This special issue of Community Dentistry and Oral Epidemiology constitutes a published proceedings and extension of the 2020 Behavioural and Social Oral Health Sciences Summit. Introducing this special issue, we offer a brief historical perspective, a description of the process of events that influenced our work and culminated in the Summit and these published proceedings, and an overview of the articles included. It has been with great enthusiasm and considerable humility that we have championed this special issue and the activities and processes that preceded it, hopefully allowing this initiative to blossom. Truly, we are “standing on the shoulders of giants”,1 some of whom came well before us in this field and others to whom we are grateful for contributing articles to this special issue. From the very beginnings of the Summit planning, our efforts, and those of our colleagues, were designed to look to the future. Rather than being only an accounting of what is happening at present, we envisioned that the Summit, the Consensus Statement on Future Directions for the Behavioural and Social Sciences in Oral Health2 that emanated from it, and this special issue would provide a roadmap of possible and important future directions for the field.
Although behavioural and social factors have been acknowledged as inextricably intertwined with dentistry since its very beginnings (e.g. patient interaction, expectations of patents, coping with pain), formal scientific inquiry in these domains has been much more recent. Beginning in the 1960s, Lois Cohen—later labeled as the ‘principal architect’ of the social and behavioural sciences in dentistry3—and others developed a research agenda for what would become an entire field in its own right. This progress has continued for decades to the present. The science and its applications to practice evolved into the 1970s and 1980s. In the USA, this work came together in the first national conference on ‘behavioural dentistry’ in 1977.4 A second national conference took place just 2 years later.5 Coincidentally, these two conferences were held at West Virginia University, where we (DWM and CLR) first began working together, albeit much later than those conferences. A third national conference happened in 1989 and was captured in a special issue of the Annals of Behavioural Medicine.6 Relatedly, a national conference on the teaching of behavioural science curricula in dentistry was held in 1981. Similar conferences, symposia and other academic meetings have been held more recently, including at the University of Gothenberg.7 In the first 50 or so years of this organized scientific approach, many seminal articles (e.g. Social Science and Medicine;8 Journal of Dental Research;9 International Dental Journal10) were published, special journal issues were organized (e.g. Journal of Public Health Dentistry11), and books were released (e.g. Social Science and Dentistry;12 The Psychology of Dental Care;13 Behavioural Sciences for Dentistry;14 Behavioural Dentistry;15 Sociology and Psychology for the Dental Team16).
As evidenced by this brief historical account, the behavioural and social sciences in oral health have been evolving and growing in impact and recognized importance. Still, there were two issues that we believed impeded the field. First, as noted above, it had been quite a long time since there was a large-scale conference organized specifically for behavioural and social scientists working in the oral health arena. Annual meetings of the International Association for Dental Research (IADR) provided regular opportunities for the IADR Behavioural, Epidemiologic and Health Services Research (BEHSR) scientific group to gather, but those meetings typically involved shorter sessions and interdisciplinary interaction with those in various other specialty fields of dentistry. There was a need for another longer-form and focused conference designed specifically for the interaction of behavioural and social scientists working in oral health. Second, to our knowledge, there never had been a conference of behavioural and social scientists working in oral health that was international in scope. There was (and is) important behavioural and social science work in oral health happening around the world, but it was siloed by country and region. In some ways, this is understandable given the range of social structures, social welfare systems and health issues and oral healthcare systems across the globe. Scientific advances in theory and practice were happening, however, and they had some degree of universal applicability but were not globally inclusive or widely shared. Clearly, cross-fertilization of ideas and practices was needed across countries and regions of the world.
Inspired by the history of the field and the issues that were inhibiting its growth, and formally beginning in 2018 with the encouragement and support of the IADR BEHSR scientific group, we started imagining and planning a large international gathering of behavioural and scientists working in oral health. We envisioned a congress that would include presentations by researchers from around the world on the state of the science and future directions, as well as opportunities for networking and encouraging a new generation of students/trainees and early career researchers. To help plan this event—the Behavioural and Social Oral Health Sciences Summit—we invited behavioural and social scientist colleagues who had been active in BEHSR to participate in a 12-person steering committee, who are acknowledged here with sincere thanks (Tables 1).
TABLE 1.
Behavioural and Social Oral Health Sciences Summit Steering Committee
| Sarah R. Baker, University of Sheffield, UK |
| Belinda Borrelli, Boston University, USA |
| Jacqueline Burgette, University of Pittsburgh, USA |
| Barry J. Gibson, University of Sheffield, UK |
| Lisa J. Heaton, University of Washington, USA |
| George Kitsaras, University of Manchester, UK |
| Colman McGrath, University of Hong Kong, HK |
| Daniel W. McNeil, University of Florida, USA |
| J. Tim Newton, Kings College, London, UK |
| Cameron L. Randall, University of Washington, USA |
| Elise Rice, National Institute on Aging, USA |
| Melissa Riddle, National Institute of Dental and Craniofacial Research, USA |
Note: Daniel W. McNeil formerly was at West Virginia University, USA. Elise Rice formerly was at the National Institute of Dental and Craniofacial Research, USA.
