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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]

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: 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]

It is known that parental experiences of perceived racism are associated with poorer mental health in children. However, little is known about the mechanism of transmission of intergenerational racism among Aboriginal Australians. This study aims to explore the causal effect of Aboriginal mothers' experience of perceived racism on children's social and emotional well-being mediated by parenting sense of competence. Pregnant Aboriginal women (N = 159) reported their experiences of perceived racism using the Measure of Indigenous Racism Experiences instrument, and completed a five year follow-up survey, reporting their sense of parenting competence using the Parenting Sense of Competence Scale and their child's social and emotional well-being using the Strengths and Difficulties Questionnaire. A single causal mediation analysis was used to examine the causal effects while accounting for confounding variables (mother's age, education, and socioeconomic status). Mothers who experienced perceived racism in at least one setting were at an increased odds of their child experiencing social and emotional difficulties (OR = 1.28, 95% CI [0.55, 2.98]). This effect was not mediated by parenting sense of competence, despite an effect between parenting competence and children's social and emotional well-being (OR = 0.44, 95% CI [0.19, 1.06]). The findings suggest that maternal experiences of perceived racism has a longitudinal effect on their children's social and emotional well-being, which is not mediated through the mothers' parenting sense of competence. These findings highlight the importance of reducing racism as these may have far-reaching effects across generations on socio-social and emotional well-being. What is already known about this topic: Racism is a significant public health issue in Australia as experiences of racism are highly prevalent among Aboriginal Australians, and associated with adverse health and wellbeing. The effects of racism are known to have pervasive intergenerational impacts, with parental experiences of racism affecting children's social and emotional wellbeing. To date, little is known about the mechanism by which parental perceptions of racism lead to adverse social-emotional wellbeing for children. What this topic adds: This paper is the first to explore whether parenting sense of competence mediates the effect of maternal experience of perceived racism on children's social and emotional well-being. Children aged five years were at an increased risk of social and emotional difficulties if their mother had experienced perceived racism in at least one setting during pregnancy. The impact of maternal experience of perceived racism on children's social and emotional well-being was not transmitted through the mother's parenting sense of competence. [ABSTRACT FROM AUTHOR]

Knowledge of and practice around health inequities have been limited by scarce investigations on intersecting forms of structural oppression, including the extent to which their effects are more severe among multiply marginalized groups. We addressed these insufficiencies by adopting a structural intersectionality approach to the study of edentulism (i.e. complete tooth loss), the dental equivalent of mortality. While individual information was gathered from approximately 200,000 adult (ages 18–64 years) respondents to the 2010 US Behavioral Risk Factor Surveillance System survey, state-level data for 2000 and 2010 were obtained from a 2021 study by Homan et al. (J Health Soc Behav. 2021;62(3):350–370) and the US Census. These 3 sources provided information on edentulism, race, sex, structural racism, structural sexism, and income inequality, in addition to multiple covariates. Analyses showed that the intersections between structural sexism and state-level income inequality and structural racism were associated with 1.4 (95% confidence interval: 1.1, 1.9) and 1.5 (95% confidence interval: 1.1, 2.2) times' increased odds of complete tooth loss, respectively. The frequency of edentulism was highest among non-Hispanic Black men residing in states with high structural racism, high structural sexism, and high economic inequality. Based on these and other findings, we highlight the importance of a structural intersectionality approach to research and policy related to health inequities in the United States and elsewhere. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to estimate the incidence/progression and reversal of chronic periodontitis and to identify factors associated with chronic periodontitis in Australian adults over a 12‐year period. Materials and Methods: Data were obtained from the longitudinal component of the National Study of Adult Oral Health (NSAOH) in 2004–2006, and repeated data, among the same adults, in 2017–2018. NSAOH 2004–2006 was a population‐based study of Australian adults aged 15+ years. The American Academy of Periodontology/European Federation of Periodontology case definitions were used, and then compared with two other case definitions. Multivariable Poisson regression models were used to estimate incidence rate ratios (IRRs) and reversal rate ratio (RRRs) of periodontitis. Results: A total of 775 dentate Australian adults had dental examinations at both times. The proportion of incidence/progression and reversal among Australian adults was 56.4% and 11.0%, respectively. Tobacco smokers presented with more than three times higher incidence (IRR: 3.32, 95% CI: 1.50–7.60) and lower reversals (RRR: 0.94, 95% CI: 0.39–0.98) than those who had never smoked. Cessation of smoking was positively associated with periodontitis reversal. The total incidence/progression was 471.7/10,000 person‐years, with reversal being 107.5/10,000 person‐years. The average number of teeth lost due to periodontal disease was 1.9 in 2017–2018. Being male and not having periodontal treatment were significant risk markers for the incidence/progression of periodontitis. Conclusion: Smoking is a risk factor for periodontitis. Cessation of smoking is an effective means of reducing the incidence and progression of chronic periodontitis, to reduce the risk of tooth loss, and to improve overall periodontal health. [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 aimed to investigate the associations of oral health literacy (OHL), sense of coherence (SOC) and other covariates with self‐reported school performance (SRSP) in adolescents enrolled in public schools in Brazil. METHODS: This was a cross‐sectional study conducted with adolescents aged from 14 to 18 years enrolled in 6 public schools in Piracicaba, São Paulo, Brazil. Researchers carried out data collection at schools using a self‐administered structured questionnaire. The dependent variable was SRSP. The explanatory factors included were sociodemographic characteristics, OHL, SOC, self‐rated oral health, health behaviors, and experience of bullying. Analyses included simple and multiple logistic regression models. RESULTS: The final sample consisted of 385 adolescents with a mean age of 16 years. Poor school performance was associated (95%CI) with being male, with more than 1 sibling, individual whose last visit to the dentist was due to dental pain, with a lower level of OHL and SOC. CONCLUSIONS: OHL and SOC were important factors associated with SRSP performance together with other sociodemographic and oral health‐related variables in high school students. Our findings reinforce the importance of intersectoral actions between the health and education sectors to promote better school performance among adolescents, including actions to improve OHL and SOC. [ABSTRACT FROM AUTHOR]

