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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: The Oral Health Assessment Tool (OHAT) was a component of the Best Practice Oral Health Model for Australian Residential Care study. The OHAT provided institutional carers with a simple, eight category screening tool to assess residents' oral health, including those with dementia. This analysis presents OHAT reliability and validity results., Methods: A convenience sample of 21 residential care facilities (RCFs) in urban and rural Victoria, NSW and South Australia used the OHAT at baseline, three-months and six-months to assess intra- and inter-carer reliability and concurrent validity., Results: Four hundred and fifty five residents completed all study phases. Intra-carer reliability for OHAT categories: percent agreement ranged from 74.4 per cent for oral cleanliness, to 93.9 per cent for dental pain; Kappa statistics were in moderate range (0.51-0.60) for lips, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p < 0.05). Inter-carer reliability for OHAT categories: percent agreement ranged from 72.6 per cent for oral cleanliness to 92.6 per cent for dental pain; Kappa statistics were in moderate range (0.48-0.60) for lips, tongue, gums, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p < 0.05). Intraclass correlation coefficients for OHAT total scores were 0.78 for intra-carer and 0.74 for inter-carer reliability. Validity analyses of the OHAT categories and examination findings showed complete agreement for the lips category, with the natural teeth, dentures, and tongue categories having high significant correlations and percent agreements. The gums category had significant moderate correlation and percent agreement. Non-significant and low correlations and percent agreements were evident for the saliva, oral cleanliness and dental pain categories., Conclusion: The Oral Health Assessment Tool was evaluated as being a reliable and valid screening assessment tool for use in residential care facilities, including those with cognitively impaired residents.

Background: The purpose of this study was to assess the prevalence of specific oral diseases in a Vietnamese background population living in Melbourne, Australia, and to compare these findings to existing oral health data., Methods: One hundred and fifty-eight subjects of Vietnamese background, 18 and older, participated in the study., Results: Subjects were clinically examined, in a cross-sectional study, using standard World Health Organization criteria. The mean decayed, missing and filled surfaces scores were 27.8 (26.1). With the exception of one person, all subjects displayed clinical signs of gingivitis and 39 per cent had shallow pockets. Complex periodontal therapy was required by about 5 per cent of the sample. Comparing these findings to existing data on oral health in Melbourne, subjects in the study had lower DMFS scores, a higher number of untreated decayed surfaces and higher prevalence of gingivitis but less need for advanced periodontal treatment., Conclusions: These findings, in terms of dental caries and periodontal disease, represent a more encouraging oral health situation than that previously described in this immigrant population. Inequalities within the present sample were not reflected in the overall caries experience but were reflected in the proportion of unmet restorative needs. Further research is needed to get a clearer picture of the factors that shape the oral health of migrant Vietnamese populations and expansion of this research into other migrant groups is also necessary.

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.

Previous work has shown that variations exist amongst general dental practitioners in the volume and type of orthodontic services provided, the type of orthodontic appliances used, and the objectives of the orthodontic treatment. The aims of this survey were to identify practitioner characteristics that account for variations in the level of orthodontic services provided and which distinguish providers and non-providers of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 41 per cent of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients: 1) treated more general practice patients; 2) frequently used multiple sources to keep up to date in orthodontics; 3) perceived their patient base to contain more children; and 4) were likely to have attended a Truitt course. Eleven variables best distinguished providers from non-providers of orthodontic treatment; 1, 2 and 3 above had the highest correlation with the discriminant function. The Null Hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education as well as treating more general practice patients, especially children.

Information regarding orthodontic service provision by general dental practitioners in Australia is limited. The aim of this survey was to determine the amount and variety of orthodontic services provided by general dental practitioners in the Melbourne Statistical Division, Victoria, Australia. A random sample of 307 dentists drawn from the Victorian Dentists Register was surveyed by mailed questionnaire: 218 (71%) replied. Data were collected using a fortnight log. During this time 59 per cent of the dentists saw at least one orthodontic patient; one dentist saw 66 orthodontic patients. Removable orthodontic appliances were used by 35 per cent of the dentists and fixed orthodontic appliances by 18 per cent. Twenty-six per cent provided comprehensive orthodontic treatment, 22 per cent aligned incisors, and 21 per cent corrected anterior crossbites. The general dental practitioners surveyed provided a wide range of preventive and interceptive orthodontic services to generally a small percentage of their patients.

Changing patterns of oral health were investigated in a selected population of children and adolescents in Heidelberg, Victoria. Oral health was examined in terms of caries experience, oral hygiene and gingival condition. The findings were compared with the results of a study conducted in the same area 10 years previously. The findings were also related to sociodemographic variables such as age, sex, and ethnic and socioeconomic background. A random sample of 403 children and adolescents aged 6-8 years, 11-13 years, and 14-16 years were selected from 5 primary schools and 3 secondary schools in the area. A questionnaire eliciting sociodemographic information was administered and an intra-oral examination was conducted on each subject. Dental caries was recorded in terms of DMF-T. Oral hygiene was assessed by the Plaque Index and gingival status by the Gingival Index. Results showed that subjects from this study demonstrated improved oral health compared with subjects from the previous study. In 1981, 25 per cent of 6-8 year olds and 9 per cent of 14-16 year olds were caries free. In 1991, 92 per cent of 6-8 year olds and 36 per cent of 14-16 year olds were caries free. Predictably, it was also found that age was significantly related to caries level, oral hygiene and gingival condition.

