{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T23:56:12Z","timestamp":1781567772727,"version":"3.54.5"},"reference-count":75,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Shanghai Jiao Tong University \"Startup Plan for New Young Teachers\u201d","award":["21X010501094"],"award-info":[{"award-number":["21X010501094"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72204156"],"award-info":[{"award-number":["72204156"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72293580"],"award-info":[{"award-number":["72293580"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72293585"],"award-info":[{"award-number":["72293585"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Soft Science Research Project of Shanghai","award":["22692192000"],"award-info":[{"award-number":["22692192000"]}]},{"name":"Soft Science Research Project of Shanghai","award":["25692115100"],"award-info":[{"award-number":["25692115100"]}]},{"name":"Shanghai Pujiang Program","award":["2020PJC081"],"award-info":[{"award-number":["2020PJC081"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,5,22]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Oral diseases affect nearly half of the global population and impose substantial health and economic burdens, particularly in China. However, evidence on the cost-effectiveness of preventive oral health interventions remains limited. This study aims to evaluate the long-term cost-effectiveness of promoting population-based oral self-care behaviours across China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed the China Oral Health Model, a prevention-oriented population policy simulation that projects annual transitions across major oral health states (dental caries, periodontitis, tooth loss and edentulism) among individuals aged \u226512 years. Preventive self-care strategies were modelled as relative reductions in the probabilities of disease onset and progression, implemented through changes in intermediate clinical states. The model was parameterised using nationally representative data from the Fourth National Oral Health Survey of China, 2015 to 2017, supplemented by age-specific prevalence estimates from the literature. We evaluated three key oral self-care behaviours: brushing teeth twice daily, using dental floss and using mouthwash. Intervention effect parameters for brushing, flossing and mouthwash were obtained from published clinical and epidemiological studies, with uncertainty assessed in sensitivity analyses. We conducted a societal-perspective cost-effectiveness analysis, stratified by rural and urban populations, including intervention costs estimated from market price data. Outcomes included lifetime reductions in tooth loss, total costs, quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratios (ICERs) compared with current practice. Cost-effectiveness was assessed against a willingness-to-pay threshold of $12,720.20 per QALY (one time GDP per capita), with threshold sensitivity analyses using one to three times GDP per capita.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Brushing teeth twice daily was the only cost-saving intervention, reducing periodontitis by 50.2% relative to status quo, dental caries by 6.5% and tooth loss by 24.8%, while generating $718.82\u2009billion in medical cost savings. The intervention yielded 148.27\u2009million QALYs nationally (98.10\u2009million in urban areas and 50.17\u2009million in rural areas), with a greater reduction in periodontitis observed in rural regions (1.38\u2009percentage points higher than urban). In contrast, dental flossing and mouthwash use increased costs and were not cost-effective at the one time GDP-per-capita threshold (ICERs of $49,677.58\/QALY and $84,283.51\/QALY, respectively). Findings were robust in threshold sensitivity analyses using one to three times GDP per capita.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Promoting twice-daily toothbrushing is cost-saving and improves oral health outcomes in China, particularly by reducing periodontitis and tooth loss, with larger periodontitis reductions in rural areas. These findings support the integration of basic oral hygiene practices into national health promotion and disease prevention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004037","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T23:40:16Z","timestamp":1781566816000},"page":"e004037","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effectiveness of promoting preventive oral self-care in China: a population-based modelling study"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6736-1189","authenticated-orcid":false,"given":"Chang","family":"Ma","sequence":"first","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Prosthodontics,Stomatological Hospital and Dental School, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuanjing","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Yu","sequence":"additional","affiliation":[{"name":"School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China"},{"name":"Key Laboratory of Urban Complex Risk Control and Resilience Governance, Shanghai Emergency