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Background: Although community water fluoridation has been one of the cornerstone strategies for the prevention and control of dental caries, questions are still raised regarding its cost-effectiveness. This study assessed the impact of changing dental needs on the cost savings from community water fluoridation in Australia. Methods: Net costs were estimated as Costs(programme) minus Costs(averted caries). Averted costs were estimated as the product of caries increment in non-fluoridated community, effectiveness of fluoridation and the cost of a carious surface. Modelling considered four age-cohorts: 6–20, 21–45, 46–65 and 66+ years and three time points 1970s, 1980s, and 1990s. Cost of a carious surface was estimated by conventional and complex methods. Real discount rates (4, 7 (base) and 10%) were utilized. Results: With base-case assumptions, the average annual cost savings/person, using Australian dollars at the 2005 level, ranged from $56.41 (1970s) to $17.75 (1990s) (conventional method) and from $249.45 (1970s) to $69.86 (1990s) (complex method). Under worst-case assumptions fluoridation remained cost-effective with cost savings ranging from $24.15 (1970s) to $3.87 (1990s) (conventional method) and $107.85 (1970s) and $24.53 (1990s) (complex method). For 66+ years cohort (1990s) fluoridation did not show a cost saving, but costs/person were marginal. Conclusions: Community water fluoridation remains a cost-effective preventive measure in Australia.

Background: The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are at high risk of developing dental diseases, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Traditionally, dental service provision has been problematic and sporadic for these residents. Methods: A postal survey of a random sample of Victorian general dentists and Directors of Nursing (DONs) of Victorian RACFs was undertaken in 2006 to ascertain the participation of dentists in the provision of dental care and to identify factors impacting on the organization and provision of dental care for residents. Results: The response rate for dentists was 57.3 per cent, and for DONs 64.4 per cent. Half of the dentists reported that they had provided care to residents of aged care facilities in the past 12 months, and they spent an average of one hour per month providing care. Overall, dentists were concerned with their level of undergraduate education and training in various aspects of dentistry for residents of aged care facilities. DONs reported significant difficulty obtaining adequate dental care for their residents. Common problems identified by both dentists and DONs included a preference for dentists to treat residents in their own practice, dentists not willing to go to RACFs and a lack of portable dental equipment for dentists to use. Conclusions: There were low levels of interest and participation from Victorian dentists in providing dental care for residents of aged care facilities. Dentists had a strong preference for treating patients at their own practice, and there were a number of significant barriers that appeared to impact on the provision of dental care in RACFs.

BACKGROUND: Recent data have suggested that the trend of decreasing caries experience in Australian children is slowing with increasing dmft and DMFT scores seen in children. However, there are limited data on dental caries experience in young Australian adults. METHODS: A cross-sectional study of 973 Australian Army recruits was conducted between November 2002 and March 2003. A clinical examination with bitewing radiographs was conducted and a questionnaire was used to elicit socio-demographic information. RESULTS: Mean DMFT scores were 2.43, 3.44, 5.48, 7.02 and 10.77 for subjects aged 17-20, 21-25, 26-30, 31-35 and 36-51 years respectively. Subjects with a lifetime exposure to fluoridated drinking water had a mean DMFT of 2.80 while subjects with no exposure to fluoridated drinking water had a mean DMFT of 3.91. Multivariate Poisson regression found that age, level of educationand lifetime exposure to fluoridated drinking water had a statistically significant effect on caries experience. CONCLUSIONS: It appears that there has been a continual decline in caries experience and prevalence in young Australian adults between 1996 and 2002-2003. Lifetime exposure to fluoridated drinking water conferred an appreciable benefit for subjects in this study compared with subjects with no exposure to fluoridated drinking water.

Background: The purpose of this study was to investigate a group of young Australian adults to determine their caries experience and compare these current levels with similar aged cohorts over the past 30 years. Caries experience was also related to lifetime exposure of fluoridated water consumption. Methods: This was achieved through a crosssectional study involving Australian Army recruits seen for their initial dental examination at 1 st Recruit Training Battalion, Kapooka. A total of 499 recruits had a clinical examination with the aid of bitewing radiographs and an orthopantogram. Sociodemographic and fluoride history data were elicited via a questionnaire. Results: Mean DMFT scores for age cohorts were: 17-20 years of age ‐ DMFT 3.59; 21-25 years of age ‐ DMFT 4.63; 26-30 years of age ‐ DMFT 7.07; 3135 years of age ‐ DMFT 9.04. Subjects with a lifetime exposure to fluoridated water had significantly lower dental caries experience (DMFT 3.80) than subjects with no exposure to fluoridated water (DMFT 5.15). Conclusions: It was found that there has been a decline in the level of caries experience in young Australian adults when the data from this study were compared to other ad hoc studies.

