A Case of Sotos Syndrome With Right Shoulder Disarticulation Due to a High-Grade Malignant Peripheral Nerve Sheath Tumor in the Right Arm and Shoulder.

The global population is aging at an unprecedented pace, with older adults representing an increasingly substantial demographic segment worldwide. In China, the proportion of individuals aged 65 years and above has risen sharply, and this demographic transition poses significant challenges for geriatric healthcare systems. Among the multifaceted health concerns confronting older adults, oral health remains a critical yet frequently underemphasized domain. Epidemiological evidence consistently demonstrates that older adults bear a disproportionately high burden of dental caries, periodontal diseases, and tooth loss, all of which substantially impair quality of life, nutritional status, and systemic health., Oral health literacy (OHL), defined as the degree to which individuals can obtain, process, and understand basic oral health information needed to make appropriate health decisions, has emerged as a key determinant of oral health outcomes. Individuals with higher OHL are more likely to engage in preventive behaviors, seek timely dental care, and demonstrate better clinical oral health indicators., Conversely, low OHL has been associated with poorer self-care practices, delayed treatment-seeking, and worse oral health status, particularly among vulnerable populations such as older adults. Despite the recognized importance of OHL, research on its determinants among older populations, especially within the Chinese context, remains limited. The Andersen’s behavioral model of health services utilization provides a well-established theoretical framework for understanding the determinants of health-related outcomes. This model posits that health outcomes are shaped by the interplay of three categories of factors: predisposing factors, enabling/behavioral factors, and need factors. The Andersen model has been widely applied in oral health research to examine patterns of dental service utilization, oral health behaviors, and health outcomes. However, few studies have adopted this framework to systematically investigate the complex associated pathways of OHL. Previous studies on OHL have primarily focused on establishing bivariate associations between sociodemographic variables and OHL levels, without exploring the underlying mechanisms through which these factors operate. Sociodemographic characteristics may not only directly affect OHL but also indirectly shape it through their influence on clinical oral conditions and health behaviors. For instance, education level may enhance OHL both directly by improving cognitive capacity for health information processing and indirectly by promoting dental service utilization, which in turn provides exposure to oral health education. Similarly, gender and residential location may influence OHL through differential patterns of disease experience and healthcare access. Understanding these mediating pathways is essential for designing effective, targeted interventions to improve OHL among older adults. Furthermore, the clinical oral conditions such as experience with dental diseases may serve as a catalyst for acquiring oral health knowledge, as patients who have undergone treatment or experienced disease may develop heightened awareness of oral health issues. This hypothesis, however, has not been formally tested within a structural framework that simultaneously accounts for the roles of health behaviors and access to care. Additionally, the moderating roles of education level and residence in shaping the pathways to OHL remain largely unexplored.