Management, Shanghai Jiao Tong University, Shanghai, China"},{"name":"School of Emergency Management, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Gao","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxiang","family":"Tao","sequence":"additional","affiliation":[{"name":"Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Prosthodontics,Stomatological Hospital and Dental School, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6155-0389","authenticated-orcid":false,"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China"},{"name":"Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4128-8501","authenticated-orcid":false,"given":"Yipeng","family":"Lv","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China"},{"name":"Key Laboratory of Urban Complex Risk Control and Resilience Governance, Shanghai Emergency Management, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"2026061516401071000_4.2.e004037.1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-040119-094318"},{"key":"2026061516401071000_4.2.e004037.2","unstructured":"World Health Organization . Global oral health status report: towards universal health coverage for oral health by 2030. 2022."},{"key":"2026061516401071000_4.2.e004037.3","doi-asserted-by":"crossref","first-page":"930","DOI":"10.5114\/aoms\/165962","article-title":"Burden of oral disorders, 1990-2019: estimates from the Global Burden of Disease Study 2019","volume":"19","author":"Tu","year":"2023","journal-title":"Arch Med Sci"},{"key":"2026061516401071000_4.2.e004037.4","doi-asserted-by":"publisher","DOI":"10.1177\/0022034517750572"},{"key":"2026061516401071000_4.2.e004037.5","unstructured":"World Health Organization . Oral health. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/oral-health [Accessed 27 Aug 2024]."},{"key":"2026061516401071000_4.2.e004037.6","first-page":"173","article-title":"Evidence accumulates indicating periodontal disease as a risk factor for colorectal cancer or lymphoma","volume":"67","author":"Barton","year":"2017","journal-title":"CA A Cancer J Clinicians"},{"key":"2026061516401071000_4.2.e004037.7","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2007.060062"},{"key":"2026061516401071000_4.2.e004037.8","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1996.67.10s.1103"},{"key":"2026061516401071000_4.2.e004037.9","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1002\/ijc.30486","article-title":"Periodontal disease, tooth loss and colorectal cancer risk: Results from the Nurses\u2019 Health Study: Periodontal disease, tooth loss and colorectal cancer risk","volume":"140","author":"Momen-Heravi","year":"2017","journal-title":"Int J Cancer"},{"key":"2026061516401071000_4.2.e004037.10","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-010-1263-9"},{"key":"2026061516401071000_4.2.e004037.11","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2013.1340011"},{"key":"2026061516401071000_4.2.e004037.12","doi-asserted-by":"publisher","DOI":"10.1038\/nri3785"},{"key":"2026061516401071000_4.2.e004037.13","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1177\/154411130401500606","article-title":"Oral health, atherosclerosis, and cardiovascular disease","volume":"15","author":"Meurman","year":"2004","journal-title":"Critical Reviews in Oral Biology & Medicine"},{"key":"2026061516401071000_4.2.e004037.14","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2005.76.11-S.2066"},{"key":"2026061516401071000_4.2.e004037.15","doi-asserted-by":"crossref","first-page":"665","DOI":"10.3233\/JAD-121918","article-title":"Determining the Presence of Periodontopathic Virulence Factors in Short-Term Postmortem Alzheimer\u2019s Disease Brain Tissue","volume":"36","author":"Poole","year":"2013","journal-title":"Journal of Alzheimer\u2019s Disease"},{"key":"2026061516401071000_4.2.e004037.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.chom.2016.07.006"},{"key":"2026061516401071000_4.2.e004037.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-12262-x","article-title":"Trend on dental caries status and its risk indicators in children aged 12 years in China: a multilevel analysis based on the repeated national cross-sectional surveys in 2005 and 2015","volume":"21","author":"Li","year":"2021","journal-title":"BMC Public Health"},{"key":"2026061516401071000_4.2.e004037.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-068724","article-title":"Association between periodontitis and hypertension: cross-sectional survey from the Fourth National Oral Health Survey of China (2015-2016)","volume":"13","author":"Zhan","year":"2023","journal-title":"BMJ Open"},{"key":"2026061516401071000_4.2.e004037.19","unstructured":"Chinese Stomatological Association . The fourth national oral health epidemiological survey of china(2015-2017) - national survey report. beijing: People\u2019s Medical Publishing House; 2015."