Editorial: Addressing oral health disparities in maternal and child populations

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providers favored fully online delivery because of travel constraints. Together, these studies show that expanding preventive oral health care requires targeted investment in contextspecific training (8).Two studies measure how dental disease affects children's daily lives. A study of 183 mother-child pairs in Chile found that dental caries accounted for over half of the relationship between maternal age and children's oral health-related quality of life. The finding suggests that caries prevention can help address equity gaps linked to maternal life-course factors (9). A national study of 892 Kuwaiti preschoolers found that 88.6% had early childhood caries (ECC). Nearly two-thirds of these cases showed extensive, untreated lesions. Caries experience strongly affected quality of life more than its severity. This indicates that even a high-income country with universal healthcare access, then, can still face a significant and preventable disease burden (10).Four articles examine how systems and policies shape access. In the United States, an analysis of Medicaid-CHIP data found that children with public insurance have limited or no access to endodontic, oral surgery, or orthodontic specialists in about half of states. The gap is most severe for endodontic care, despite broad access to pediatric dentists (11). Two companion studies evaluate Canada's Interim Canada Dental Benefit. An analysis of the first 18 months found that low-income families made up most approved applicants. The program allocated hundreds of millions of dollars to families in need. Geographic disparities in uptake remained (12). A follow-up analysis of the program's first year, focused on children under 12, shows that expanding affordability significantly improves access. Affordability alone, however, does not eliminate every barrier families face. Services must also be available where families live, particularly in rural and remote communities, and programs must address the accessibility, accommodation, and cultural fit of care, not just its cost (13).Two studies examine how to integrate oral health promotion into trusted community settings. In Western Kenya, a proposed strategy integrates oral health promotion into Chamas for Change, a maternal health program built around microfinance. The strategy uses the WHO's Basic Package of Oral Care to reach mothers and children in areas without formal dental infrastructure (14). A qualitative study of immigrant parents in Norway examined an intervention with limited effectiveness. Parents valued nativelanguage materials. Parents trusted public health nurses more than researchers as messengers. Cultural differences in norms around sugar and toothbrushing also shaped how guidance was received. Together, the two studies indicate that oral health promotion works best when it is part of trusted relationships and adapted to specific cultural contexts, rather than delivered as a generic message (15).Two studies in Peru examine which preventive tools work, and whether they reach the children who need them. A randomized trial of 200 schoolchildren in Peru compared four topical fluoride formulations. 5% fluoride varnish maintained elevated salivary pH, a marker of protection against demineralization, longer than fluoride gels or standard toothpaste, suggesting that fluoride varnish offers superior protection for children in highrisk, high-altitude environments (16). A companion study found no association between access to dental services and use of adequately fluoridated toothpaste. Instead, toothpaste use varied by region, urban or rural residence, and household wealth. Improving access to dental care and expanding the availability of everyday preventive products are two separate problems. Each needs its own solution (17).These 14 studies show one thing clearly: expanding access does not reliably translate into better oral health, and this should change how policymakers and funders think about closing this gap. Canada's dental benefit helped low-income families as intended, but it did not eliminate all thebarrier they encountered (12,13). Peruvian children with access to dental services were just as likely to use adequately fluoridated toothpaste as children without access (17). A country with universal healthcare access still faces one of the highest reported ECC burdens globally (10). Access is necessary, but access alone is not enough. It must be combined with trust, training, and cultural fit. Without these, investment and appointments will not translate into disease prevention. Funders and policymakers should stop viewing coverage expansion as the end goal. Instead, they need to invest in training, outreach, and trust-building to make coverage effective and accessible. Healthcare providers outside dentistry, including nurses, family physicians, obstetric teams, and community health workers, face a training barrier, not a lack of desire. Studies consistently show high interest alongside real gaps in preparation. Researchers should ask "for whom, delivered how, and trusted by whom" before asking "does the program work." A fluoride varnish, a training format, or a benefit design that succeeds in one setting will not automatically succeed in another. The WHO targets 2030 for universal oral health coverage (1). Based on this evidence, insurance and infrastructure alone will not meet that target. Training determines whether the providers families already see, nurses, family physicians, obstetric teams, and community health workers, can act on oral health rather than defer it to dentistry alone. Trust determines whether families use the services once they exist, since uptake follows the messenger as much as the message. Cultural adaptation determines whether guidance fits how a community actually lives, from language and norms around sugar and toothbrushing to who is seen as a credible source of health information. Coverage expansion creates the conditions for better oral health. It does not, on its own, produce it.

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