Strait Islander children and youth.Methods: Following development of a conceptual framework comprising six domains of SEWB and identification of existing SEWB tools, an iterative process of item refinement took place. Items were assigned to corresponding SEWB domains, and their content validity and face validity were examined. Community‐Controlled Health Services provided expert feedback. Statistical analyses were conducted to assess floor and ceiling effects, item redundancy, network structure, item stability, model fit and reliability. An ant colony optimisation (ACO) algorithm was employed to identify a reduced number of items with adequate model fit.Design: Data on SEWB were generated as part of the baseline assessment for a national study involving Aboriginal and Torres Strait Islander Communities.Setting: 11 Aboriginal and Torres Strait Islander Communities from six states and territories.Participants: Aboriginal and Torres Strait Islander children and youth aged 2–18 years.Main Outcome Measures: Network structure, item stability, model fit and reliability and reduced scales.Results: Different sets of items were developed to accommodate the needs of different age groups. A total of 235 participants and 162 guardians answered the self‐report and the carer‐report tool, respectively. A unidimensional structure was identified for both scales. Adequate item stability, model fit and reliability were obtained.Conclusions: The short versions of the SEWB tools offer a friendly, age‐appropriate and time‐efficient approach while capturing all relevant domains of SEWB.

This study investigated whether sex assigned at birth and sexuality have a moderating role on the effect of discrimination on oral health impacts among adolescents. Using data from the Longitudinal Study of Australian Children, a sample representative of all Australian adolescents aged 14 to 15 y ( N = 2,905), we employed propensity score overlap weights to achieve covariate balance between participants exposed and unexposed to discrimination. Various forms of discrimination were examined: due to cultural background, due to mental health condition, due to sexual orientation, and due to sex assigned at birth. Oral health impact was assessed using the PedsQ Oral Health Scale. Poisson regression with robust variance was conducted including sex, sexual attraction, and discrimination as interaction terms. The sample included 1,407 females (49%) and 336 lesbian, gay, bisexual, and questioning (LGBQ) individuals (11%). More than 22% experienced at least 1 form of discrimination in the previous 6 mo. Findings from the overlap weighting analysis revealed that, in general, females had higher proportions of oral health impact compared with males, whereas sexually diverse youth tended to have worse oral health outcomes compared with non-LGBQ youth. A 2-fold higher prevalence rate of oral health impacts was found for sexually diverse females exposed to discrimination due to cultural background (95% confidence interval [CI]: 1.36–2.44) and due to mental health conditions (95% CI: 1.62–2.46). The largest effects of discrimination on oral health impacts were consistently observed among sexually diverse females. This novel study provides evidence on the moderating role of sex and sexuality in the relationship between discrimination and oral health among adolescents.

Purpose: To estimate the additive effects of parent’s nativity status/language spoken at country of birth, education, and area-level socioeconomic status (SES) on untreated dental caries among children aged 5 to 9 y in Australia. Methods: Cross-sectional population-based data were obtained from the 2014 National Child Oral Health Study (N = 12,140). Indicators of social position used to explore additive effects on dental caries included nativity status, language, university degree, and neighborhood socioeconomic level. Multiple-way interactions were examined, and departure from additivity resulting from 2- and 3-way interactions were estimated as relative excess risk due to interaction (RERI). Results: Children marginalized across multiple layers of disadvantage had substantially higher frequencies of dental caries compared with children in the most advantaged category. RERI for the 3-way interaction between immigrant status, education, and neighborhood SES was negative (RERI ₃ : −0.14; 95% confidence interval [CI]: −1.68, 1.40). When operationalizing language, education, and neighborhood SES, the joint effect of the 3 marginalized positions was additive (RERI ₃ : 0.43; 95% CI: −2.08, 2.95). Conclusion: Children marginalized across multiple intersecting axes of disadvantage bear the greatest burden of dental caries, with frequencies surpassing the cumulative effect of each social position alone. Findings emphasize the need to account for intersecting inequities and their oral health effects among children with immigrant backgrounds. Knowledge Transfer Statement: Our analysis underscores the necessity for policies and public health strategies targeting dental caries–related inequities to comprehensively account for various indicators of social disadvantage, particularly encompassing language proficiency, educational attainment, and neighborhood socioeconomic status. Within the intricate interplay of these factors, we identify a vulnerable subgroup comprising children with the highest prevalence of dental decay. Therefore, prioritizing this specific demographic should be the focal point of policies and public health initiatives aimed at fostering equitable oral health outcomes.