Many studies on toothbrushing have concentrated on clinically diagnosing plaque and measuring periodontal status as indicators of oral health behaviour. From a behavioural point of view, however, the more important objective is the health behaviour itself. To investigate the relationship of oral health behaviour to periodontal status, 517 urban employees in Japan (249 men and 268 women aged 20-59 years) responded to a 20-item dental health behaviour questionnaire, entitled the HU-DBI, and had their periodontal conditions examined using the CPITN. Only 1 per cent were found with a healthy periodontium (Code 0), and 9 per cent had bleeding on probing (Code 1). Calculus (Code 2) was the most prevalent condition with 51 per cent of subjects having this code as the worst condition, followed by shallow pockets (Code 3) in 30 per cent, and deep pockets (Code 4) in 9 per cent of the sample. The mean HU-DBI score was 4.2 (out of 12). Females had somewhat higher scores than males (4.4 vs. 4.0, p < 0.05). CPITN had a negative relationship with the HU-DBI (r = -0.26, p < 0.001), and a positive relationship with age (r = 0.40, p < 0.001). Similar relationships were observed in each gender. These data demonstrate the relationship of age with periodontal status, and periodontal status with oral health behaviour. A two-dimensional matrix of HU-DBI score by CPITN may provide a simple and effective means of identifying low and high risk individuals.

A survey of 60 pre-school children both from Anglo-Saxon and Lebanese backgrounds collected detailed information on subjects' oral health status and dietary and feeding habits. Lebanese subjects had significantly higher caries experience (mean dmfs = 4.88) than Anglo-Saxon subjects (mean dmfs = 0.56). Subjects from the different backgrounds varied significantly also in the frequency of exposure to cariogenic agents and health practices. In each situation Lebanese children were exposed to higher risk factors than Anglo-Saxon children. Notwithstanding the association between variables, the best single predictor of variance in caries experience of subjects, explaining 23 per cent of the variance of dmfs, was the mother's level of education. Culturally relevant health education programmes need to address the specific requirements of high risk groups.

Seven-hundred and sixty dentists, selected randomly from all States and Territories except Victoria, responded to a questionnaire survey on beliefs, attitudes and the techniques used in the management of children with anxiety or behaviour problems. The most common techniques used were permitting the child some degree of control over terminating treatment if difficulties were experienced, coaxing and reinforcing positive behaviours, and furnishing waiting areas with child-oriented play materials. Most respondents never used TV or video-tape distraction strategies, film or video-modelling tape or hypnosis. More than half of the respondents believed there was insufficient information available to them on current anxiety/behaviour management techniques. The use of particular management techniques varied by gender, age, university of graduation, State or Territory of residence, and membership of the Australian and New Zealand Society of Paediatric Dentistry. Patterns of use of particular techniques showed similarities and contrasts with other studies. Patterns of use in the national sample were almost identical to the frequency and pattern of use by Victorian dentists. In contrast, however, North American studies have reported a higher frequency of use of hand-over-mouth, and lower use of general anaesthesia within the armamentarium of techniques and strategies used by dentists to manage anxious or difficult children.

A survey of 303 subjects over the age of 60 years collected demographic and oral health status data for analysis. The majority of the sample (64.2 per cent) were edentulous. Over 90 per cent of the dentate subjects required scaling and the removal of plaque (CPITN score of TN2); however, just less than half of the sextants examined were excluded because they contained fewer than two functional teeth. About one-third of the dentate subjects required no treatment for dental caries. Of those who required treatment, most needed only one restoration of any particular type. Total tooth loss was associated with gender, level of education, previous occupation, and birthplace. The need for complex periodontal treatment (TN3) was not high, nor was there a high prevalence of root or cervical dental caries.

Recent studies have shown a decline in the caries experience in Australian children. It has also been shown that a number of socio-demographic variables are associated with risk of caries experience. The aims of the present study were to identify changes in caries experience and the association of socio-demographic variables with risk of caries experience in five- and six-year-old children over the period 1977 to 1985. In 1985, a sample of 174 children resident in the municipality of Brunswick, a suburb of Melbourne, was examined. A similar sample was drawn from the same area in 1977. The percentage of children caries-free had greatly increased, while caries experience had decreased. Parental birthplace, occupation and ethnicity were associated with caries experience in 1977 and were used to control for socio-demographic changes in the samples between the two survey times. In 1985 exposure to water fluoridation was also associated with caries experience. The study highlighted the improvement in dental health of five- and six-year-old children in Melbourne since 1977 and the consistency of associations between socio-demographic variables and 'at risk' children.

Since 1975, more than 100,000 Indo-Chinese refugees from Vietnam, Kampuchea, and Laos have been resettled in Australia. This dental survey was undertaken to compare the dental health of 104 Australian-born and 126 Indo-Chinese adolescents from a State high school within a high migrant area of Melbourne. The mean DMFT score for the Australian-born group was 3.37 teeth, compared with 6.05 for the Vietnamese group, and 3.10 for the Kampuchean-Laotian group. More restorations and extractions were required by the Vietnamese subjects compared with the Australian-born and Kampuchean-Laotian subjects. Almost all subjects had gingivitis, however the proportion of Indo-Chinese subjects with shallow and deep pockets was greater than that of the Australian-born subjects. The periodontal health of the Kampucheans and Laotians was the most severe of the Indo-Chinese groups. These findings indicate that the Indo-Chinese adolescent refugees represent a high risk group for dental problems within the Australian population.