Search

Objective: Accurate assessment of child oral health is important for guiding economic evaluations and informing healthcare decision‐making. Early Childhood Oral Health Impact Scale (ECOHIS‐4D) is a preference‐based instrument that measures the oral health‐related quality of life of young children. The aim of this study was to compare the utility scores of ECOHIS‐4D and Child Health Utility Index (CHU‐9D), against an oral health indicator to evaluate which utility score corresponds better with the oral health indicator. Method: The ECOHIS‐4D and CHU‐9D were applied to 314 parent/child dyads from preschools in a primary healthcare setting in Perth, Western Australia. Four parameters were used to assess which instrument corresponds better with the oral health indicator (decayed, missing and filled teeth score‐dmft score): (i) discrimination, the ability to discriminate between different clinical severity groups, (ii) external responsiveness, how much the utility values relate to the changes in dmft scores, (iii) correlation, the association between the two instruments and the related dimensions and (iv) differences in the utility values across the two instruments. Results: Most participants (81%) were 2–6 years old, and nearly 50% had a dmft score <3. ECOHIS‐4D demonstrated a superior ability to differentiate between dmft severity groups and respond to changes in dmft scores. A significant weak correlation was observed between dmft and ECOHIS‐4D (−0.26, 95%, CI −0.36 to −0.15) compared to a non‐significant very poor correlation between dmft and CHU‐9D (0.01, 95% CI −0.12 to 0.10). The utility scores of the two instruments had relatively good agreement towards good health and weak agreement towards poor health. Conclusions: ECOHIS‐4D, the oral health‐specific instrument, is more sensitive in assessing children's oral health‐related quality of life than the generic CHU‐9D. Thus, ECOHIS‐4D is more appropriate for utility estimates in economic evaluations of oral health‐related interventions and resource allocation decision‐making. [ABSTRACT FROM AUTHOR]

Objectives: In celebration of the journal's 50th anniversary, the aim of the study was to review the whole collection of Community Dentistry and Oral Epidemiology (CDOE) publications from 1973 to 2022 and provide a complete overview of the main publication characteristics. Methods: The study used bibliometric techniques such as performance and science mapping analysis of 3428 articles extracted from the Scopus database. The data were analysed using the 'Bibliometrix' package in R. The journal's scientific production was examined, along with the yearly citation count, the distribution of publications based on authors, the corresponding author's country and affiliation and citation count, citing source and keywords. Bibliometric network maps were constructed to determine the conceptual, intellectual and social collaborative structure over the past 50 years. The trending research topics and themes were identified. Results: The total number of articles and average citations has increased over the years. D Locker, AJ Spencer, A Sheiham and WM Thomson were the most frequently published authors, and PE Petersen, GD Slade and AI Ismail published papers with the highest citations. The most published countries were the United States, United Kingdom, Brazil and Canada, frequently engaging in collaborative efforts. The most common keywords used were 'dental caries', 'oral epidemiology' and 'oral health'. The trending topics were healthcare and health disparities, social determinants of health, systematic review and health inequalities. Epidemiology, oral health and disparities were highly researched areas. Conclusion: This bibliometric study reviews CDOE's significant contribution to dental public health by identifying key research trends, themes, influential authors and collaborations. The findings provide insights into the need to increase publications from developing countries, improve gender diversity in authorship and broaden the scope of research themes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate how education level affects dental service utilization patterns in the Australian adult population. This study tested how education level mediated these service patterns through behavioural mediators such as smoking, tooth brushing and oral health status and investigated these mediation effects in different dental service providers. Method: Following the flexible mediation approach, the direct and indirect effects of education through behavioural mediators on dental service utilization patterns (time of last dental visit, reason for last dental visit and frequency of seeking dental care) were calculated for the South Australian population from the Dental Care and Oral Health Study. Results: Participants with lower educational attainment were 33% (Odds Ratio: 0.67, 95% CI 0.56–0.78) and 38% (Odds Ratio: 0.62, 95% CI 0.53–0.74), less likely than their counterparts with higher education to visit a dentist or to receive dental care in the last 12 months, respectively. Low education was associated with a 23% increase in odds of receiving emergency and treatment services (Odds Ratio: 1.23, 95% CI 1.05–1.43) compared to routine dental check‐ups or examinations. Conclusion: Low education, regardless of oral health behaviours and status, reduces the odds of dental service utilization in terms of frequency of seeking dental care and time of last dental visit. There is more tendency towards receiving emergency and treatment services compared to routine dental check‐ups or examinations in participants with lower educational attainment. [ABSTRACT FROM AUTHOR]

Objectives: Arguably, the deficit narrative of oral health inequities, perpetuated by colonial re‐search agendas, media and sociopolitical discourse, contributes to oral disease burden and fatalism among Aboriginal and Torres Strait Islander Peoples. There remains a need to evolve the way oral health is understood, in a manner that reflects the lived experiences of Aboriginal and Torres Strait Islander Peoples. Methods: This paper proposes decolonising methodologies as a strategy to ensure oral health re‐search creates more equitable oral health outcomes and realities for Aboriginal and Torres Strait Islander Communities. Anchored by a critical reflection of the failure of dominant oral health inequity re‐search practices to address Indigenous oral health, both in Australia and internationally, we propose five explicit pathways for decolonising Aboriginal and Torres Strait Islander oral health re‐search. Results: We argue the need for (1) positionality statements in all re‐search endeavours, (2) studies that honour reciprocal relationships through the development of proposals that ask questions and follow models based on Traditional Knowledges, (3) the development of culturally secure and strengths‐based data capturing tools, (4) frameworks that address the intersection of multiple axes of oppression in creating inequitable conditions and (5) decolonising knowledge translation techniques. Conclusion: Importantly, we recognize that re‐search will never be entirely 'decolonised' due to the colonial foundations upheld by academic institutions and society more broadly; however, as oral health re‐searchers, we ascertain that there is an ethical compulsion to drive decolonising re‐search pursuits that produce equitable oral health outcomes for Aboriginal and Torres Strait Islander Communities. [ABSTRACT FROM AUTHOR]