Background: Perceived self-efficacy has been associated with psychological well-being, health behaviours and health outcomes. Little is known about the influence of self-efficacy on oral health outcomes for Aboriginal adults in Australia, a population experiencing high levels of oral health conditions. This study examines associations between oral health-related self-efficacy and oral health outcomes in a regional Aboriginal Australian population and investigates whether the associations persist after adjusting for sociodemographic characteristics and other general and oral health-related psychosocial factors. Methods: Cross-sectional data were obtained from the baseline questionnaire of the Indigenous Oral Heath Literacy Project, South Australia. Oral health-related self-efficacy was measured using a six item scale, with total sum scores dichotomised into high/low self-efficacy. Oral health outcomes included self-rated oral health and oral health impacts, measured using the Oral Health Impact Profile (OHIP-14). Generalized linear models with a log-Poisson link function were used to estimate Prevalence Ratios (PR) of poor self-rated oral health according to levels of oral health-related self-efficacy. Multivariable linear regressions were used to estimate the association between oral health-related self-efficacy and OHIP-14 scores. Blocks of confounders were subsequently added into the models, with the final model including all factors. Results: Complete data were available for 252 participants (63%) aged 18 to 82 years (mean age of 37.6 years). Oral health-related self-efficacy was associated with poor self-rated oral health, with a 43% (PR = 1.43 (95% CI 1.09, 1.88)) greater prevalence of poor self-rated oral health among those with low self-efficacy. Oral health-related self-efficacy was associated with OHIP-14 severity scores, with a score over six points higher for those with low self-efficacy (B = 6.27 95% CI 2.71, 9.83). Although addition of perceived stress into the models attenuated the relationship, associations remained in the final models. Conclusion: Lower levels of oral health-related self-efficacy were associated with a higher prevalence of poor self-rated oral health and greater impacts of oral health among Aboriginal adults in regional South Australia. These associations persisted after controlling for sociodemographic and psychosocial confounders, suggesting that increasing self-efficacy may provide an opportunity for improving oral health outcomes for Aboriginal adults. [ABSTRACT FROM AUTHOR]