},{"key":"2026061516401071000_4.2.e004037.20","first-page":"27","article-title":"The prevalence of dental flossing in patients with chronic periodontitis inIranian population","volume":"10","author":"Salari","year":"2021","journal-title":"Journal of Dentomaxillofacial Radiology, Pathology and Surgery"},{"key":"2026061516401071000_4.2.e004037.21","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/idj.12600","article-title":"Socio-Economic Disparities in Dental Health and Dental Care Utilisation Among Older Chinese","volume":"71","author":"Li","year":"2021","journal-title":"Int Dent J"},{"key":"2026061516401071000_4.2.e004037.22","unstructured":"Oral health: supporting adults who require assistance | rnao.ca. Available: https:\/\/rnao.ca\/bpg\/guidelines\/oral-health-supporting-adults-who-require-assistance [Accessed 20 Mar 2026]."},{"key":"2026061516401071000_4.2.e004037.23","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12366"},{"key":"2026061516401071000_4.2.e004037.24","article-title":"Fluoride toothpastes of different concentrations for preventing dental caries","volume":"3","author":"Walsh","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2026061516401071000_4.2.e004037.25","article-title":"Powered versus manual toothbrushing for oral health","volume":"2014","author":"Yaacob","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"2026061516401071000_4.2.e004037.26","article-title":"Chlorhexidine mouthrinse as an adjunctive treatment for gingival health","volume":"3","author":"James","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2026061516401071000_4.2.e004037.27","unstructured":"Global strategy and action plan on oral health 2023\u20132030. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240090538 [Accessed 17 Mar 2025]."},{"key":"2026061516401071000_4.2.e004037.28","doi-asserted-by":"publisher","DOI":"10.3290\/j.cjdr.a41079"},{"key":"2026061516401071000_4.2.e004037.29","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.glohj.2019.06.004","article-title":"Oral health status of Chinese residents and suggestions for prevention and treatment strategies","volume":"3","author":"Si","year":"2019","journal-title":"Global Health Journal"},{"key":"2026061516401071000_4.2.e004037.30","doi-asserted-by":"crossref","DOI":"10.1186\/s12903-025-06696-7","article-title":"Predictive validity and cost-effectiveness analysis of two caries risk assessment tools for preschool children","volume":"25","author":"Menglin","year":"2025","journal-title":"BMC Oral Health"},{"key":"2026061516401071000_4.2.e004037.31","first-page":"45","article-title":"Cost-effectiveness Analysis of Comprehensive Oral Health Care for Severe Early Childhood Caries in Urban Beijing, China","volume":"22","author":"Xie","year":"2019","journal-title":"Chin J Dent Res"},{"key":"2026061516401071000_4.2.e004037.32","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/2052-3211-8-S1-O5","article-title":"A cost\/benefit analysis of self-care initiatives in the European Union: who gains, who loses?","volume":"8","author":"Renner","year":"2015","journal-title":"J of Pharm Policy and Pract"},{"key":"2026061516401071000_4.2.e004037.33","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph16152668","article-title":"Clinical Effectiveness and Cost-Effectiveness of Oral-Health Promotion in Dental Caries Prevention among Children: Systematic Review and Meta-Analysis","volume":"16","author":"Fraihat","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"2026061516401071000_4.2.e004037.34","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.1243246","article-title":"Nudging oral habits; application of behavioral economics in oral health promotion: a critical review","volume":"11","author":"Kazemian","year":"2023","journal-title":"Front Public Health"},{"key":"2026061516401071000_4.2.e004037.35","doi-asserted-by":"publisher","DOI":"10.1177\/0022034517693566"},{"key":"2026061516401071000_4.2.e004037.36","unstructured":"Global Burden of Disease Collaborative Network . Global burden of disease study 2019 (gbd 2019) results. Seattle, WA:Institute for Health Metrics and Evaluation (IHME); 2020. Available: https:\/\/ghdx.healthdata.org\/gbd-2019"},{"key":"2026061516401071000_4.2.e004037.37","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.23949","article-title":"Estimated Cost-effectiveness of Newborn Screening for Congenital Cytomegalovirus Infection in China Using a Markov Model","volume":"3","author":"Chen","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2026061516401071000_4.2.e004037.38","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1902\/jop.2006.050362","article-title":"Clinical efficacy of flossing versus use of antimicrobial rinses","volume":"77","author":"Zimmer","year":"2006","journal-title":"J Periodontol"},{"key":"2026061516401071000_4.2.e004037.39","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1111\/idh.12642","article-title":"Oral health status, oral health-related quality of life and personality factors among users of three-sided sonic-powered toothbrush versus conventional manual toothbrush","volume":"21","author":"Al-Omiri","year":"2023","journal-title":"Int J Dent Hyg"},{"key":"2026061516401071000_4.2.e004037.40","unstructured":"National Economic and Social Development . Statistical communiqu\u00e9 of the people\u2019s republic of china on the 2023. 2024. Available: https:\/\/www.stats.gov.cn\/sj\/zxfb\/202402\/t20240228_1947915.html"},{"key":"2026061516401071000_4.2.e004037.