Background: The first steps towards gender equity in science are measuring the magnitude of inequity and increasing awareness of the problem. Objectives: To describe trends in gender disparities in first and last authorship in the most cited dental publications and general dental literature over a 20‐year period. Methods: Articles and bibliometric data were retrieved from the Scopus database for the period 1996 to 2015. Two groups of 1000 articles each were retrieved: a random sample and another sample of top‐cited articles for each year. The gender of the first and last author of each publication was manually identified. When this was not possible, we used an online software platform (https://genderize.io/). Descriptive analyses identified the proportion of women first and last authors in both samples, stratifying by dental discipline and geographic region. Trends were ascertained by frequency metrics across years. Gender disparity was observed in both first and last authorship, with a larger gap being observed in the top‐cited sample. Results: Women led 28.4% and 20.3% of articles in the random and top‐cited samples, respectively. A similar pattern was observed for the last authorship group (22.1% and 16.1%, respectively). An increasing trend in the proportion of articles led by women over time was observed in both samples. This increase was larger in the top‐cited sample (from 15.0% in 1996–2000 to 25.1% in 2015) than in the random sample (from 26.3% in 1996–2000 to 33.2% in 2011). Conclusions: Clear gender disparities in dental research publications in the last 20 years were identified in both general and top‐cited manuscripts, across dental disciplines, across countries, across first and last authorship, and over time. It is paramount that actions are taken to attract, retain and promote women in science, as well as to monitor and ensure progress towards gender equity. [ABSTRACT FROM AUTHOR]

Objectives: With elimination of the financial burden of dental services, one can expect an increase in utilization of dental services. This study aimed to investigate the effective mechanisms of financial barriers to the utilization of dental services in an Australian adult population. Methods: South Australian survey data from the Dental Care and Oral Health Study (2015) were analysed. Following the flexible mediation approach, the direct effect of income and indirect effect of income through mediators (insurance, concession card and service sector) on the outcomes (visit avoidance and treatment prevention due to the cost) were calculated. Results: Findings showed that around half of the low‐income people and one‐third of the high‐income South Australians experienced a financial burden on receiving a dental visit or service. The indirect effect of income on both outcomes of financial burden was negligible, while the direct effect was significant. By changing the potential outcome distribution to their counterfactual exposure distribution and if the mediators are drawn from their counterfactual exposure (lower/higher income) distribution, the odds of visit avoidance and treatment prevention due to the cost were almost twice (Odds Ratio: 2.13, 95% CI 1.72–2.60) and 98% (Odds Ratio: 1.98, 95% CI 1.67–2.35) than in the lower‐income individuals, respectively. Conclusions: It can be concluded that the level of household income, directly and regardless of insurance status, concession card ownership and whether the service sector was public or private, affected the financial burden on utilization of dental services. [ABSTRACT FROM AUTHOR]

Objectives: Indigenous health workers (IHW) play an integral role in the provision of culturally safe care for Indigenous communities. Despite this, IHW involvement in oral health has been limited. Therefore, this qualitative systematic review aimed to build an understanding of IHW insights on oral health. Methods: Two independent reviewers searched PubMed, EMBASE, Web of Science and Scopus using a pre‐established search strategy. Qualitative studies that included IHW illustrations about oral health were considered. The search was not limited by geographic setting. Included articles were critically appraised with the Joanna Briggs Institute appraisal tool for qualitative studies. Results: The search identified 1856 articles eligible for inclusion; a total of 10 articles were included. Four synthesized findings were identified during the meta‐aggregation: oral health challenges in community, systemic barriers limiting IHW ability to support oral health, benefits of IHW involvement in oral health and avenues to increase IHW involvement in oral health. Conclusion: The prioritization of Indigenous leadership in oral health has the potential to address many of the current challenges Indigenous communities face. Future works need to determine the capacity of IHW to provide oral health care and explore opportunities to create specific oral health roles for IHW. [ABSTRACT FROM AUTHOR]

There is a need for a theoretically informed, contextualized approach to measuring oral health from a multidisciplinary perspective that goes beyond the commonly used clinical indices and sociodental measures. This commentary aims to discuss the potential for the WHO's International Classification of Functioning, Disability and Health (ICF) to provide a model for the development of indicators for oral health. It is suggested that the ICF might provide both a theoretical model and an operational classification for indicators of oral health. The ICF model states that human experience of physical, cognitive and social functioning is universal and, thus, can be described and qualified. Human function is given social and environmental context within the model at both an individual and population level. The ICF can not only capture data regarding oral health and function at the physiological level (e.g. chewing) but also at the social level (e.g. sharing meals). It is able not only to capture aspects of preventive behaviour (e.g. caring for teeth) but also aspects of social facilitation (e.g. economic self‐sufficiency) or ability to fulfil a social role (e.g. remunerative employment). It also includes aspects of social environment, such as healthcare services or political, economic and legal systems. Case studies are given as examples of the potential use of the ICF in the oral health domain. Examples are also given of the first steps that have been made towards operationalization of the ICF in data collection and oral health research. The challenges of encompassing such a comprehensive model into a practical oral health measure are discussed. [ABSTRACT FROM AUTHOR]