Background The incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCCs) is increasing globally. Common oral conditions such as periodontitis may contribute. We undertook a meta-analysis to quantify the association between periodontitis, oral HPV and OPSCCs. Methods Multiple electronic databases were searched until 12 February 2020. Studies conducted in males and/or females aged ≥ 18 years that examined periodontitis, periodontal procedures, oral HPV infection, and where possible, oral cancers, were eligible. Meta-analyses were conducted and the GRADE approach was used to examine the quality of evidence. Results Of 2709 studies identified, 13 met the eligibility criteria. Five studies could be included in the meta-analyses. There was no significant increase in the odds of high-risk oral HPV infection among individuals with confirmed periodontitis (odds ratio 4.71, 95% confidence interval 0.57–38.97). Individuals with periodontitis had a 3.65 times higher odds of having any type of oral HPV infection compared with those without periodontitis (95% confidence interval 1.67–8.01). The overall body of evidence was rated as low to very-low certainty. Conclusion Meta-analysis confirms there is a positive association between periodontitis and oral HPV infection, although the overall quality of this evidence is low. Evidence for an association between periodontitis and high-risk oral HPV infection is inconclusive. [ABSTRACT FROM AUTHOR]

Background: Oral health during pregnancy is vital for both mother and child. Indigenous Australians face many barriers in accessing dental care. Service approachability is one of the key domains in accessing health services. There is little empirical evidence of the association between service approachability and dental care attendance or oral health outcome. The aim of this study is to examine the relationship between dental service approachability on dental care attendance and self-reported gum disease among South Australian women pregnant with an Aboriginal child. Methods: Four hundred and twenty-seven women pregnant with an Aboriginal child completed questionnaires in both metropolitan and regional health settings in South Australia in 2011. Four variables related to approachability of dental services: (1) perception of need; (2) service-related health literacy; (3) oral health beliefs and; (4) trust and expectation of dental service. The association between service approachability-related factors, dental utilisation and self-reported gum disease during pregnancy were assessed using Generalised Poisson regression models, after adjusting for age, remoteness, employment status and education. Estimates were presented as adjusted prevalence ratios (APR). Results: Most participants (85.8%) reported a need for dental care, had positive oral health beliefs (88.3%) and had expectations towards dental care (86.2%). Dental service utilisation during pregnancy was low (35.7%). Many participants (78.0%) expressed knowing what to do if they needed dental care, while most (39.8%) doubted that dental care would be available the next day. Poor health service literacy was identified as a risk factor for non-optimal dental attendance (APR = 0.86, 95%CI 0.74–0.99). Perceived need for dental care was positively associated with self-reported gum disease (APR = 1.24, 95%CI 1.06–1.45). Conclusion: Inability to navigate the dental care system was a risk factor for poor dental attendance among South Australian women pregnant with an Aboriginal child. Perceived need for dental care was associated with gum disease. [ABSTRACT FROM AUTHOR]

Background: Interpersonal racism has had a profound impact on Indigenous populations globally, manifesting as negative experiences and discrimination at an individual, institutional and systemic level. Interpersonal racism has been shown to negatively influence a range of health outcomes but has received limited attention in the context of oral health. The aim of this paper was to examine the effects of experiences of interpersonal racism on oral health-related quality of life (OHRQoL) among Indigenous South Australians. Methods: Data were sourced from a large convenience sample of Indigenous South Australian adults between February 2018 and January 2019. Questionnaires were used to collect data on sociodemographic characteristics, cultural values, utilization of dental services, and other related factors. OHRQoL was captured using the Oral Health Impact Profile (OHIP-14) questionnaire. We defined the dependent variable 'poor OHRQoL' as the presence of one or more OHIP-14 items rated as 'very often' or 'fairly often'. Experiences of racism were recorded using the Measure of Indigenous Racism Experiences instrument. Interpersonal racism was classified into two categories ('no racism' vs 'any racism in ≥ 1 setting') and three categories ('no racism', 'low racism' (experienced in 1–3 settings), and 'high racism' (experienced in 4–9 settings)). Logistic regression was used to examine associations between interpersonal racism, covariates and OHRQoL, adjusting for potential confounding related to socioeconomic factors and access to dental services. Results: Data were available from 885 participants (88.7% of the total cohort). Overall, 52.1% reported experiencing any interpersonal racism in the previous 12 months, approximately one-third (31.6%) were classified as experiencing low racism, and one-fifth (20.5%) experienced high racism. Poor OHRQoL was reported by half the participants (50.2%). Relative to no experiences of racism in the previous 12 months, those who experienced any racism (≥ 1 setting) were significantly more likely to report poor OHRQoL (Odds Ratio (OR): 1.43; 95% Confidence Interval (CI): 1.08–1.92), after adjusting for age, education level, possession of an income-tested health care card, car ownership, self-reported oral health status, timing of and reason for last dental visit, not going to a dentist because of cost, and having no family support. This was particularly seen among females, where, relative to males, the odds of having poor OHRQoL among females experiencing racism were 1.74 times higher (95% CI: 1.07–2.81). Conclusion: Our findings indicate that the experience of interpersonal racism has a negative impact on OHRQoL among Indigenous Australians. The association persisted after adjusting for potential confounding factors. Identifying this link adds weight to the importance of addressing OHRQoL among South Australian's Indigenous population by implementing culturally-sensitive strategies to address interpersonal racism. [ABSTRACT FROM AUTHOR]