Early in the planning process, and with our colleagues on the steering committee, we developed a vision for the Summit: “Promote oral health globally by advancing the robust application of behavioural and social sciences.” Meeting virtually on a regular basis during the planning stages, we had numerous discussions about the needs of the field, ultimately identifying four thematic content areas of crucial importance. Although the labels for these areas changed somewhat over the course of our work, the four over-arching themes were: (a) Behavioural and social theory and concepts; (b) Methodological issues; (c) Intervention science; and (d) Dissemination and implementation science. Members of the steering committee led workgroups that developed Summit programming for each of these thematic areas.
The Summit was planned to be a one-and-a-half-day in-person conference, organized as a satellite symposium immediately preceding the IADR/AADR/CADR 98th General Session and Centennial Celebration in Washington, DC, in March of 2020. As the entire General Session had to be canceled just 1 week prior to the event due to the COVID-19 pandemic, we (like many colleagues in similar situations) were left a bit bereft. The originally planned event included a number of talks by eminent scholars, interspersed with experiential and small group interactive sessions, which could not be easily implemented using the virtual environments readily available at that time. Only later did we say that we ‘rose from the ashes’ and ‘reimagined’ the Summit.
Over the subsequent weeks and months, we pivoted and prepared for a virtual Summit, which at the time was innovative and somewhat novel. With funding provided by the National Institute of Dental and Craniofacial Research, we were able to enlist the assistance of a vendor that had some experience with webinars. The virtual Summit ultimately was presented 8 months later than originally planned, in October and November 2020. Spanning 3 days, the Summit was reimagined with programming scheduled to maximize access by those living in various time zones so that it could reach as much of the world as possible in real time. There were live presentations by 28 speakers and reactor panel commentary from 23 discussants representing 13 countries, 5 continents and all career stages. The contributions of these colleagues are noted with appreciation (Tables 2). Asynchronous programming, including six short talks, 31 poster presentations and an interview were made available for viewing on the meeting platform along with other resources.
TABLE 2.
List of Summit Invited Speakers and Commentators on Reactor Panels
| Melissa Adiatman, DDS, PhD, University of Indonesia, ID |
| Judith Albino, PhD, University of Colorado, USA |
| P. Finbarr Allen, BDS, PhD, PG CERT TLHE, FDSRCPS, FDS, RCPS, FFDRCCSI, National University of Singapore, SG |
| Sarah R. Baker, PhD, University of Sheffield, UK |
| Belinda Borelli, PhD, Boston University, USA; University of Manchester, UK |
| Tom Broomhead, PhD, University of Sheffield, UK |
| Jacqueline Burgette, DMD, PhD, University of Pittsburgh, USA |
| Roger Keller Celeste, PhD, Universidade Federal Do Rio Grande Do Sul, BR |
| Lois K. Cohen, PhD, National Institute of Dental and Craniofacial Research, USA |
| Tuti Mohd Dom, BDS, MPH, PhD, National University of Malaysia, MY |
| Samuel F. Dworkin, DDS, PhD, University of Washington, USA |
| Edward G. Feil, PhD, Oregon Research Institute, USA |
| Jocelyne Feine, DDS, MS, McGill University, CA |
| Christopher H. Fox, DMD, DMSC, USA |
| Barry J. Gibson, PhD, University of Sheffield, UK |
| Noha Gomaa, BDS, PhD, Schulich School of Medicine and Dentistry; University of Western Ontario, CA |
| Carol C. Guarnizo-Herreno, PhD, National University of Colombia, CO; University College London, UK |
| Kate Gustaferro, PhD, MPH, Pennsylvania State University, USA |
| Dandara Gabriella Haag, PhD, University of Adelaide, AU |
| Rebecca Harris, BDS, PhD, University of Liverpool, UK |
| Lisa J. Heaton, PhD, University of Washington, USA |
| Brenda Heaton, PhD, Boston University, USA |
| Masahiro Heima, RDT, DDS, PhD, Kagoshima University, JP |
| Fang Hua, BDS, PhD, Wuhan University, CN |
| George Kitsaras, PhD, University of Manchester, UK |
| Satu Lahti, DDS, PhD, University of Turku, FI |
| Mary Ellen Macdonald, PhD, McGill University, CA |
| Rani Maharani, DDS, PhD, Universitas Indonesia, ID |
| Colman McGrath, FDSRCS, PhD, University of Hong Kong, HK |
| Daniel W. McNeil, PhD, West Virginia University, USA |
| Gila Neta, PhD, MPP, National Cancer Institute, USA |
| J. Tim Newton, PhD, King’s College London, UK |
| Cynthia Pine, CBE, PhD, Queen Mary University of London; Queen’s University, UK |
| Francisco Ramos-Gomez, DDS, MPH, University of California Los Angeles, USA |
| Cameron L. Randall, PhD, University of Washington, USA |