Major sociohistorical processes have profound effects on oral health, with impacts experienced through structural oppression manifested in policies and practices across the lifespan. Structural oppression drives oral health inequities and impacts population‐level oral health. In this global perspective paper, we challenge old assumptions about oral health inequities, address misleading conceptualizations in their description and operation and reframe oral health through the lens of intersecting systems of oppression. Furthermore, we emphasize the need for oral health researchers to explore causal pathways through which oppression harms oral health and engage in social science concepts to understand the root causes of oral health inequities fully. Finally, we call on policymakers, dental scholars and decision makers to consider health equity in all policies and to take a systems‐oriented approach to effectively address oral health inequities. [ABSTRACT FROM AUTHOR]

Objectives: The management of early childhood caries is challenging and the impacts of its treatment on child oral health‐related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control). Methods: Consenting Aboriginal communities in the North‐West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow‐up. The questionnaire sought information on COHRQoL using the proxy‐reported Early Childhood Oral Health Impact Scale (ECOHIS) and the self‐reported Caries Impacts and Experiences Questionnaire for Children (CARIES‐QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow‐up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow‐up within groups were evaluated using appropriate paired (t‐test, Wilcoxon paired test), and between groups with unpaired tests (t‐test). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities. Results: Twenty‐five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow‐up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6–4.1;control = 3.3 years, 95% CI 3.1–3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8–5.0;control dmft = 3.1, 95% CI 2.5–3.7), but there was no significant difference in COHRQoL or anxiety levels between the groups. At follow‐up, parents in the delayed intervention reported worsening of COHRQoL (70% worsening of the family impact section of the ECOHIS and 37% worsening of the total ECOHIS scale), and there was an 8% reduction in child dental anxiety among the early treatment group. Conclusions: The application of the ART/HT approaches was feasible, effective, and impacted positively on child oral health‐related quality of life and child dental anxiety among Aboriginal children in remote communities. The model of care as tested in this study should be further developed for inclusion in main‐stream service delivery programmes. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the association between social support and oral health outcomes is modified by levels of household income. Methods: Data were from the National Study of Adults Oral Health (NSAOH 2004‐06), a nationally representative study comprising n = 3619 adults in Australia. Effect measure modification (EMM) analysis was adopted to verify whether the association between social support and poor/fair self‐rated oral health, lack of a functional dentition (<21 teeth) and low Oral Health Related Quality of Life (OHRQoL; measured using OHIP‐14) varies according to levels of income. Poisson regressions adjusted for age, sex, education, country of birth, main language spoken at home and remoteness were used to estimate prevalence ratios (PR) for oral health outcomes for each stratum of social support (overall, family, friends and significant other) and income (effect modifier). We then computed the Relative Excess Risk due to Interaction (RERI), which represents the risk that is over what would be expected if the combination of low social support and low income was entirely additive. Sensitivity analyses for different cut‐offs of household income were performed. Results: Adults with lower levels of social support had a 2.1, 1.2 and 1.9 times higher prevalence of fair/poor self‐rated oral health, <21 teeth and poor OHRQoL respectively. The RERIs observed were 0.98 (95% CI −0.01; 1.96) for poor/fair self‐rated oral health; 0.52 (95% CI −0.06; 1.10) for lack of a functional dentition and 0.50 (95% CI −0.16; 1.15) for poor OHRQoL. For all outcomes and all individual domains of social support, the positive RERIs indicated that the joint association of low social support and low household income surpassed the sum of their separate associations with objective and subjective oral health indicators. Conclusion: Individuals with lower levels of social support had poorer oral health than those with high levels of social support, although this association was small for the outcome <21 teeth. The association between social support and poor oral health indicators is modified by levels of household income. Hence, the provision of social support had a stronger association with the oral health of low‐income participants, suggesting that socioeconomically disadvantaged individuals would mostly benefit from a social support intervention. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the mediating pathways of oral health literacy (OHL) and oral health‐related behaviours on the relationship between education and self‐reported tooth loss among Australian adults. Methods: Data used for studying the effects of mediating pathways are from the National Dental Telephone Interview Survey 2013, a random sample survey of Australian adults aged 18+ years. To study the mediating effects, we use counterfactual‐based analysis. To decompose the effect of multiple mediator's alternate, to natural effect, methods such as interventional effects have been proposed. In this paper, we use these approaches to decompose the effect between education, OHL and oral health‐related behaviours on self‐reported tooth loss. Sensitivity analysis was performed for unmeasured confounding with multiple mediators. Results: Data were available for 2936 Australian adults. The prevalence of persons with ≥12 self‐reported tooth loss was approximately 15%. The average total causal effect from the low education group was nearly 150%, and the interventional indirect effect through OHL and the dependence of oral health‐related behaviours on OHL to more than 12 missing teeth were 20% and 120%, respectively, higher than in the high education group. Sensitivity analysis indicated if the difference in the prevalence of unmeasured confounder is as big as 6% the direct effect and the indirect effect remains as observed. Conclusions: An additional two‐fifths reduction on having more than 12 missing teeth for Australian adults with lower education level could be achieved if the proportion of lower OHL was decreased and optimal dental behaviours were increased. [ABSTRACT FROM AUTHOR]