A primary preventive dental programme targeting adolescents living in non-fluoridated areas of Victoria, Australia was evaluated for a three-year period. The programme comprised annual placement or replacement/repair of fissure sealants combined with a weekly 0.2 per cent sodium fluoride mouthrinse and was evaluated in terms of acceptance by the providers and the community to which it was directed. Acceptance was measured using accessibility, availability, continuity, quality of care, role responsibility, provider and consumer satisfaction, and cost-effectiveness. In general, the programme was considered to represent an acceptable model for future preventive interventions, although there were areas of its design that were found to require improvement. In particular, deficiencies in the manner in which the fluoride mouthrinsing component was delivered indicate that further investigation would be required before a recommendation to adopt its use could be made.

The benefit of a public sector sealant programme for children in Australia is yet to be established. This study evaluated sealants placed by therapists of the School Dental Service in Victoria, between 1989 and 1994, on permanent teeth of children in 15 primary schools in Melbourne. Seven hundred and seventy four children aged 6-12 years were examined in school dental clinics by six calibrated examiners. A total of 5363 sealants placed on 2875 permanent teeth (including 2616 first molars, 91 per cent of sample) up to four and a half years previously was examined. Values for complete and partial sealant retention were highest for premolars (86 per cent, 9 per cent respectively, total 95 per cent); similar for occlusal surfaces of maxillary and mandibular first molars (63 per cent, 30 per cent; 62 per cent, 32 per cent respectively) and buccal pits of mandibular molars (66 per cent); and low for pits/fissures of Carabelli's cusps of maxillary molars (44 per cent). Cross-sectional examination up to 24 months for both maxillary and mandibular first molars indicated average values of 67 per cent complete retention, 27 per cent partial retention, 6 per cent missing; thereafter complete retention decreased and partial retention increased. Sealant failures in the six months post-placement were attributed to technique failure. Regardless of sealant retention, caries experience was low under partially retained or missing sealants (4.5 per cent) and completely retained sealants (0.4 per cent). It is concluded that the SDS sealant programme is a sound preventive dental public health approach.

Background The poor oral health of nursing home residents is the cause of substantial morbidity and has major implications relating to health care policy. The aim of this study was to measure dental caries experience in Australians living in nursing homes, and investigate associations with resident characteristics. Methods Clinical dental examinations were conducted on 243 residents from 19 nursing homes in Melbourne. Resident characteristics were obtained from nursing home records and interviews with residents, family and nursing home staff. Two dental examiners assessed coronal and root dental caries using standard ICDAS-II criteria. Results Residents were elderly, medically compromised and functionally impaired. Most required assistance with oral hygiene and professional dental care was rarely utilized. Residents had high rates of coronal and root caries, with a mean 2.8 teeth with untreated coronal caries and 5.0 root surfaces with untreated root caries. Functional impairment and irregular professional dental care were associated with higher rates of untreated tooth decay. There were no significant associations with medical conditions or the number of medications taken. Conclusions Nursing home residents have high levels of untreated coronal and root caries, particularly those with high needs due to functional impairment but poor access to professional services.

An oral health status survey was conducted on 818 adolescents aged 12 to 16 years in a non-fluoridated area in rural Victoria. The prevalence and severity of dental caries experience was found to increase with age. The occlusal surface was the predominant surface affected by dental caries for all age groups. Filled surfaces represented the largest component of the DMFS index and were responsible for the increasing dental caries experience with age. Fewer fissure sealants were present with increasing age and second molars were sealed less often than the first molars. Although no difference was evident in the total caries experience between those with and without access to public dental services, a statistical difference was found to exist in unmet need between these two groups. Untreated caries levels were significantly higher in health card holders. The provision of preventive and dental treatment services to this group should be a priority in the future.