| Elise Rice, PhD, National Institute of Dental and Craniofacial Research, USA |
| Melissa Riddle, PhD, National Institute of Dental and Craniofacial Research, USA |
| Brad Rindal, DDS, Health Partners, USA |
| Alastair Ross, PhD, University of Glasgow, UK |
| Roslan Bin Saub, PhD, BDS, University of Malaya, MY |
| Helena Schuch, BDS, PhD, Federal University of Pelotas, BR |
| Laura D. Seligman, PhD, ABPP, University of Texas Rio Grande Valley, USA |
| Linda Slack-Smith, BSC, PhD, University of Western Australia, AU |
| Woosung Sohn, DDS, PhD, DRPH, University of Sydney, AU |
| W. Murray Thomson, BDS, PhD, University of Otago, NZ |
| Tamanna Tiwari, BDS, MDS, MPH, University of Colorado Anschutz Medical Campus, USA |
| Georgios Tsakos, PhD, University of College London, UK |
| Bryan Weiner, PhD, University of Washington, USA |
| Dawn Wilson-King, PhD, University of South Carolina, USA |
| Siyang Yuan, BDS, MPH, PhD, University of Dundee, UK |
In retrospect, hosting the Summit virtually and at no cost to participants allowed much greater reach for the event. Truly international involvement was possible, as cost of meeting registration and travel was no longer an impediment. The Summit was live-streamed and recorded, which allowed for those in various time zones across the world to access the programming at a time convenient for them. There were over 600 Summit registrants, with representation from 57 countries. The Summit fulfilled our goal of addressing constrained communication that had limited growth of the field—it was the first large-scale, comprehensive meeting of its type in over 25 years, and one that brought a global perspective in that it was the inaugural international conference on behavioural and social oral health sciences.
The first formal product of the Summit was the Consensus Statement on Future Directions for the Behavioural and Social Sciences in Oral Health.2 A working draft of the Consensus Statement was developed by the Summit steering committee based on Summit thematic areas and content. Excerpts from the working draft were presented during the Summit. Following the event, Summit participants and all members of the IADR were invited to provide feedback on the working draft, which was subsequently refined by the steering committee in an iterative process. The final version of the Consensus Statement, which is composed of four parts that map to the Summit’s thematic areas, was then posted online for endorsement. Ultimately, the Consensus Statement was a landmark publication endorsed by over 400 individuals and groups.2
The second formal product of the Summit is this special issue. Following the major thematic areas originally identified by the Summit steering committee, this special issue has four sections: (a) Behavioural and social theories, models, conceptual frameworks and mechanisms related to oral health; (b) Use of multiple and novel methodologies in social and behavioural research and practice related to oral health; (c) Intervention science: Developing and testing behavioural and social science approaches to promote oral health; and (d) Dissemination and implementation for oral health. To assemble the special issue, steering committee members continued in their leadership roles by coordinating the preparation of or call for the articles that would appear in these various sections. Most of the articles included in this collection were prepared by the Summit presenters and, in that way, serve as published proceedings. Additionally, steering committee members invited some articles from experts who did not present at the Summit, based on the Summit’s illumination of areas that needed additional focus. In this way—and because all authors were asked to draw upon the most contemporary literature available, including material published after the Summit—this special issue constitutes not just a published proceedings but also serves as an extension of the Summit. Importantly, we hope that the special issue provides a roadmap for future research and other initiatives that will contribute to the evolution and full inclusion of the behavioural and social sciences in the oral health arena.
Considerable latitude was given to the steering committee members in planning the type of articles in and the format of their section. We asked that there be at least one foundational article in each section to provide readers with a basic introduction to each thematic area. Beyond that, we encouraged creativity and a customized approach to the construction of each section to accommodate area-specific needs and innovative scholarship. Consequently, there are varying number of articles across sections, as well as differing types and lengths of papers. In total, there are 22 articles in this special issue, in addition to this introductory piece and a bookending concluding piece on future directions.
