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Background: The burden of childhood dental caries amongst Indigenous Australians is higher than in other Australians. Because of differences in lifestyle and the evolutionary history of the oral microbiota, associated risk indicators may differ. Here, we evaluate associations between caries increment, salivary biomarkers and baseline caries among children aged 5-17 years residing in a remote rural Indigenous community., Methods: This study was part of a trial assessing cost-effectiveness of an intervention to prevent dental caries among children. Baseline epidemiology and application of topical caries-preventive measures was conducted in 2015, followed-up in 2016 and 2017. Children who did not consent or failed to attend the prevention visits but did attend for follow-up epidemiology constituted a natural comparison group for evaluating the intervention. Saliva flow, pH, buffering and bacterial loads were measured at all visits. Caries was scored by the International Caries Detection and Assessment system. Outcome was caries increment. Explanatory variables were sex, being in experimental or comparison group, baseline caries, saliva flowrate and buffering, pH, and salivary loads of mutans streptococci (MS), Lactobacilli (LB), and yeast. Chi Square tests compared caries incidence in relation to explanatory variables and Generalised Linear Models explored associations between explanatory and outcome variables., Results: Of 408 participants at baseline, only 208 presented at 2-year follow-up. Of caries-free children at baseline, significantly fewer had incipient (p = 0.01) and advanced (p = 0.04) caries after two years. Children in the experimental group experienced fewer tooth surfaces with advanced caries (p = 0.02) than comparison children. Having caries at baseline (p = 0.02) and low salivary flow-rates (p < 0.001) saw a significant increase in advanced caries after two years. Children with high salivary loads of MS (p = 0.03) and LB (p = 0.004) experienced more advanced carious surfaces. Multivariable analysis revealed 58% reduction (p = 0.001) in advanced caries among children with high salivary flow rates. Caries increment was 61% (p = 0.03) more for incipient and 121% (p = 0.007) more for advanced caries among children who harboured higher loads of MS., Conclusion: As with other ethnicities, children with low salivary flow and those with high MS had higher incipient and advanced caries increments after two years. Such risk assessments facilitate targeted preventive interventions for such communities., Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527: 3 July 2015., (© 2021. The Author(s).)

We tested the effect of an annual caries preventive intervention, delivered by a fly-in/fly-out oral health professional team, with Indigenous children residing in a remote Australian community. Around 600 Indigenous children aged 5 to 17 years were invited to participate at baseline, of who 408 had caregiver consent. One hundred and ninety-six consented to the epidemiological examination and intervention (Intervention group) and 212 consented to the epidemiological examination only (Comparison group). The intervention, which occurred annually, comprised placement of fissure sealants on suitable teeth, and application of povidone-iodine and fluoride varnish to the whole dentition, following completion of any necessary restorative dental treatment. Standard diet and oral hygiene advice were provided. Caries increment (number of tooth surfaces with new dental caries) in both deciduous and permanent dentitions was measured at the 2-year follow-up. Comparison group children had significantly higher number of new surfaces with advanced caries in the permanent dentition than the Intervention group (IRR = 1.61; 95% CI: 1.02-2.54; p = 0.04); with a preventive fraction of 43%. The effect of intervention remained significant with children in the Comparison group developing significantly more advanced caries lesions in the permanent dentition than the Intervention group children in the adjusted multivariable analysis (IRR = 2.21; 95% CI: 1.03-4.71). Indigenous children exposed to the intervention had less increment in advanced dental caries in the permanent dentition than those not exposed to the intervention., Competing Interests: The authors have no competing interests.