Background: Recent studies have shown a substantial decline in caries experience in Australian Army recruits between 1996 and 2002–2003, and in Australian adults between 1987–1988 and 2004–2006. However, studies in children have reported an increasing trend in caries experience between 1998 and 2002. The aim of this study was to investigate caries experience in Australian Army recruits in 2008. Methods: A cross-sectional study involving 1084 Australian Army recruits was conducted from January to May 2008. Data were obtained from a clinical dental examination with bitewing radiographs, and a questionnaire elicited socio-demographic data and history on lifetime exposure to fluoridated drinking water. Results: Mean DMFT scores were 3.16, 4.08, 5.16 and 7.11 for recruits aged 17–20, 21–25, 26–30 and 31–35 years, respectively. Recruits with a lifetime exposure to fluoridated drinking water had a mean DMFT of 3.02, while recruits with no exposure had a mean DMFT of 3.87. Conclusions: Caries experience in Australian Army recruits aged 17–25 years increased between 2002–2003 and 2008. Recruits with lifetime exposure to fluoridated drinking water had 25 per cent less caries experience compared with recruits who had no exposure to fluoridated drinking water after adjusting for the effects of age, gender, education and socio-economic status.

A sample of 1100 Royal Australian recruits were examined for dental caries in 1988. Socio-demographic data were also collected. The mean DMFT scores were 4.33, 6.85, and 8.87 teeth for the 15-19 year-olds, 20-24 year-olds, and 25-29 year-olds, respectively. Caries experience varied between the state of origin of recruitment with Victorian and Queensland subjects having the highest DMFT scores, and Tasmanian subjects, the lowest. Comparison with previous military studies indicated not only a decreased dental caries experience, but also that restoration of teeth rather than extraction is a more likely treatment outcome of dental caries in recent recruits.

Background: Over the last 50 years an increasing number of migrants have settled in Australia. These immigrants now constitute a large proportion of the Australian population, and some research suggests that they may be at high-risk for oral diseases. Methods: This paper presents data on the oral health status of a convenience sample of 721 ambulant Greek- (n=367) and Italian-born (n=354) adults aged 55 years or older. The volunteer participants were recruited through ethnic social clubs located in Melbourne, Australia. Results: The sample was largely a dentate one (83.6 per cent); with a mean DMFS score of 67.5 (s.d. 37.4). Dentate participants had 13 per cent of their restorative care unmet, and 57.3 per cent needed oral hygiene instruction plus removal of stain and hard deposits on their teeth. Almost 8 per cent required complex periodontal therapy and 30 per cent of those fully edentulous were in need of full dentures. Conclusions: Comparing these findings with existing data on oral health of older adults in Australia, the participants in this study appear to have lower DMFS scores and a higher prevalence of gingivitis, but less need for complex periodontal treatment. Inequalities were apparent in the proportion of unmet restorative and prosthetics needs.

Background: People with hepatitis C (over 259 000 Australians) experience stigma and discrimination, whether perceived or actual, in health care settings. They are less likely to access health care, presenting a major barrier to preventive care and treatment. This study aims to identify factors contributing to such discrimination, barriers to optimal care and strategies to overcome these. Methods: A purposive sample of 25 Victorian dentists took part in semi-structured interviews to investigate their experiences and attitudes in providing care to people with hepatitis C. Interviews were taped, transcribed and coded for thematic analysis. Results: All dentists interviewed were aware of Standard Precautions. However, there were some who changed practices when seeing a client with hepatitis C, suggesting that they lack confidence in Standard Precautions. When prompted, these dentists were concerned that patients may perceive these actions as discriminatory. All participants, including a small minority who expressed negative views about injecting drug users, felt a professional obligation to treat all patients. Conclusions: Most dentists have appropriate attitudes regarding patients with blood-borne viruses. However, it is important for dentists to understand how their actions may be interpreted by those who feel sensitive about their status. Dentists need to feel genuinely confident about Standard Precautions and have a realistic view of the infection risk posed by patients with blood-borne viruses.

Background: Recently there has been a considerable increase in the consumption of bottled water in Australia. Overseas studies have found the fluoride levels in many bottled waters are well below levels considered optimal for preventing dental caries. This raises the concern that if bottled water is regularly consumed an effective means of preventing dental caries is unavailable. The aim of this study was to determine the fluoride concentration in 10 popular brands of still bottled water currently sold in Australia. Methods: The fluoride content of water samples were determined using an ion analyser and compared to a fluoride standard. Results: The fluoride concentration of all bottled waters was less than 0.08ppm. Only three of the 10 brands indicated the fluoride content on their labels. Melbourne reticulated water was found to be fluoridated at 1.02ppm. Conclusions: All bottled waters tested contained negligible fluoride which justifies the concern that regular consumption of bottled water may reduce the benefits gained from water fluoridation. It is recommended that all bottled water companies should consider stating their fluoride content on their labels. This will inform consumers and dental care providers of the levels of fluoride in bottled water and allow an informed decision regarding consumption of fluoridated versus non- fluoridated drinking water.