Objectives: Network analysis is an innovative, analytic approach that enables visual representation of variables as nodes and their corresponding statistical associations as edges. It also provides a new way of framing oral health‐related questions as complex systems of variables. We aimed to generate networks of oral health variables using epidemiological data of Indigenous children, and to compare network structures of oral health variables among participants who received immediate or delayed delivery of an oral health intervention. Methods: Epidemiological data from 448 mother‐child dyads enrolled in a randomized controlled trial of dental caries prevention in South Australia, Australia, were obtained. Networks were estimated with nodes representing study variables and edges representing partial correlation coefficients between variables. Data included dental caries, impact on quality of life, self‐rated general health, self‐rated oral health, dental service utilization, knowledge of oral health, fatalism and self‐efficacy in three time points. Communities of nodes, centrality, clustering coefficient and network stability were estimated. Results: The oral health intervention interacted with the network through self‐rated general health and knowledge of oral health. Networks depicting groups shortly after receiving the intervention presented higher clustering coefficients and a similar arrangement of nodes. Networks tended to return to a preintervention state. Conclusion: The intervention resulted in increased connectivity and changes in the structure of communities of variables in both intervention groups. Our findings contribute to elucidating dynamics between variables depicting oral health networks over time. [ABSTRACT FROM AUTHOR]

Objectives: Most of the paediatric quality‐of‐life instruments in oral health research are not preference‐based measures, thus cannot be used in economic evaluations. The Early Childhood Oral Health Impact Scale (ECOHIS) is one such instrument which assesses oral health impact on children's quality of life among three‐ to five‐year‐olds. With increasing demands for more resource allocation in oral health care, there is a need for an outcome metric which can be used as the outcome in economic evaluations. The aim of this study was to develop a preference‐based, health‐state classification system from the existing ECOHIS instrument. Methods: The 13‐item ECOHIS instrument was applied to the carers of 280 preschoolers who participated in a clinical trial in metropolitan Perth, Western Australia. Exploratory factor analysis was conducted to assess the dimensionality of the ECOHIS. Rasch analysis was used to eliminate and select items per determined dimensions and to reduce the number of response options for each item, because six levels were not amenable to valuation. The final classification system was determined through a combination of psychometric and expert advice. Results: Items loaded on to four dimensions with the factor analysis. Using Rasch analysis, three items were selected from the first dimension (child functional and psychological impact) and one item from the second dimension (child social interaction impact). None were selected from the third dimension (parental distress and family function impact) as it is not an appropriate proxy method of measuring the level of impact on a child. The final classification system has four dimensions with three levels in each, and so it has been named the ECOHIS‐4D. Conclusions: The ECOHIS‐4D classification system is a new preference‐based instrument derived from the existing ECOHIS instrument. Future valuation studies will develop a utility value set for the health states defined by this classification system, and this will guide economic evaluations related to oral health interventions. [ABSTRACT FROM AUTHOR]

Objective: To compare patterns of dental caries, periodontal disease and dental care among Indigenous and non‐Indigenous Central‐West Brazilian subpopulations. Methods: Data were from two population‐based cross‐sectional studies involving 5‐, 12‐, 15‐19‐ and 35‐44‐year‐olds. The first examined were the Guarani, Kaiowá, Terena and Kadiwéu Indigenous groups from Mato Grosso do Sul Brazilian state and the second comprised a non‐Indigenous population. Mean numbers of sound teeth, decayed, missing and filled teeth (dmft/DMFT), prevalence of poor oral hygiene for adults (35‐44 years) and of periodontal disease were estimated. Restorative dental service utilization was measured using the Care Index. Results: The study populations comprised of 1830 Indigenous and 29 395 non‐Indigenous people. The Kaiwoá ethnic group had the lowest DMFT among Indigenous groups for ages 12, 15‐19 years; 0.9 (95% CI 0.7‐1.1) and 2.4 (95% CI 1.9‐2.9), respectively. The highest values were observed among the 12‐year‐old Terena ethnic group and 15‐ to 19‐year‐old Kadiwéo groups; 2.2 (95% CI 1.8‐2.5) and 3.7 (95% CI 3.1‐4.4), respectively. The mean DMFT values were significantly lower among Indigenous than non‐Indigenous people for all age groups. The prevalence of bleeding and calculus was 70.3% (95% CI 64.5%‐75.5%) and 80.1% (95% CI 74.8%‐84.5%), respectively, for Indigenous people and 43.9% (95% CI 34.4%‐50.7%) and 61.5% (95% CI 55.4%‐67.2%), respectively, for the non‐Indigenous population. Restorative services were higher among 5‐year‐old non‐Indigenous children and adults than for Indigenous groups. Among Indigenous groups, the Terena had the highest level of restored teeth (38.0% at 12 years) and Kadiwéu the lowest level (8.8% at 12 years). Conclusion: In our study, Indigenous people had a lower caries burden, but less access to restorative services than their non‐Indigenous counterparts. These disparities likely reflect differences in historical, socioeconomic, cultural, environmental and political determinants that both groups have experienced differently over time. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of studies on the extent to which perceived racial discrimination shapes oral health. Following an intersectional perspective, we estimated the prevalence of perceived racial discrimination in Australia, its association with oral health impairment, and examined whether this association was more severe among low socioeconomic status (SES) groups. Methods: Data came from the 2013 National Dental Telephone Interview Survey (N = 2798), a population‐based study of Australian adults. Multivariable Poisson regression models were estimated to test the relationship between perceived racial discrimination and self‐reported oral health impairment, as well as to investigate whether the magnitude of this association was greater among low‐SES respondents. Relative Excess Risks due to Interaction (RERI) were used to indicate the presence of potentially large discrimination effects within low‐SES strata. Results: Racial discrimination in the past 12 months was reported by 11.5% of all participants. Australians reporting racial discrimination had 1.4 (95% CI 1.1, 1.7) times the prevalence of impaired oral health. The association between perceived racial discrimination and oral health impairment was stronger among low‐SES groups. The RERI was 0.55, indicating a super‐additive Effect Measure Modification (EMM) by income on the additive scale. Similar results were observed with the EMM analyses by educational attainment. Conclusion: Our findings indicate that perceived racial discrimination, as a specific form of widespread inequality, is associated with higher frequencies of oral health impairment among Australian adults. We also suggest that socially marginalized groups bear a greater burden of the oral health effects of racial discrimination. [ABSTRACT FROM AUTHOR]