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2016.02.017"},{"key":"2026061516401071000_4.2.e004037.42","first-page":"207","article-title":"An assessment of the cost effectiveness of a postal toothpaste programme to prevent caries among five-year-old children in the North West of England","volume":"20","author":"Davies","year":"2003","journal-title":"Community Dent Health"},{"key":"2026061516401071000_4.2.e004037.43","first-page":"265","article-title":"A cost-benefit analysis of an advocacy project to fluoridate toothpastes in Nepal","volume":"21","author":"Yee","year":"2004","journal-title":"Community Dent Health"},{"key":"2026061516401071000_4.2.e004037.44","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/ipd.13214","article-title":"Modeling the cost\u2010effectiveness of school\u2010based supervised toothbrushing program in reducing the dental caries burden in India","volume":"35","author":"Sharda","year":"2025","journal-title":"Int J Paed Dentistry"},{"key":"2026061516401071000_4.2.e004037.45","doi-asserted-by":"crossref","DOI":"10.2196\/resprot.4485","article-title":"\u201cEverybody brush!\u201d: protocol for a parallel-group randomized controlled trial of a family-focused primary prevention program with distribution of oral hygiene products and education to increase frequency of toothbrushing","volume":"4","author":"Cunha-Cruz","year":"2015","journal-title":"JMIR Res Protoc"},{"key":"2026061516401071000_4.2.e004037.46","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4103\/0795-3038.197750","article-title":"A study of the effect of frequency of tooth brushing on the prevalence of inflammatory periodontal diseases","volume":"10","author":"Akhionbare","year":"2016","journal-title":"Port Harcourt Med J"},{"key":"2026061516401071000_4.2.e004037.47","doi-asserted-by":"crossref","first-page":"83","DOI":"10.5051\/jpis.2020.50.2.83","article-title":"Efficacy of non-surgical treatment accompanied by professional toothbrushing in the treatment of chronic periodontitis in patients with type 2 diabetes mellitus: a randomized controlled clinical trial","volume":"50","author":"Lee","year":"2020","journal-title":"J Periodontal Implant Sci"},{"key":"2026061516401071000_4.2.e004037.48","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/j.1875-595X.2008.tb00206.x","article-title":"Tooth brushing behaviour in Europe: opportunities for dental public health","volume":"58","author":"Eaton","year":"2008","journal-title":"Int Dent J"},{"key":"2026061516401071000_4.2.e004037.49","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s40258-022-00758-5","article-title":"Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review","volume":"21","author":"Nguyen","year":"2023","journal-title":"Appl Health Econ Health Policy"},{"key":"2026061516401071000_4.2.e004037.50","first-page":"1","article-title":"Mouthwash Use and the Prevention of Plaque, Gingivitis and Caries","volume":"20","year":"2014","journal-title":"Oral Dis"},{"key":"2026061516401071000_4.2.e004037.51","first-page":"30","article-title":"Comparative study of four over-the-counter mouthrinses claiming antiplaque and\/or antigingivitis benefits","volume":"13","author":"Nelson","year":"1991","journal-title":"Clin Prev Dent"},{"key":"2026061516401071000_4.2.e004037.52","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics11060727","article-title":"Evidence on the Use of Mouthwash for the Control of Supragingival Biofilm and Its Potential Adverse Effects","volume":"11","author":"Takenaka","year":"2022","journal-title":"Antibiotics (Basel)"},{"key":"2026061516401071000_4.2.e004037.53","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1007\/s00784-016-1876-2","article-title":"Effect of mouthwashes on the composition and metabolic activity of oral biofilms grown in vitro","volume":"21","author":"Fernandez y Mostajo","year":"2017","journal-title":"Clin Oral Invest"},{"key":"2026061516401071000_4.2.e004037.54","doi-asserted-by":"crossref","DOI":"10.1038\/s41522-020-0124-3","article-title":"Oral biofilms exposure to chlorhexidine results in altered microbial composition and metabolic profile","volume":"6","author":"Chatzigiannidou","year":"2020","journal-title":"NPJ Biofilms Microbiomes"},{"key":"2026061516401071000_4.2.e004037.55","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1111\/j.1600-051X.1989.tb00003.x","article-title":"Effects of 6 months use of an antiseptic mouthrinse on supragingival dental plaque microflora","volume":"16","author":"Minah","year":"1989","journal-title":"J Clinic Periodontology"},{"key":"2026061516401071000_4.2.e004037.56","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/j.1574-695X.2008.00443.x","article-title":"Plaques from different individuals yield different microbiota responses to oral-antiseptic treatment","volume":"54","author":"Filoche","year":"2008","journal-title":"FEMS Immunology & Medical Microbiology"},{"key":"2026061516401071000_4.2.e004037.57","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-61912-4","article-title":"Effects of Chlorhexidine mouthwash on the oral microbiome","volume":"10","author":"Bescos","year":"2020","journal-title":"Sci