Background: The aims of this study were to describe dental health and perceived barriers to dental care in a regional centre and surrounding smaller towns in rural Victoria. Methods: A stratified, randomized, face-to-face household survey was undertaken to assess levels of edentulism and access to oral health services. A study response rate of 70.3 per cent (6316/9260) was achieved. Results: When compared with those in the regional centre, people living in the shire capitals were more likely to travel greater distances to see a dentist and were less likely to have seen a dentist within the past 12 months. While there was little difference in the edentulous proportion living in shire capitals compared with the regional centre, the level of edentulousness over the entire region was greater than overall Australian estimates. Differences in perceived barriers to care within the region were less than expected. Existing perceived barriers were lack of need, time until available appointments, attitudes of dentists and lack of public dental facilities. Differences in these barriers existed between socioeconomic groups. Conclusions: This study shows that the prevalence of edentulism was higher in the areas studied relative to the Australian population. Significant patient perceived barriers to care exist which may contribute to the problem.

Background: The anticariogenic potential of casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP) has been demonstrated using laboratory, animal and human in situ caries models. The aim of this study was to determine the effect of CPP-ACP incorporation into a sugar-free lozenge (pressed mint tablet) on enamel remineralization in a human in situ model. Methods: The study utilized a double-blind, randomized, cross-over design with four treatments: (i) a lozenge containing 56.4mg (3 per cent w/w) CPP-ACP; (ii) a lozenge containing 18.8mg (1 per cent w/w) CPP-ACP; (iii) a lozenge not containing CPP-ACP; and (iv) a no lozenge nil-treatment control. Ten subjects wore removable palatal appliances with four, human-enamel, half-slab insets containing subsurface lesions. Lozenges were consumed, without chewing, four times per day for 14 days duration. After each treatment period the enamel slabs were removed, paired with their respective demineralized control, embedded, sectioned and subjected to microradiography and computer-assisted densitometric image analysis to determine the level of remineralization. Results: The incorporation of CPP-ACP into the lozenge significantly increased enamel subsurface lesion remineralization with 18.8 and 56.4mg of CPP-ACP increasing remineralization by 78 and 176 per cent respectively, relative to the control sugarfree lozenge. Conclusion: This study demonstrates that lozenges are a suitable vehicle for the delivery of CPP-ACP to promote enamel remineralization.

Background: The consumption of acidic foods and drinks is increasing in popularity. The purposes of the present study were to investigate the consumption patterns of acidic foods and drinks among several sport groups and to examine any relationships between consumption patterns and dental erosion. Methods: A questionnaire of oral health habits, diet and dental health was developed. Thirty-two sports clubs (690 members) of the University of Melbourne participated in a survey. A total of 508 usable questionnaires were received (74.9 per cent response). Descriptive statistics were prepared and logistic regression was used to explore relationships between dental erosion (dependent variable) and the independent variables. Results: Dental erosion was reported by 25.4 per cent of respondents, particularly among athletes of the Martial arts (affecting 37.4 per cent). The consumption of acidic foods and drinks was frequent among most athletes. No significant associations were identified between dental erosion and the frequency of drinking soft drinks or sports drinks. Statistically significant associations were found between dental erosion and age group (p=0.004), frequency of drinking juices (p=0.05), and tooth sensitivity (p=0.001). Conclusion: Athletes may be placing themselves unintentionally at risk of dental erosion and dentists could counsel athletes to control and reduce the effect of potentially erosive foods and drinks.

A review of the literature on dental auxiliaries and their utilization in the dental workforce is presented, and their future role is examined in the light of broader issues relating to changing disease patterns and service delivery. Legislative factors, productivity, quality assurance and the potential scope for dental auxiliaries in both the public sector and private practice setting are discussed. A strategy for adopting a team approach in the delivery of dental services is suggested, which would necessitate the dentist taking on the role of team leader and maintaining responsibility for overall treatment planning and quality assurance. Dental auxiliaries could provide basic preventive and restorative dental services, allowing dentists to concentrate on providing more complex high-technology treatment. Implications for the future training of dental auxiliaries are presented.