Objective: To investigate risk indicators for untreated dental decay among Indigenous Australian children using a national representative sample. Methods: Data were from the National Child Oral Health Study 2012‐2014, which included a nationally representative sample of Indigenous Australian children aged 5‐14 years. Outcomes were the prevalence (% ds/DS >0) and severity (mean ds/DS) of untreated dental decay at the tooth surface level. Caries of the primary dentition was estimated among 5‐ to 10‐year‐olds, while that of the permanent dentition was among 8‐ to 14‐year‐olds. Independent variables included residential location, household income, frequency and age commencement of toothbrushing, sugar‐sweetened beverages (SSB) consumption, dental visiting and residential fluoridation status. Multivariable log‐Poisson regression models with robust standard error estimation were used to identify risk indicators for untreated decay. The complex sampling design was taken into account in all analyses. Results: There were 720 5‐ to 10‐year‐old and 736 8‐ to 14‐year‐old Indigenous children. Indigenous children experienced significant amount of untreated dental caries. Among 5‐ to 10‐year‐olds, % ds >0 was 43.1 (95% CI: 36.8‐49.6) and mean ds was 3.4 (95% CI: 2.4‐4.4). Among 8‐ to 14‐year‐olds, % DS >0 was 27.3 (22.3‐32.9), while mean DS was 0.8 (0.6‐1.0). In multivariable modelling, risk indicators for % ds >0 among 5‐ to 10‐year‐olds were low household income, commencing toothbrushing after 30 months of age, consuming 2+ cups of SSB per day and not residing in fluoridated areas. Risk indicators for mean ds among 5‐ to 10‐year‐olds included infrequent toothbrushing and consuming 2+ cups of SSB per day. Risk indicators for % DS >0 among 8‐ to 14‐year‐olds were low household income, while risk indicators for mean DS among 8‐ to 14‐year‐olds were residing in non‐capital city, low household income, consuming 2+ cups of SSB per day and not residing in fluoridated areas. Conclusion: Indigenous Australian children experienced significant amount of untreated dental caries. Risk indicators for untreated decay included demographic factors, socioeconomic factors, oral hygiene behaviours, dietary behaviours and environmental factors. [ABSTRACT FROM AUTHOR]

Objective To compare the magnitude of relative oral health inequalities between Indigenous and non-Indigenous persons from Brazil, New Zealand and Australia. Methods Data were from surveys in Brazil (2010), New Zealand (2009) and Australia (2004-06 and 2012). Participants were aged 35-44 years and 65-74 years. Indigenous and non-Indigenous inequalities were estimated by prevalence ratios ( PR) and their corresponding 95% confidence intervals ( CI), adjusting for sex, age and income. Outcomes included inadequate dentition, untreated dental caries, periodontal disease and the prevalence of 'fair' or 'poor' self-rated oral health in Australia and New Zealand, and satisfaction with mouth/teeth in Brazil ( SROH). Results Irrespective of country, Indigenous persons had worse oral health than their non-Indigenous counterparts in all indicators. The magnitude of these ratios was greatest among Indigenous and non-Indigenous Australians, who, after adjustments, had 2.77 times the prevalence of untreated dental caries (95% CI 1.76, 4.37), 5.14 times the prevalence of fair/poor SROH (95% CI 2.53, 10.43). Conclusion Indigenous people had poorer oral health than their non-Indigenous counterparts, regardless of setting. The magnitude of the relative inequalities was greatest among Indigenous Australians for untreated dental decay and poor SROH. [ABSTRACT FROM AUTHOR]