Background: Associations between kidney disease and periodontal disease are not well documented among Aboriginal people of Australia. The purpose of this investigation was to report and compare demographic, oral health, anthropometric and systemic health status of Aboriginal Australians with kidney disease and to compare against relevant Aboriginal Australians and Australian population estimates. This provides much needed evidence to inform dental health service provision policies for Aboriginal Australians with kidney disease. Methods: Sample frequencies and means were assessed in adults represented in six datasets including: (1) 102 Aboriginal Australians with kidney disease residing in Central Australia who participated in a detailed oral health assessment; (2) 312 Aboriginal participants of the Northern Territory's PerioCardio study; (3) weighted estimates from 4775 participants from Australia's National Survey of Adult Oral Health (NSAOH); (4) Australian 2016 Census (all Australians); (5) National Health Survey 2017–2018 (all Australians) and; (6) Australian Health Survey: Biomedical Results for Chronic Diseases, 2011–2012 (all Australians). Oral health status was described by periodontal disease and experience of dental caries (tooth decay). Statistically significant differences were determined via non-overlapping 95% confidence intervals. Results: Aboriginal Australians with kidney disease were significantly older, less likely to have a tertiary qualification or be employed compared with both PerioCardio study counterparts and NSAOH participants. Severe periodontitis was found in 54.3% of Aboriginal Australians with kidney disease, almost 20 times the 2.8% reported in NSAOH. A higher proportion of Aboriginal Australians with kidney disease had teeth with untreated caries and fewer dental restorations when compared to NSAOH participants. The extent of periodontal attachment loss and periodontal pocketing among Aboriginal Australians with kidney disease (51.0%, 21.4% respectively) was several magnitudes greater than PerioCardio study (22.0%, 12.3% respectively) and NSAOH (5.4%, 1.3% respectively) estimates. Conclusions: Aboriginal Australians with kidney disease exhibited more indicators of poorer oral health than both the general Australian population and a general Aboriginal population from Australia's Northern Territory. It is imperative that management of oral health among Aboriginal Australians with kidney disease be included as part of their ongoing medical care. [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]

