Objective To examine tooth loss and dental caries by sociodemographic characteristics from community-based oral health examinations conducted by dentists in northern Manhattan. Background The ElderSmile programme of the Columbia University College of Dental Medicine serves older adults with varying functional capacities across settings. This report is focused on relatively mobile, socially engaged participants who live in the impoverished communities of Harlem and Washington Heights/Inwood in northern Manhattan, New York City. Materials and Methods Self-reported sociodemographic characteristics and health and health care information were provided by community-dwelling ElderSmile participants aged 65 years and older who took part in community-based oral health education and completed a screening questionnaire. Oral health examinations were conducted by trained dentists in partnering prevention centres among ElderSmile participants who agreed to be clinically screened (90.8%). Results The dental caries experience of ElderSmile participants varied significantly by sociodemographic predictors and smoking history. After adjustment in a multivariable logistic regression model, older age, non-Hispanic Black and Hispanic race/ethnicity, and a history of current or former smoking were important predictors of edentulism. Conclusion Provision of oral health screenings in community-based settings may result in opportunities to intervene before oral disease is severe, leading to improved oral health for older adults.

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Samples of water and sediments were collected from 24 urban wetlands in Melbourne, Australia, in April 2010, and tested for more than 90 pesticides using a range of gas chromatographic (GC) and liquid chromatographic (LC) techniques, sample 'hormonal' activity using yeast-based recombinant receptor-reporter gene bioassays, and trace metals using spectroscopic techniques. At the time of sampling, there was almost no estrogenic activity in the water column. Twenty-three different pesticide residues were observed in one or more water samples from the 24 wetlands; chemicals observed at more than 40% of sites were simazine (100%), atrazine (79%), and metalaxyl and terbutryn (46%). Using the toxicity unit (TU) concept, less than 15% of the detected pesticides were considered to pose an individual, short-term risk to fish or zooplankton in the ponds and wetlands. However, one pesticide (fenvalerate) may have posed a possible short-term risk to fish (log10TUf > -3), and three pesticides (azoxystrobin, fenamiphos and fenvalerate) may have posed a risk to zooplankton (logTUzp between -2 and -3); all the photosystem II (PSII) inhibiting herbicides may have posed a risk to primary producers in the ponds and wetlands (log10TUap and/or log10TUalg > -3). The wetland sediments were contaminated with 16 different pesticides; no chemicals were observed at more than one third of sites, but based on frequency of detection and concentrations, bifenthrin (33%, maximum 59 μg/kg) is the priority insecticide of concern for the sediments studied. Five sites returned a TU greater than the possible effect threshold (i.e. log10TU > 1) as a result of bifenthrin contamination of their sediments. Most sediments did not exceed Australian sediment quality guideline levels for trace metals. However, more than half of the sites had threshold effect concentration quotients (TECQ) values >1 for Cu (58%), Pb (50%), Ni (67%) and Zn (63%), and 75% of sites had mean probable effect concentration quotients (PECQ) >0.2, suggesting that the collected sediments may have been having some impact on sediment-dwelling organisms.

Racial/ethnic and socioeconomic disparities regarding untreated oral disease exist for older adults, and poor oral health diminishes quality of life. The ElderSmile program integrated screening for diabetes and hypertension into its community-based oral health activities at senior centers in northern Manhattan. Findings were that minority seniors were willing to be screened for primary care sensitive conditions by dental professionals, and a high level of unrecognized disease was found (7.8% and 24.6% of ElderSmile participants had positive screening results for previously undiagnosed diabetes and hypertension, respectively). Dental professionals may screen for primary care sensitive conditions and refer patients to health care providers for definitive diagnosis and treatment. The ElderSmile program is a replicable model for community-based oral and general health screening.

In both developed and developing countries, population aging has attained unprecedented levels. Public health strategies to deliver services in community-based settings are key to enhancing the utilization of preventive care and reducing costs for this segment of the population. Motivated by concerns of inadequate access to oral health care by older adults in urban environments, this article presents a portfolio of systems science models that have been developed on the basis of observations from the ElderSmile preventive screening program operated in northern Manhattan, New York City, by the Columbia University College of Dental Medicine. Using the methodology of system dynamics, models are developed to explore how interpersonal relationships influence older adults’ participation in oral health promotion. Feedback mechanisms involving word of mouth about preventive screening opportunities are represented in relation to stocks that change continuously via flows, as well as agents whose states of health care utilization change discretely using stochastic transitions. Agent-based implementations illustrate how social networks and geographic information systems are integrated into dynamic models to reflect heterogeneous and proximity-based patterns of communication and participation in the ElderSmile program. The systems science approach builds shared knowledge among an interdisciplinary research team about the dynamics of access to opportunities for oral health promotion. Using “what if” scenarios to model the effects of program enhancements and policy changes, resources may be effectively leveraged to improve access to preventive and treatment services. Furthermore, since oral health and general health are inextricably linked, the integration of services may improve outcomes and lower costs.