Objective To determine the effect of an oral health literacy intervention on oral health literacy-related outcomes among rural-dwelling Indigenous Australian adults. Methods A total of 400 Indigenous adults (203 intervention and 197 control participants) were recruited into a randomized controlled trial; a functional, context-specific oral health literacy interventions were developed and implemented by Indigenous staff. The intervention comprised five sessions, each lasting 1.5 hours, across a 1-year period. The primary outcome was oral health literacy as assessed by the He LD-14 instrument, with secondary outcomes including the social impact of oral disease, and psychosocial and knowledge-related factors. Three scenarios were used in data analysis: (I) intention to treat; ( II) as treated and; ( III) adherence only. Multiple imputation ( MI) was used to replace missing data. Results The proportion reporting that 'water with fluoride' was good increased in the intervention group within both crude and MI data analyses under the three scenarios. Other crude data analysis yielded no significant differences for either primary or secondary outcomes between intervention and control groups under the three scenarios. After MI, oral health literacy improved when assessed under scenario II (mean change=1.3, 95% CI: 1.1, 1.6). Improvements under three scenarios were also observed for the Oral Health Impact Profile ( OHIP-14; mean change ranged from −0.7 to −3.8), sense of control (mean change ranged from 0.4 to 1.1), oral health-related fatalism (mean change ranged from −0.7 to −0.4) and perceived stress (mean change ranged from −2.1 to −1.1). The proportion reporting that 'cordial was good' decreased in the intervention group from MI analysis under scenarios II and III. Conclusions A context-specific oral health literacy intervention was partially successful in improving oral health literacy and oral health literacy-related outcomes in this vulnerable population, but only after MI. [ABSTRACT FROM AUTHOR]

Objectives To conduct cross-national comparison of education-based inequalities in tooth loss across Australia, Canada, Chile, New Zealand and the United States. Methods We used nationally representative data from Australia's National Survey of Adult Oral Health; Canadian Health Measures Survey; Chile's First National Health Survey Ministry of Health; US National Health and Nutrition Examination Survey; and the New Zealand Oral Health Survey. We examined the prevalence of edentulism, the proportion of individuals having <21 teeth and the mean number of teeth present. We used education as a measure of socioeconomic position and measured absolute and relative inequalities. We used random-effects meta-analysis to summarize inequality estimates. Results The USA showed the widest absolute and relative inequality in edentulism prevalence, whereas Chile demonstrated the largest absolute and relative social inequality gradient for the mean number of teeth present. Australia had the narrowest absolute and relative inequality gap for proportion of individuals having <21 teeth. Pooled estimates showed substantial heterogeneity for both absolute and relative inequality measures. Conclusions There is a considerable variation in the magnitude of inequalities in tooth loss across the countries included in this analysis. [ABSTRACT FROM AUTHOR]

Objective To estimate the effect of mothers' education on Indigenous Australian children's dental caries experience while controlling for the mediating effect of children's sweet food intake. Methods The Longitudinal Study of Indigenous Children is a study of two representative cohorts of Indigenous Australian children, aged from 6 months to 2 years (baby cohort) and from 3.5 to 5 years (child cohort) at baseline. The children's primary caregiver undertook a face-to-face interview in 2008 and repeated annually for the next 4 years. Data included household demographics, child health (nutrition information and dental health), maternal conditions and highest qualification levels. Mother's educational level was classified into four categories: 0-9 years, 10 years, 11-12 years and >12 years. Children's mean sweet food intake was categorized as <20%, 20-30%, and >30%. After multiple imputation of missing values, a marginal structural model with stabilized inverse probability weights was used to estimate the direct effect of mothers' education level on children's dental decay experience. Results From 2008 to 2012, complete data on 1720 mother-child dyads were available. Dental caries experience for children was 42.3% over the 5-year period. The controlled direct effect estimates of mother's education on child dental caries were 1.21 (95% CI: 1.01-1.45), 1.03 (95% CI: 0.91-1.18) and 1.07 (95% CI: 0.93-1.22); after multiple imputation of missing values, the effects were 1.21 (95% CI: 1.05-1.39), 1.06 (95% CI: 0.94-1.19) and 1.06 (95% CI: 0.95-1.19), comparing '0-9', '10' and '11-12' years to > 12 years of education. Conclusion Mothers' education level had a direct effect on children's dental decay experience that was not mediated by sweet food intake and other risk factors when estimated using a marginal structural model. [ABSTRACT FROM AUTHOR]

Objective To develop a short-form version of the 29-item Health Literacy in Dentistry (He LD-29) instrument. Methods Deriving the short-form version used data from a cross-sectional study of 400 indigenous Australians aged 18+ years in Port Augusta, South Australia, which was split to enable short-form testing ( N = 191). Internal reliability analysis, factor analysis and regression analysis were undertaken to derive a subset (He LD-14) questionnaire. Its validity was evaluated by assessing associations with socio-demographic and self-reported oral health variables. Internal consistency of the He LD-14 was evaluated using Cronbach's coefficient α. A He LD-14 scale was derived from regression analysis. Results The He LD-14 accounted for 94% of variance in the He LD-29 mean scores; had high reliability (α = 0.88); contained questions from each of the seven conceptual dimensions of the He LD-29; and had a good distribution of prevalence for individual questions. He LD-14 scores and He LD-29 scores displayed the same pattern of variation among socio-demographic groups of indigenous Australians. Cronbach's α for the He LD-14 was 0.87. In a multivariable analysis, the same socio-demographic and self-reported oral health variables were associated ( P < 0.05) with both the He LD-29 and the He LD-14. Conclusions The reliability, validity and precision of the short-form version (He LD-14) were acceptable when tested in a sample of rural dwelling indigenous Australians. However, it will be important to replicate these findings in other populations before it can be used in health services research to determine the effects of interventions or programs aimed at improving oral health outcomes. This short form will be easy and efficient for use in research and clinical settings. [ABSTRACT FROM AUTHOR]