Objectives: To characterise racism experiences in the past year and to investigate a causal association between racism, stress, and sense of personal control in a sample of pregnant South Australian Aboriginal women. Methods: Data was from the baseline sample of 369 Aboriginal women participating in a randomised controlled trial to prevent early caries in children. Data on demographics, racism experiences, stress, sense of personal control, and health behaviours were collected through interview‐guided questionnaires. Linear regression modelling was used to test the association between racism and stress and sense of personal control in separate models. The final models presented were adjusted for confounding. Results: Participant mean age was 24.7 years (SD ±0.30; Min–Max: 14–43 years). Almost two‐thirds (64.7%) resided in rural and regional areas and the highest educational attainment for almost three‐quarters (73.7%) was high school or less. Nearly half (48.3%) reported at least one experience of racism in the previous year and almost one third (31.8%) reported racism occurring in a public setting. The adjusted regression coefficients for the effect of racism on stress and sense of personal control were respectively 0.61 (95% confidence interval [CI] 0.28, 0.93) and −0.36 (95% CI −0.68, −0.04). Conclusions: Our findings contribute with evidence that racism is one of the psychosocial causes of poor mental health among Aboriginal Australians. Culturally sensitive and safe mental health interventions may be beneficial in buffering racism effects during pregnancy. Societal‐level policies aimed at both naming and reducing institutionalised racism against Aboriginal Australian Aboriginals are necessary. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate associations between oral health literacy (OHL), self‐rated oral health (SROH), and oral health‐related quality of life (OHRQoL) in Brazilian adults. A sample of 523 Brazilian adults completed the short‐form Health Literacy in Dentistry (HeLD‐14) and the Oral Health Impact Profile‐14 (OHIP‐14) instruments that measure OHL and OHRQoL, respectively. The prevalence ratios (PRs) for outcome variables and their 95% CIs were quantified. Multivariable log‐binomial regression models were applied, as the statistical models, to estimate bivariate and multivariable relationships of oral health outcomes with OHL, after adjusting for covariates. No significant association was found between poor SROH (as measured by single items) and OHL (PR = 1.28; 95% CI: 0.87–1.88); by contrast, significant associations were found between poor SROH and income (PR = 1.52; 95% CI: 1.04–2.21), toothbrushing frequency (PR = 1.69; 95% CI: 1.11–2.58), reason for dental visiting (PR = 1.48; 95% CI: 1.03–2.13), and self‐rated general health (PR = 3.44; 95% CI: 2.38–4.97). The OHL level (PR = 1.76; 95% CI: 1.21–2.56), educational level (PR = 0.62; 95% CI: 0.41–0.93), reason for dental visiting (PR = 1.84; 95% CI: 1.30–2.61), and self‐rated general health (PR = 1.51; 95% CI: 1.03–2.23) were associated with poor OHRQoL. [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]

Psychosocial factors may explain variance in health beyond conventional indicators, such as behaviours. This study aimed to examine changes in health associated with perceived stress, social support, and self‐efficacy, controlling for sociodemographic characteristics and health behaviour. A random sample of 45‐ to 54‐yr‐old subjects was surveyed in 2004–2005, with a follow‐up 2 yr later. The outcomes were self‐reported changes in oral and general health. Explanatory variables included stress, social support, and perceived health competence with covariates of income, gender, dentition status, toothbrushing, and smoking. Responses were collected from 986 persons (response = 44.4%). At the 2‐yr follow‐up, 25.6% reported worsening in oral health and 15.3% reported worsening in general health. Prevalence ratios (PR) from adjusted log‐binomial regression showed an association between worsening oral health and higher perceived health competence (PR = 0.75, 95% CI: 0.57–0.99), and worsening general health was associated with perceived health competence (PR = 0.82, 95% CI: 0.72–0.94) and stress (PR = 1.17, 95% CI: 1.03–1.32). Worsening oral and general health were seen for male subjects (PR = 1.33, 95% CI: 1.06–1.68 and PR = 1.14, 95% CI: 1.01–1.29) and low income (PR = 1.40, 95% CI: 1.04–1.89 and PR = 1.20, 95% CI: 1.03–1.40). Health‐related self‐efficacy representing psychosocial resilience was associated with oral and general health, while stress was associated with general health. Psychosocial factors were independent predictors of change in health after controlling for sociodemographic characteristics and health behaviours. [ABSTRACT FROM AUTHOR]

Objective. To compare general and oral health perceptions between Indigenous and non-Indigenous Australians and to quantify Indigenous Australian health-related frames of reference. Methods. A mixed-methods approach was used. The quantitative component comprised data from four convenience studies of Indigenous oral health and one national oral health survey stratified by Indigenous status. Qualitative data with questions pertaining to frames of reference were collected from 19 Indigenous Australian interviews. Results. Among the Indigenous studies, deficits in perceptions of excellent, very good, or good general health and excellent, very good, or good oral health ranged from 10.5% to 43.8%. Among the non-Indigenous population, the deficit was 5%. Frames of reference appeared to underpin a biomedical conceptual outlook. Conclusion. The deficit in perceived oral health compared with general health was far greater among Indigenous Australians. The frame of reference underpinning Indigenous Australian's perceptions of health reflect those of the general Australian population. [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]

