{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:54:44Z","timestamp":1790747684524,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Climate change is a major public-health concern, but short-term population-level evidence linking annual climate variability to oral-health outcomes remains limited. This study evaluates within-country associations between temperature, extreme heat days, and three oral-health indicators across EU member states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A longitudinal ecological panel analysis was conducted for the 27 EU member states from 2016 to 2023. Daily temperatures at each country centroid were obtained from the Open-Meteo Historical Weather API and aggregated to annual mean temperature and days with maximum temperature above 30\u202f\u00b0C. Outcomes were GBD 2023 carries and periodontal prevalence and Eurostat unmet dental care. Two-way fixed-effects models used country-clustered finite-sample-corrected standard errors and 999-replication wild-cluster bootstrap\n                      <jats:italic>p<\/jats:italic>\n                      -values.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Neither mean annual temperature nor extreme heat days were associated with any outcome in the two-way fixed-effects models. Within R-squared values were 0.056 for caries, 0.032 for periodontal disease, and 0.044 for unmet dental care. Wild-cluster bootstrap inference confirmed the absence of associations at the 5% level. Quadratic temperature terms and climate-by-expenditure interactions were also non-significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Over the eight-year study period, short-term within-country variation in the reconstructed climate indicators was not associated with the examined oral-health outcomes. Nonlinear and expenditure-interaction models were also null. Longer panels, spatially resolved exposure measures, and oral-health-specific financing, coverage, and utilization indicators are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1939057","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:56:19Z","timestamp":1790744179000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Climate risk or healthcare investment? Explaining oral health outcomes across European Union member states"],"prefix":"10.3389","volume":"14","author":[{"given":"Cassandra","family":"Lupita","sequence":"first","affiliation":[{"name":"Department of Oral Pathology, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca-Cristina","family":"Perpelea","sequence":"additional","affiliation":[{"name":"Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura-Cristina","family":"Rusu","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iulia","family":"Muntean","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edida","family":"Maghet","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Ramona","family":"Lobon\u021b","sequence":"additional","affiliation":[{"name":"Finance, Business Information Systems and Modeling Department, Faculty of Economics and Business Administration, West University of Timisoara","place":["Timisoara, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magda-Mihaela","family":"Luca","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Faculty of Dental Medicine, \u201cVictor Babes\u201d, University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref1","volume-title":"Climate Change 2022: Impacts, Adaptation and Vulnerability","year":"2022"},{"key":"ref2","volume-title":"Climate change and Health","year":"2023"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1016\/S0140-6736(21)01787-6","article-title":"The 2021 report of the lancet countdown on health and climate change","volume":"398","author":"Watts","year":"2021","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12940-016-0105-2","article-title":"Effects of air temperature on climate-sensitive mortality and morbidity outcomes","volume":"15","author":"Bunker","year":"2016","journal-title":"Environ Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1038\/nclimate3322","article-title":"Global risk of deadly heat","volume":"7","author":"Mora","year":"2017","journal-title":"Nat Clim Chang"},{"key":"ref6","volume-title":"Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030","year":"2022"},{"key":"ref7","first-page":"661","article-title":"The global burden of oral diseases and risks to oral health","volume":"83","author":"Petersen","year":"2005","journal-title":"Bull World Health Organ"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1177\/0022034515573272","article-title":"Global burden of untreated caries","volume":"94","author":"Kassebaum","year":"2015","journal-title":"J Dent Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"S30","DOI":"10.1111\/j.1753-4887.2005.tb00152.x","article-title":"Human water needs","volume":"63","author":"Sawka","year":"2005","journal-title":"Nutr Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1111\/j.1753-4887.2010.00304.x","article-title":"Water, hydration, and health","volume":"68","author":"Popkin","year":"2010","journal-title":"Nutr Rev"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2598","DOI":"10.1152\/japplphysiol.00202.2003","article-title":"Aging and human temperature