Jamieson LM, Roberts-Thomson KF, Sayers SM. Dental caries risk indicators among Australian Aboriginal young adults. Community Dent Oral Epidemiol 2010; 38: 213–221. © 2009 John Wiley & Sons A/S Objectives: To determine dental caries risk indicators among a birth cohort of Australian Aboriginal young adults ( n = 442). Methods: Data were from the Aboriginal Birth Cohort study, a prospective longitudinal investigation of Aboriginal individuals born 1987–1990 at an Australian regional hospital. Models representing demographic, socioeconomic, behavioural, dental service utilization and clinical oral health variables were tested using multivariate regression. Results: The percent DT > 0 was 72.9 (95% CI 68.7–77.1), mean DT was 4.19 (95% CI 3.8–4.6), percent DMFT > 0 was 77.4 (95% CI 73.5–81.3) and mean DMFT was 4.84 (95% CI 4.4–5.3). After controlling for other covariates, risk indicators for percent DT > 0 included soft drink consumption every day or a few times a week (PR 1.25, 95% CI 1.08–1.45), not consuming milk every day or a few times a week (PR 1.16, 95% CI 1.04–1.30) and sweet consumption every day or a few times a week (PR 1.18, 95% CI 1.04–1.33). Risk indicators for mean DT included sweet consumption every day or a few times a week ( B = 1.14, 95% CI 0.27–2.02), nonownership of a toothbrush ( B = 0.91, 95% CI 0.10–1.87) and presence of plaque ( B = 2.46, 95% CI 0.96–3.96). Those with 4 + occupants in their house the previous night had 1.2 times the prevalence of having DMFT > 0 than their counterparts with less household occupants (95% CI 1.01–1.49). Percent DMFT > 0 was also associated with consumption of soft drink every day or a few times a week (PR 1.18, 95% CI 1.04–1.34) and consumption of sweets every day or a few times a week (PR 1.23, 95% CI 1.10–1.37). Mean DMFT was higher among those who consumed sweets every day or a few times a week ( B = 0.13, 95% CI 0.05–0.22) and who had dental anxiety ( B = 0.10, 95% CI 0.01–0.19). Conclusions: In an Australian Aboriginal young adult cohort, risk indicators for dental caries included social determinants such as household size, dietary behaviours such as regular consumption of soft drink and sweets, dental behaviour such as nonownership of a toothbrush and dental anxiety. [ABSTRACT FROM AUTHOR]

Objectives: To determine predictors of untreated dental decay among 15–34-year-olds in Australia. Methods: Data were from Australia’s National Survey of Adult Oral Health, a representative survey that utilized a three-stage, stratified clustered sampling design. Models representing demographic, socioeconomic, dental service utilization and oral health perception variables were tested using multivariable logistic regression to produce odds ratios. Results: An estimated 25.8% (95% CI 22.4–29.5) of 15–34-year-old Australians had untreated dental decay. After controlling for other covariates, those who lived in a location other than a capital city had 2.0 times the odds of having untreated dental decay than their capital city-dwelling counterparts (95% CI 1.29–3.06). Similarly, those whose highest level of education was not a university degree had 2.1 times the odds of experiencing untreated dental decay (95% CI 1.35–3.31). Perceived need of extractions or restorations predicted untreated coronal decay, with 2.9 times the odds for those who perceived a treatment need over those with no such treatment need perception (95% CI 1.84–4.53). Participants who experienced dental fear had 2.2 times the odds of having untreated dental decay (95% CI 1.38–3.41), while those who reported experiencing toothache, orofacial pain or food avoidance in the last 12 months had 1.9 times the odds of having untreated dental decay than their counterparts with no such oral health-related quality-of-life impact (95% CI 1.20–2.92). The multivariate model achieved a ‘useful’ level of accuracy in predicting untreated decay (area under the ROC curve = 0.74; sensitivity = 0.63; specificity = 0.73). Conclusions: In the Australian young adult population, residential location, education level, perceived need for dental care, dental fear, toothache, orofacial pain or food avoidance together were predictors of untreated dental decay. The prediction model had acceptable specificity, indicating that it may be useful as part of a triage system for health departments wishing to screen by means of a questionnaire for apparently-dentally healthy 15–34-year-olds. [ABSTRACT FROM AUTHOR]

Objectives: To explore factors contributing to dental service use and toothbrushing among Mäori, Pacific and New Zealand European or Other (NZEO) children in New Zealand. Methods: Data were obtained from the 2002 National Child Nutrition Survey. Models representing demographic, socio-economic status (SES), lifestyle, dietary, food security and oral health paradigms were tested using logistic regression. Results: Mäori and Pacific children were more likely to not attend for dental care (OR: 1.99 and 2.05 respectively) than NZEO children when age, sex and time lived in New Zealand were accounted for. The addition of household (OR: 1.93 and 2.05 respectively) or lifestyle (OR: 1.95 and 1.81 respectively) factors resulted in minimal OR changes for Mäori or Pacific child dental attendance, whereas addition of dietary (OR: 1.44 and 1.23 respectively) and food security (OR: 1.43 and 1.32 respectively) items reduced the ORs of Mäori and Pacific child dental attendance so they no longer differed significantly to NZEO children. Addition of dental factors increased the ORs of Mäori and Pacific children not utilizing dental services compared with NZEO children (OR: 2.30 and 2.13 respectively). Mäori and Pacific children were more likely to not brush teeth (OR: 3.86 and 1.49 respectively) than NZEO children when age, sex and time lived in New Zealand were accounted for. Addition of dietary factors resulted in a 36% OR reduction of Mäori children not brushing (OR: 2.57), while addition of household SES (OR: 1.06), lifestyle (OR: 1.14), dietary (OR: 0.71) or food security factors (OR: 1.19) reduced the ORs of Pacific children so they were no longer significantly different to NZEO children. Conclusions: Mäori and Pacific children were more likely to have not received dental care (variance largely explained by dietary and food security factors) and Mäori children were more likely to not brush their teeth (variance largely explained by dietary items) than NZEO children. [ABSTRACT FROM AUTHOR]

