Making science and doing justice: The need to reframe research on racial inequities in oral health.

This article combines a review of dental studies on race with sociological insights into systemic racism to advance a counter-narrative on the root causes of racial oral health inequities. Taking racism as a form of oppression that cuts across institutional, cultural, and behavioral dimensions of social life, we ask: How pervasive are racial inequities in the occurrence of adverse oral health outcomes? What is the direction and magnitude of racial inequities in oral health? Does the inequitable distribution of negative outcomes persist over time? How can sociological frameworks on systemic racism inform initiatives to effectively reduce racial oral health inequities? The first three questions are addressed by reviewing dental studies conducted in the past few years around the globe. The fourth question is addressed by framing racial oral health inequities around sociological scholarship on racism as a systemic feature of contemporary societies. The paper concludes with a set of practical recommendations on how to eliminate racial oral health inequities, which include engaging with a strong anti-racist narrative and actively dismantling the race discrimination system. Amid the few attempts at moving the field towards improved racial justice, this paper should be followed by research on interventions against racial oral health inequities, including the conditions under which they succeed.

A Psychometric Network Analysis of OHIP-14 across Australian and Brazilian Populations.

OBJECTIVES: The aim of this study was to assess the structural validity of the Oral Health Impact Profile-14 (OHIP-14) instrument in Indigenous and non-Indigenous populations from Australia and Brazil using a network analysis approach. METHODS: Cross-sectional data collected using OHIP-14 were obtained for Indigenous and non-Indigenous populations from Australia and Brazil. Networks were estimated using the Gaussian graphical model. Items of the OHIP-14 instrument are represented as nodes and the partial correlations between items as edges. Dimensionality was assessed using exploratory graph analysis. Structural consistency and item stability were computed using a bootstrap sampling method. Standardized node strength across each dimension was also calculated. RESULTS: Four dimensions were identified across all samples, although the item arrangement of most dimensions presented variation. Similarities with the theoretical domains of the instrument were found. Items from the conceptually derived OHIP-14 domains formed separated clusters or blended with other items in a single dimension. Most dimensions across all samples showed an acceptable structural consistency. Item stability revealed some discrepancies among items of dimensions of both Indigenous networks. CONCLUSION: The psychometric network perspective adopted in this study provides validation of the OHIP-14 structure in Indigenous and non-Indigenous populations. The structural consistency and item stability analyses showed that both Indigenous networks present a higher number of cross-domain items and less defined boundaries between dimensions. These findings indicate that OHIP-14 does not measure attributes in the same extent among different cultures. KNOWLEDGE TRANSFER STATEMENT: This study demonstrates a new analytical framework from which to conceptualize and interpret the construct oral health-related quality of life using the Oral Health Impact Profile (OHIP-14). Network graphs facilitate knowledge translation of findings to professionals with no expertise in psychometric methods. OHIP-14 is a valuable tool to oral health research and clinical practice. Differences in conceptions of health may influence the extent that the instrument measures oral health impacts. Consequently, dimension scores do not always provide appropriate measures and should be avoided in research reports and assessments of treatment outcomes.

Reducing Indigenous Oral Health Inequalities: A Review from 5 Nations.

Indigenous populations around the world experience a disproportionate burden in terms of oral diseases and conditions. These inequalities are likely due to a complex web of social determinants that includes poverty, historical consequences of colonialism, social exclusion, government policies of assimilation, cultural annihilation, and racism in all its forms (societal, institutional). Despite documented oral health disparities, prevention interventions have been scarce in Indigenous communities. This review describes oral health interventions and their outcomes conducted for Indigenous populations of the United States, Canada, Brazil, Australia, and New Zealand. The review includes research published since 2006 that are available in English in electronic databases, including MEDLINE. A total of 13 studies were included from the United States, Canada, Brazil, and Australia. The studies reviewed provide a wide range of initiatives, including interventions for prevention and treatment of dental disease, as well as interventions that improve oral health knowledge, behaviors, and other psychosocial factors. Overall, 6 studies resulted in improved oral health in the study participants, including improvements in periodontal health, caries reduction, and oral health literacy. Preferred intervention methodologies included community-based research approaches, culturally tailored strategies, and use of community workers to deliver the initiative. Although these studies were conducted with discrete Indigenous populations, investigators reported similar challenges in research implementation. Recommendations for future work in reducing oral health disparities include addressing social determinants of health in various Indigenous populations, training future generations of dental providers in cultural competency, and making Indigenous communities true partners in research.