This study evaluates the effect of a topical intervention comprising of fissure sealant, povidone-iodine, and fluoride varnish in preventing caries on occlusal, approximal, and smooth surfaces. This three-year clinical trial was conducted in a remote Indigenous community of Australia. All schoolchildren (age range: 4-17) were invited to participate; those with parental consents to receive three-annual epidemiological examinations and interventions constituted the experimental group, while those with consents for only the epidemiological examination formed a comparison group. The intervention group received an annual application of fissure sealant, povidone-iodine and fluoride varnish for two consecutive years along with the restoration of any cavitated lesions, while the comparison group did not receive any intervention except for the usual care that included emergency treatment and restorations. Incipient and advanced caries were recorded in the permanent dentition while data on confounding variables were collected through questionnaires. Caries increment and progression were the outcome variables. A total of 408 children participated in the baseline examination, 208 finished the study. After adjusting for confounders, the prevented fraction (PF) on occlusal surfaces for advanced caries in the experimental group was 76.1% (mean difference- -0.35, 95% CI: -0.67-0.04), while the PF for progression from incipient to advanced caries was 100%(mean difference- -0.30, 95% CI: -0.52-0.09). The mean number of smooth surfaces that progressed from incipient to advanced caries in the comparison group was more than twice that of the experimental group, the mean difference was -0.25 (95% CI: -0.46--0.03) with a PF of 61%. The intervention was only effective in preventing advanced caries on occlusal surfaces and in halting the progression of caries on occlusal and smooth surfaces but not on approximal caries.

Background: The oral health of Indigenous children in remote communities is much worse than other population groups in Australia. Providing and maintaining an oral health service is challenging due to the remoteness of communities, the associated high cost, and the low retention of clinical staff. An annual preventive intervention delivered by fly-in clinicians may be a more cost-effective way to manage this problem. In this analysis we estimate the cost-effectiveness of an annual professional intervention for the prevention of dental caries in children of a remote Indigenous community in Far North Queensland., Methods: A cost-effectiveness analysis was conducted based on an annual preventive intervention protocol. This included treating all dental decay in those with disease, applying fissure sealants, a disinfectant swab, fluoride varnish and providing oral hygiene instructions and dietary advice to all participating school children. This study included an intervention group and a natural comparison group and both groups were followed-up for 2 years after the initial preventive intervention. A Markov model was built to assess the cost-effectiveness of the intervention compared with the usual care. Costs of treatment from the Queensland Department of Health were used and effectiveness was measured as quality-adjusted life years (QALYs) with the CHU-9D. One-way and probabilistic sensitivity analyses were conducted to identify key drivers and quantify uncertainty., Results: The preventive intervention was found to be highly cost-effective. The incremental cost per QALY gained was AU$3747. Probability of new caries and seeking treatment were identified as the main drivers of the model. In probabilistic sensitivity analysis intervention was cost effective in 100% of simulations., Conclusion: An annual preventive intervention for remote Indigenous communities in Australia is a highly cost-effective strategy to prevent dental caries and improve the quality of life of children.

Objectives: To report on changes in dental caries experience in children of a remote Indigenous community following 6 years of passive preventive intervention (PPI) and 2 years of active preventive intervention (API)., Methods: Five consecutive cross-sectional surveys were conducted on 4- to 15-year-old school going children between 2004 and 2017 following phases of Community Water Fluoridation (CWF), post-cessation of CWF and API. Following treatment of any cavities present, API included selective placement of fissure sealants (FS) and an annual application of povidone-iodine (PI) and fluoride varnish (FV). The World Health Organization's (WHO) "Oral Health Surveys - Basic Methods (4th Edition)" methodology was used in the first two and the International Caries Detection and Assessment System (ICDAS-II) in the latter three surveys. ICDAS-II codes of 3-6, representing advanced caries, were combined to allow comparison to the decayed component of the DMF caries index., Results: Age-weighted mean dmft decreased by 37.7% in the deciduous (DD) and DMFT by 35% in the permanent (PD) dentitions between the pre- and post-CWF surveys, followed by increases of 25% and 7.7%, respectively, between the 1-year and 4-year post-CWF surveys. After 2 years of API, mean dmft decreased by 14.3% and DMFT by 7.1%. Untreated dental caries however remained a concern in the DD and PD during both phases of PPI and of API. The decline in caries experience for both dentitions following 2 years of API exceeded that for the 6-year period of PPI., Conclusions: The annual reductions in caries experience of 7.2% (DD) and 8% (PD) during the phase of API exceeded annual decreases of 4.7% (DD) and 4.6% (PD) during the phase of PPI. Due to remoteness, cost and logistics in ensuring long-term viability of API programmes, CWF remains necessary in this type of community., (© 2019 The Authors. Community Dentistry and Oral Epidemiology Published by John Wiley & Sons Ltd.)