Objective: To describe oral health inequalities among indigenous and nonindigenous children in the Northern Territory of Australia using an area-based measure of socioeconomic status (SES). Methods: Data were obtained from indigenous and nonindigenous 4-13-year-old children enrolled in the Northern Territory School Dental Service in 2002-2003. The Socio-Economic Indices For Areas (SEIFA) were used to determine socioeconomic relationships with dental disease experience. Results: Some 12,584 children were examined, 35.1% of whom were indigenous. Across all age-groups, socially disadvantaged indigenous children experienced higher mean dmft and DMFT levels than their similarly aged, similarly disadvantaged nonindigenous counterparts. Indigenous children aged 5 years had almost four times the dmft of their nonindigenous counterparts in the same disadvantage category (P < 0.05), while indigenous children aged 10 years had almost five times the DMFT of similarly disadvantaged nonindigenous children (P < 0.05). A distinct social gradient was apparent among indigenous and nonindigenous children, respectively, whereby those with the highest dmft/DMFT levels were in the most disadvantaged SES category and those least disadvantaged had the lowest dmft/DMFT levels. In most age-groups, indigenous children who were least disadvantaged had worse oral health than the most disadvantaged nonindigenous children. Conclusions: The findings suggest that indigenous status and SES have strong oral health outcome correlations but are not mutually dependent, that is, indigenous status influences oral health outcomes irrespective of social disadvantage. From a health policy perspective, greater oral health gains may be possible by concentrating public health and clinical effort among all indigenous children irrespective of SES status. [ABSTRACT FROM AUTHOR]

Jamieson LM, Thomson WM, McGee R. An assessment of the validity and reliability of self-report items used in a National Child Nutrition Survey. Community Dent Oral Epidemiol 2004; 32: 49–54. © Blackwell Munksgaard, 2004 – To examine the clinical validity and reliability of dental self-report items used in a national child nutrition survey. The study involved completion of dental self-report questionnaires by 6–9-year-old children who attended one of the three schools with ethnic distributions, similar to schools in the national survey, and their care-givers. Children were then dentally examined. Two hundred and four children (response rate 74.2%) returned questionnaires and were dentally examined. The highest degree of child and care-giver concordance for the self-reported dental items was for the ‘has had an extraction due to dental caries’ item (kappa = 0.92), while the lowest was for the ‘brushes twice or more per day’ item (kappa = 0.61). The prevalence of dental caries in the deciduous dentition was 67.6%. The mean dfs, mean DFS and mean number of missing primary teeth because of caries were 6.15 (SD 6.51), 0.83 (SD 1.28) and 0.30 (SD 0.82), respectively. Caries severity was higher in children who reported brushing infrequently, having received a filling, having had an extraction because of caries, having been kept awake at night because of dental pain or having had a general anaesthetic for dental treatment. Values for self-report and clinical reliability were above 0.80 in all instances. The dental self-report items showed a high level of concordance between child and care-giver, and appeared to be clinically valid. The findings suggest that using dental self-report measures for children may be valuable in dental epidemiological investigations. [ABSTRACT FROM AUTHOR]

Determines whether the Dental Neglect and Dental Indifference scales measure similar constructs and have similar associations in the same population sample. Degree of concordance between the Dental Neglect and Dental Indifference Scales; Suggestion that the scales may measure different constructs; Associations with important oral health and sociodemographic variables of the scales.

Objective Method Results Conclusion Oral health is often overlooked in ageing health issues, despite its impact on overall health and quality of life. Older Australians, especially those in rural and remote areas, face difficulties accessing oral health services. The aim of the study was to investigate the factors that contribute to financial barriers to accessing dental services among the ageing population in Australia in relation to their residential location.The study included a weighted sample of Australian adults aged 65 years and over from a population‐based survey called the National Study of Adult Oral Health (NSAOH) conducted in 2017–18. Descriptive analysis was conducted and generated cross‐tabulation tables to investigate the distributions of the outcome, exposure and covariates, including Sex, Education level (the highest level of education), Equivalised household income, Dental insurance, Concession card ownership, Difficulty paying a dental bill and last dental visit. Blinder‐Oaxaca decomposition counterfactual analysis was used to explore the potential impact of a person's residence on their financial difficulty accessing dental services.The findings showed that 26.2% (95% CI: 24.3–29.3) of major city residents and 30.1% (95% CI: 26.9–33.3) of rural residents avoided or delayed dental visits due to cost. The decomposition analysis indicated that 53.8% of the disparities in the prevalence of avoided or delayed dental visits due to cost were explained by the selected variables, while 46.2% remained unexplained. The explanatory variable with the largest contribution was difficulty paying a $200 dental bill, accounting for 62.4% of the differences, followed by dental insurance, last dental visit and equivalised household income, which explained 42.1%, 20.8% and 14.9% of the differences, respectively.Regional/remote populations experience more financial barriers to accessing dental care than major city populations and the identified factors explain a significant proportion of these disparities. Based on the study findings, recommendations include expanding public dental service coverage, evaluating concession card mechanisms and advocating for regular dental visits to mitigate disparities in dental care access. [ABSTRACT FROM AUTHOR]