The first section—on theories, models, mechanisms and related concepts—includes five articles, with two foundational articles. The first of these foundational pieces, by one of us (DWM), is on behavioural and cognitive-behavioural theories, models and other conceptualizations in oral health research; the other, by Tsakos et al., is on theories, pathways and future directions for oral health inequality and inequity research. In the third article, Fleming et al. further extend that line of thought by addressing the important and urgent issue of inequities and oppression in oral health research. Summarizing an exercise that transpired during the Summit, the fourth article in this section, by Newton, reflects Summit participants’ views of priorities for future behavioural and social research into social inequalities. Finally, in the fifth article, Riddle and Rice emphasize the need to rigorously apply theory to intervention research, a topic that also links to content presented in the special issue’s third section on intervention science.
The second section, on methodological issues, includes a foundational article by Baker et al. on the evolution of methodologies in social and behavioural oral health research and practice. Then, seven brief articles follow, each presenting a specific contemporary topic that is important in current and future science, including the operationalization of conceptual models in etiological research (Celeste et al.), causal inference (Schuch et al.), qualitative research (Macdonald), mixed methods research (Nicolau et al.), data linkage (Slack-Smith), complex systems science (Heaton & Baker) and structural determinants of health such as social, economic and political mechanisms that generate social stratification and health consequences from far ‘upstream’ (Broomhead & Baker).
The third section covers behavioural and social intervention science as applied to oral health promotion. An introductory editorial by Borrelli is provided to orient readers to this section and domain of science. In the foundational article that follows, Kitsaras et al. lay out various relevant behavioural and social theories, linking to and extending from the first section of the special issue by also describing methods that logically lead to intervention development. Then, Guastaferro and Strayhorn present the Multiphase Optimization Strategy in the section’s third article, delineating aspects of feasible and effective behavioural and social interventions for oral health. Inequalities and inequities are again a focus in this section, with an article by Goodwin et al. on the impact of inequalities and potential interventions. Finally, Wilson provides an overview of various theory-based intervention strategies from behavioural medicine, including some that have not yet been fully applied to oral health.
Last, the fourth section focuses on dissemination and implementation science. The section opens with a foundational article by one of us (CLR), which presents key background on this emerging science, a review of literature applying it in oral health research and a discussion of future directions. There are two articles that follow to provide real-world examples of implementation research for dentistry and oral health: Ross et al. present data from the implementation of a national oral health improvement program for Scottish children, and Rindal et al. present data from a de-implementation project aimed at reducing opioid prescribing by dentists in a large healthcare system. Finally, Burgette et al. offer a narrative summary of a panel discussion on implementation research for oral health that occurred as part of the Summit.
With an eye to the future and the aim of further advancing the field, we offer this special issue of Community Dentistry and Oral Epidemiology. We hope this special issue has helped fulfil the mission of the Summit, to “maximize the impact of behavioural and social sciences for the promotion of oral health by building consensus among health scientists and clinicians about essential foci, identifying critical next steps and fostering transdisciplinary collaboration.” And we are excited to see where things head!
Throughout the process of organizing the Summit and preparing this special issue, we have been challenged greatly, and we have learned much. Like others—and with sensitivity to the massive global impact of the pandemic on health and well-being, and the many simultaneous overdue social and political movements occurring across the globe—we have experienced tumultuous times the last several years, almost the entire course of this overall initiative. It has been a wild ride. For the entire journey, though, we have enormously enjoyed working with our inspiring and committed colleagues from around the world. We are happy and grateful for this culmination of their efforts and contributions. In this special issue, a new generation of ‘architects’, along with accomplished experts who have already contributed so much, chart the course ahead for our field.
ACKNOWLEDGEMENTS
This article and the special issue it introduces were inspired by presentations at the 2020 Behavioural and Social Oral Health Sciences Summit. For their many roles in supporting and facilitating the Summit, gratitude is extended to: the Summit Steering Committee; the Behavioural, Epidemiologic and Health Services Research (BEHSR) scientific group of the International Association for Dental Research (IADR); IADR leadership and staff; and the National Institute of Dental and Craniofacial Research, National Institutes of Health, USA. A warm note of thanks is extended to Sarah R Baker, Editor-in-Chief of Community Dentistry and Oral Epidemiology, for her involvement in and encouragement of this special issue, as well as her support throughout the process that led to its realization. We also acknowledge with sincere gratitude those who served as reviewers for this special issue. Those who participated in the Summit by delivering invited presentations or who served as commentators on reactor panels also are acknowledged with admiration and gratitude.
FUNDING INFORMATION
Preparation of this article was supported in part by National Institute of Dental and Craniofacial Research, National Institutes of Health (UG3DE032004; K23DE028906).
Footnotes
CONFLICT OF INTEREST
DWM and CLR declare no conflicts of interest.
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no new data were created or analysed in this study.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing is not applicable to this article as no new data were created or analysed in this study.