Objectives: This study explored the association of children's salivary characteristics, past caries experience, birth weight, and reported maternal prenatal vitamin and mineral supplementation with the dental untreated decay of the child., Methods: This cross-sectional study, a sub-study of Griffith University Environments for Healthy Living birth cohort study, was conducted on 174 mother-child dyads. Mother's prenatal usage of vitamin and mineral supplements; child's birthweight; salivary pH, buffering capacity, and levels of salivary MS and LB were explored as risk indicators. Dental caries experience was assessed using International Caries Detection and Assessment System criteria. Path analysis was conducted to evaluate the association of risk indicators with children's current and past dental caries experience., Results: Children's past caries experience (β = 0.332, p = 0.018), and salivary MS counts (β = 0.215, p = 0.032) were positively associated with untreated decay at time of examination. With a trend towards significance, children whose mothers had reported taking iron supplements during pregnancy experienced lower levels of past caries (β = -0.137, p = 0.068) and untreated dental caries (β = -0.046, p = 0.051)., Conclusions: This study confirms that a child's levels of untreated decay is positively associated with their past caries, and that it correlates with current levels of salivary MS. Children of mothers who reported to have taken iron supplements during pregnancy experienced less caries throughout their lives. These observations confirm the importance to offspring of monitoring maternal health throughout pregnancy and of early monitoring of children's oral health in preventing future dental disease., (© 2018 American Association of Public Health Dentistry.)

Objectives: To determine the association of body mass index (BMI) with dental caries in Indian schoolchildren, and to analyse the influence of socio-economic status (SES)., Methods: The study population consisted of 11- to 14-year-old children from Medak District in Telangana State, India. The Indian Academy of Paediatrics 2015 growth charts were used to categorise children as underweight, overweight, normal or obese, based on their BMI. Data on the SES of the family were collected through questionnaires. Clinical examination for dental caries was performed by a single examiner., Results: A total of 1,092 subjects returned questionnaires and were clinically examined (giving a response rate of 85%). There were no significant differences in caries prevalence and experience across the categories of BMI. However, caries prevalence and experience in overweight children were 24.8% and 0.69 ± 1.51, respectively, while the corresponding values in normal-weight children were 35% and 0.85 ± 1.50, respectively. Among children of high-SES families, overweight children had approximately 71% fewer caries than did those who were normal weight [incidence rate ratio (IRR) = 0.29; 95% CI: 0.11-0.78)]., Conclusions: BMI was not associated with dental caries prevalence and experience in this population. The association of BMI with dental caries varied across SES categories. In the high-SES category, overweight children experienced fewer caries than did normal-weight children., (© 2016 FDI World Dental Federation.)

Objective: To synthesise data from the literature on the effects of various parent-related characteristics (socio-demographic, behavioural and family environment) on dental caries in the permanent dentition of children., Data: Available studies in which the effects of parent-related characteristics on dental caries experience in the permanent dentition of children aged 6-12 years were evaluated., Sources: PubMed, Medline via OVID and CINAHL Plus via EBSCO, restricted to scientific articles, were searched in April 2015. English language and time filters (articles published from 2000) were used., Study Selection: A total of 4162 titles were retrieved, of which 2578 remained after duplicates were removed. After review of titles and their abstracts by two independent reviewers, 114 articles were considered relevant for full text review. Of these, 48 were considered for final inclusion. Data extraction was performed by two authors using piloted data extraction sheets., Conclusions: Most of the literature on determinants of dental caries has been limited to socio-economic and behavioural aspects: we found few studies evaluating the effects of family environment and parental oral hygiene behaviour. Children belonging to lower socio-economic classes experienced more caries. In more than half the studies, children of highly educated, professional and high income parents were at lower risk for dental caries. There were conflicting results from studies on the effect of variables related to family environment, parents' oral hygiene behaviour and parent's disease status on dental caries in their children., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Expenditure on dental and oral health services in Australia is $3.4 billion AUD annually. This is the sixth highest health cost and accounts for 7 % of total national health expenditure. Approximately 49 % of Australian children aged 6 years have caries experience in their deciduous teeth and this is rising. The aetiology of dental caries involves a complex interplay of individual, behavioural, social, economic, political and environmental conditions, and there is increasing interest in genetic predisposition and epigenetic modification., Methods: The Oral Health Sub-study; a cross sectional study of a birth cohort began in November 2012 by examining mothers and their children who were six years old by the time of initiation of the study, which is ongoing. Data from detailed questionnaires of families from birth onwards and data on mothers' knowledge, attitudes and practices towards oral health collected at the time of clinical examination are used. Subjects' height, weight and mid-waist circumference are taken and Body Mass Index (BMI) computed, using an electronic Bio-Impedance balance. Dental caries experience is scored using the International Caries Detection and Assessment System (ICDAS). Saliva is collected for physiological measures. Salivary Deoxyribose Nucleic Acid (DNA) is extracted for genetic studies including epigenetics using the SeqCap Epi Enrichment Kit. Targets of interest are being confirmed by pyrosequencing to identify potential epigenetic markers of caries risk., Discussion: This study will examine a wide range of potential determinants for childhood dental caries and evaluate inter-relationships amongst them. The findings will provide an evidence base to plan and implement improved preventive strategies.