This study assessed links between racism and oral health outcomes among pregnant Canadian Aboriginal women. Baseline data were analyzed for 541 First Nations (94.6%) and Métis (5.4%) women in an early childhood caries preventive trial conducted in urban and on- reserve communities in Ontario and Manitoba. One- third of participants experienced racism in the past year determined by the Measure of Indigenous Racism Experience. In logistic regressions, outcomes significantly associated with incidents of racism included: wearing dentures, off- reserve dental care, asked to pay for dental services, perceived need for preventive care, flossing more than once daily, having fewer than 21 natural teeth, fear of going to dentist, never received orthodontic treatment and perceived impact of oral conditions on quality of life. In the context of dental care, racism experienced by Aboriginal women can be a barrier to accessing services. Programs and policies should address racism's insidious effects on both mothers' and children's oral health outcomes. [ABSTRACT FROM AUTHOR]

Aims. The aim of this study was to describe the impact of oral health conditions among a convenience sample of Indigenous Australian adults and compare findings with nationally representative data. Methods. Data were obtained from the Indigenous Oral Health Literacy Project (IOHLP) based in South Australia. Nationally representative data were obtained from the National Survey of Adult Oral Health (NSAOH). The impact of oral disease was measured using the shortened form of the oral health impact profile, OHIP- 14. All data were standardised by age group and sex utilising Census data. Results. For each OHIP- 14 measure the impact was greater for IOHLP participants. There was considerable variation in the degree of difference between IOHLP and NSAOH participants for individual OHIP- 14 items. Conclusion. High levels of effects of oral health conditions were reported by rural-dwelling Indigenous adults. This may exacerbate the health and social disadvantage experienced by this marginalised group. [ABSTRACT FROM AUTHOR]

Objectives. This paper assessed the fidelity of an early childhood caries MI intervention among Aboriginal mothers in South Australia. Methods. Four MI- trained staff delivered the intervention and all interviews were recorded. A randomly selected subset (n = 164, 41.2%) were tested for MI fidelity using the Motivational Interviewing Treatment Integrity (MITI) code 3.1.1. A further randomly selected 20 taped sessions were additionally scored by an external expert to assess external reliability. Results. Mean scores for evocation, collaboration, autonomy/ support, direction and empathy ranged from 3.5 (95% CI 3.4- 3.7) to 4.1 (95% CI 4.0- 4.2). The mean global score was 3.8 (95% 3.7- 3.9). The Reflection:Question ratio was 0.9 (95% CI 0.8- 1.0), % Open- ended Questions was 54.9 (95% CI 50.0- 59.8), % Complex Reflections was 54.0 (95% CI 50.5- 57.5) and % MI- adherent statements was 95.0 (95% CI 92.0- 98.0). Inter- assessor reliability was high. Conclusions. Beginner to expert competency in fidelity to the MI model was observed. [ABSTRACT FROM AUTHOR]

Objective. Dental diseases have shown to be influenced by area- level socioeconomic status. This study aims to assess the effects of change in area- level SES on the oral health of Australian Indigenous children. Methods. Data were collected from a national surveillance survey for children's dental health at two points of time (2000- 2002/ 2007- 2010). The study examines caries experienced by area- level SES and whether changes in area- level SES (stable- high, upwardly- mobile, downwardly- mobile and stable low) affects caries experience. Results. Dental caries in both the deciduous and permanent dentition increased significantly among Indigenous children during the study period. In stable lowSES areas, the experience of decayed, missing and overall dmft/ DMFT in both dentitions was highest compared with other groups at both Time 1(2.15 vs 1.61, 1.77, 1.87 and 0.86 vs 0.55, 0.67, 0.70 respectively) and Time 2 (3.23 vs 2.08, 2.17, 2.02 and 1.49 vs 1.18, 1.21 respectively). Conclusion. A change in area- level SES was associated with experience of dental disease among Indigenous Australian children. [ABSTRACT FROM AUTHOR]

Objectives. To determine factors associated with routine dental attendance in Aboriginal Australians. Methods. Data of 271 Aboriginal adults residing in Australia’s Northern Territory were used. Routine dental attendance was defined as last visiting a dentist less than one year ago or visiting a dentist for a check-up. Both bivariate and multivariable analytical techniques were used. Results. While 27% visited a dentist in the past year, 29% of these visited for a check-up. In bivariate analysis, being female, low psychological distress, and low clinical attachment loss (CAL) were associated with visiting a dentist within last year. Being aged younger than 39 years, male, no oral health impairment, being caries- free, low CAL, and low apolipoprotein B were associated with visiting for a check-up. Clinical attachment loss remained associated with visiting a dentist less than one year ago while being younger than 39 years and having no oral health impairment remained associated with usually visiting for a check-up in multivariable analysis. Conclusions. Younger age, no oral health impairment, and low CAL were associated with routine dental attendance among Indigenous Australians. [ABSTRACT FROM AUTHOR]