regulation","volume":"95","author":"Kenney","year":"2003","journal-title":"J Appl Physiol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1177\/0022034514559409","article-title":"The functions of saliva","volume":"94","author":"Dawes","year":"2015","journal-title":"J Dent Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1067\/mpr.2001.113778","article-title":"A review of saliva: Normal composition and function","volume":"85","author":"Humphrey","year":"2001","journal-title":"J Prosthet Dent"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.jdent.2004.10.009","article-title":"Saliva and oral health","volume":"33","author":"Dodds","year":"2005","journal-title":"J Dent"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e1601555","DOI":"10.1126\/sciadv.1601555","article-title":"Nighttime temperature and human sleep loss in a changing climate","volume":"3","author":"Obradovich","year":"2017","journal-title":"Sci Adv"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.1600-0528.2012.00680.x","article-title":"Integrating the common risk factor approach into a social determinants framework","volume":"40","author":"Watt","year":"2012","journal-title":"Community Dent Oral Epidemiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1016\/S0140-6736(05)71146-6","article-title":"Social determinants of health inequalities","volume":"365","author":"Marmot","year":"2005","journal-title":"Lancet"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/S0140-6736(19)31146-8","article-title":"Oral diseases: a global public health challenge","volume":"394","author":"Peres","year":"2019","journal-title":"Lancet"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1604035","DOI":"10.3389\/phrs.2021.1604035","article-title":"Climate change and health: global overview","volume":"42","author":"Helld\u00e9n","year":"2021","journal-title":"Public Health Rev"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.identj.2021.07.004","article-title":"Climate change and oral health: a systematic review","volume":"72","author":"Singh","year":"2022","journal-title":"Int Dent J"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1999","DOI":"10.1002\/qj.3803","article-title":"The ERA5 global reanalysis","volume":"146","author":"Hersbach","year":"2020","journal-title":"Q J R Meteorol Soc"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s40279-018-1033-y","article-title":"Heat, hydration and the human brain, heart and skeletal muscles","volume":"49","author":"Trangmar","year":"2019","journal-title":"Sports Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"ref24","volume-title":"EU Statistics on Income and Living Conditions (EU-SILC)","year":""},{"key":"ref25","volume-title":"Econometric Analysis of Cross Section and Panel Data","author":"Wooldridge","year":"2010"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/1550-2783-10-49","article-title":"Effects of rehydration and food consumption on salivary flow, pH and buffering capacity in young adult volunteers during ergometer exercise","volume":"10","author":"Tanabe","year":"2013","journal-title":"J Int Soc Sports Nutr"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1089\/omi.2013.0064","article-title":"Saliva: a fluid of study for OMICS","volume":"18","author":"Cuevas-C\u00f3rdoba","year":"2014","journal-title":"OMICS"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1177\/0022034510379602","article-title":"The role of bacteria in the caries process: ecological perspectives","volume":"90","author":"Takahashi","year":"2011","journal-title":"J Dent Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/prd.12116","article-title":"The physiology of salivary secretion","volume":"70","author":"Proctor","year":"2000","journal-title":"Periodontol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s44174-023-00090-z","article-title":"A review on saliva-based health diagnostics: biomarker selection and future directions","author":"Kumari","year":"2023","journal-title":"Biomed Mater Devices"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1146\/annurev-publhealth-040119-094318","article-title":"Disparities in access to oral health care","volume":"41","author":"Northridge","year":"2020","journal-title":"Annu Rev Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"415","DOI":"10.3390\/healthcare14030415","article-title":"Inequity in schoolchildren\u2019s access to oral health services in Romania: implications for public oral health policies","volume":"14","author":"Perpelea","year":"2026","journal-title":"Healthcare (Basel)"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.3390\/healthcare14111479","article-title":"Dental preventive policies and socio-economic inequalities in oral health: a panel data analysis of EU countries during and after COVID-19","volume":"14","author":"Lupita","year":"2026","journal-title":"Healthcare (Basel)"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1939057\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:56:21Z","timestamp":1790744181000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1939057\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":33,"alternative-id":["10.3389\/fpubh.2026.1939057"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1939057","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1939057"}}