Rep"},{"key":"2026061516401071000_4.2.e004037.58","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0302592","article-title":"Cost-effectiveness and cost-utility analyses of three different gargles in the treatment of chronic periodontitis","volume":"19","author":"Chen","year":"2024","journal-title":"PLoS ONE"},{"key":"2026061516401071000_4.2.e004037.59","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.sdentj.2021.03.005","article-title":"Comparison between water flosser and regular floss in the efficacy of plaque removal in patients after single use","volume":"33","author":"Abdellatif","year":"2021","journal-title":"Saudi Dent J"},{"key":"2026061516401071000_4.2.e004037.60","doi-asserted-by":"crossref","first-page":"559","DOI":"10.4103\/jisp.jisp_597_22","article-title":"Comparing the effectiveness of water flosser and dental floss in plaque reduction among adults: A systematic review","volume":"27","author":"Mohapatra","year":"2023","journal-title":"J Indian Soc Periodontol"},{"key":"2026061516401071000_4.2.e004037.61","doi-asserted-by":"crossref","unstructured":"Sultan M , Qureshi S , Jamelle A , et al . Plaque Control Efficacy: Interdental Brushes versus Dental Floss. JPRI 2022;22\u20139. doi:10.9734\/jpri\/2022\/v34i46A36373","DOI":"10.9734\/jpri\/2022\/v34i46A36373"},{"key":"2026061516401071000_4.2.e004037.62","article-title":"Comparative Evaluation of Cleaning Efficacy of Interdental Brush and Interdental Floss in Orthodontics Patients From Vidarbha Region: An Interventional Study","volume":"15","author":"Umalkar","year":"2023","journal-title":"Cureus"},{"key":"2026061516401071000_4.2.e004037.63","doi-asserted-by":"crossref","first-page":"36","DOI":"10.4103\/jihs.jihs_4_24","article-title":"Evaluation of Clinical Efficacy and Patient Compliance of Interdental Floss as an Adjunct to Toothbrushing for Control of Dental Plaque: A Comparative Study","volume":"12","author":"Chipre","year":"2024","journal-title":"Journal of Integrated Health Sciences"},{"key":"2026061516401071000_4.2.e004037.64","unstructured":"Anderson SE , Sandoval P , Sim G , et al . A Comparative Expected Cost Analysis Study on Dental Services and Products Used in the United States. ResearchGate 2020."},{"key":"2026061516401071000_4.2.e004037.65","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1007\/s00784-020-03201-y","article-title":"How to intervene in the caries process: proximal caries in adolescents and adults\u2014a systematic review and meta-analysis","volume":"24","author":"Splieth","year":"2020","journal-title":"Clin Oral Invest"},{"key":"2026061516401071000_4.2.e004037.66","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1038\/s41415-023-6601-3","article-title":"Addressing oral health inequities in rural communities: a call to action","volume":"235","author":"Bridge","year":"2023","journal-title":"Br Dent J"},{"key":"2026061516401071000_4.2.e004037.67","unstructured":"Product price information for oral care products [eb\/ol]. Available: https:\/\/www.jd.com [Accessed 26 Jan 2026]."},{"key":"2026061516401071000_4.2.e004037.68","unstructured":"Notice on optimizing and adjusting medical service price items [eb\/ol]. Available: https:\/\/ybj.sh.gov.cn\/qtwj\/20240209\/8dda128b30e94846b43fb7902043ed4a.html [Accessed 9 Feb 2024]."},{"key":"2026061516401071000_4.2.e004037.69","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2486\/indhealth.2021-0274","article-title":"Cross-sectional associations between oral diseases and work productivity loss among regular employees in Japan","volume":"61","author":"Sato","year":"2023","journal-title":"Ind Health"},{"key":"2026061516401071000_4.2.e004037.70","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2025-223754"},{"key":"2026061516401071000_4.2.e004037.71","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1134\/S1019331621060083","article-title":"The Seventh Population Census in the PRC: Results and Prospects of the Country\u2019s Demographic Development","volume":"91","author":"Akimov","year":"2021","journal-title":"Her Russ Acad Sci"},{"key":"2026061516401071000_4.2.e004037.72","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-008-0230-8"},{"key":"2026061516401071000_4.2.e004037.73","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.10951"},{"key":"2026061516401071000_4.2.e004037.74","doi-asserted-by":"crossref","first-page":"S68","DOI":"10.1111\/jcpe.12940","article-title":"Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri\u2010Implant Diseases and Conditions","volume":"45","author":"Chapple","year":"2018","journal-title":"J Clinic Periodontology"},{"key":"2026061516401071000_4.2.e004037.75","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13167"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004037","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T23:40:25Z","timestamp":1781566825000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":75,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6,15]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bmjph-2025-004037"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004037","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}