Background Simplified periodontal therapy might be a pragmatic strategy for public health programmes targeting Indigenous Australian adults. The objective of this randomized controlled trial was to evaluate oral health effects of single-visit, non-surgical periodontal therapy compared to no treatment. Methods This parallel-group, randomized, open label clinical trial enrolled 273 Indigenous Australians aged ≥18 years with periodontitis. Intervention participants received full-mouth periodontal scaling and root planing during a single visit while the control group received no treatment. Endpoints were summary variables derived from clinical assessments of probing depth, clinical attachment loss, plaque, calculus and gingival bleeding before treatment and 3 months later. Results Endpoints could be calculated for 169 participants with follow-up data. Compared to the control group, there were statistically significant reductions in extent of shallow pockets: PD ≥4 mm (mean difference −2.86, [95% CI −5.01 to −0.71], p = 0.009) and gingival bleeding (mean difference −0.25, [95% CI −0.43 to −0.08], p = 0.005) but not deeper pockets PD ≥5 mm (mean difference −0.48, [95% CI −1.78 to 0.82], p = 0.468) or plaque scores. Conclusions Periodontal therapy produced improvements in shallow periodontal pockets and measures of gingival bleeding in these Indigenous Australians. [ABSTRACT FROM AUTHOR]

Objectives: To describe rates of hospitalization for head and traumatic brain injury (TBI) among Australian adults aged 15-24 years. Design: Descriptive analysis of the Australian Institute of Health and Welfare National Hospital Morbidity Database, using data from 1 July 2000 to 30 June 2006. Results: The rate of hospitalization for head injury was 618.5 per 100 000, with 148.1 per 100 000 being high threat to life injuries. In multivariate analysis, males had 3.2-times the rate of females. Youth and young adults living in remote and very remote areas had a 2.6-3.2-fold greater rate of head injury than city-dwellers and a 2.3-2.7-fold greater rate of injuries that were high threat to life. The rate of TBI was 169.3 per 100 000, with 87.1 per 100 000 being high threat to life injuries. In multivariate analysis, males had 3.2-times the rate of females. Youth and young adults living in very remote and remote areas had a 2.5-3.0-fold greater rate of TBI than city-dwellers and a 2.1-2.3-fold greater rate of high threat to life TBI. Conclusions: Males and youth and young adults living remotely were disproportionately represented among those sustaining head injuries. A quarter of hospitalized head injuries were coded as having TBI. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic inequalities are associated with oral health status, either subjectively (self-rated oral health) or objectively (clinically-diagnosed dental diseases). The aim of this study is to compare the magnitude of socioeconomic inequality in oral health and dental disease among adults in Australia, Canada, New Zealand and the United States (US). Methods: Nationally-representative survey examination data were used to calculate adjusted absolute differences (AD) in prevalence of untreated decay and fair/poor self-rated oral health (SROH) in income and education. We pooled age- and gender-adjusted inequality estimates using random effects meta-analysis. Results: New Zealand demonstrated the highest adjusted estimate for untreated decay; the US showed the highest adjusted prevalence of fair/poor SROH. The meta-analysis showed little heterogeneity across countries for the prevalence of decayed teeth; the pooled ADs were 19.7 (95% CI = 16.7–22.7) and 12.0 (95% CI = 8.4–15.7) between highest and lowest education and income groups, respectively. There was heterogeneity in the mean number of decayed teeth and in fair/poor SROH. New Zealand had the widest inequality in decay (education AD = 0.8; 95% CI = 0.4–1.2; income AD = 1.0; 95% CI = 0.5–1.5) and the US the widest inequality in fair/poor SROH (education AD = 40.4; 95% CI = 35.2–45.5; income AD = 20.5; 95% CI = 13.0–27.9). Conclusions: The differences in estimates, and variation in the magnitude of inequality, suggest the need for further examining socio-cultural and contextual determinants of oral health and dental disease in both the included and other countries. [ABSTRACT FROM AUTHOR]