Background: The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention., Methods/design: The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally., Discussion: There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world. The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015.

Background: Psychiatric patients have increased comorbid physical illness. There is less information, however, on dental disease, especially tooth decay, despite life-style risk factors or psychotropic-induced dry mouth in this population. Importantly, poor oral health can predispose people to chronic physical disease leading to avoidable admissions to hospital for medical causes., Methods: Using MEDLINE, PsycInfo, EMBASE, and article bibliographies, we undertook a systematic search for studies from the last 25 years regarding the oral health of people with severe mental illness (SMI). Results were compared with the general population. The two outcomes were total tooth loss (edentulism) and dental decay measured through the following standardized measures: the mean number of decayed, missing, and filled teeth or surfaces., Results: We identified 25 studies that had sufficient data for a random-effects meta-analysis. These covered 5076 psychiatric patients and 39,545 controls, the latter from either the same study or community surveys. People with SMI had 2.8 the odds of having lost all their teeth compared with the general community (95% confidence interval [CI] = 1.7-4.6). They also had significantly higher decayed, missing, and filled teeth (mean difference = 5.0, 95% CI = 2.5-7.4) and surfaces scores (mean difference = 14.6, 95% CI = 4.1-25.1)., Conclusion: The increased focus on the physical health of people with SMI should encompass oral health. Possible interventions could include oral health assessment conducted using standard checklists that can be completed by non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth, and early dental referral.

Background: The caries process follows a strong social gradient which can commence in the first years of life. Yet data on young children remain limited. This study reports the potential risk factors and indicators in urban, Aboriginal and Torres Strait Islander children aged less than 5 and estimates the prevalence of caries.Methods: Demographic and risk factor and risk indicator data were collected at baseline in a cohort study of children attending a health clinic in north Brisbane. Dentulous children received a basic oral examination to explore the presence of decayed, missing and filled teeth (dmft). Descriptive analyses were performed. A backwards stepwise logistic regression model was performed to identify potential associations with dmft status.Results: In this study, 180 children enrolled: 111 children received the oral examination, of whom 14 (12.6%) (mean age 35 months) were estimated to have dmft >0. There was a high prevalence of socio-economic, dietary and behavioural risk factors/indicators present for children. Due to the small sample size, planned regression was not performed.Conclusions: Overall, the prevalence of risk factors and risk indicators for caries in the study population is high. More culturally appropriate resources that support preventive care need to be invested before children are school aged. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To assess the usage of cost‐utility analysis (CUA) in oral health interventions and to evaluate the methods used and the reporting quality of CUA in publications on oral health interventions. Methods: A systematic review was performed on literature published between 2000 and 2016 where cost‐utility analyses of oral health interventions were included. The reporting quality of these oral health CUAs was assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: Of the 6637 publications identified initially, 23 met the inclusion criteria. Of these, 14 (61%) had been published in the last 6 years. Included studies were on oral cancer (n = 6), provision of dental prosthesis (n = 6), dental caries (n = 4), periodontal diseases (n = 3), antibiotic prophylaxis (n = 2), dento‐facial anomalies (n = 1) and dental service provision (n = 1). Twenty‐one studies were able to identify the most cost‐effective intervention among the different options compared. Of the 23 studies identified, 15 (65%) used quality‐adjusted life years (QALY) as the outcome measure, and 18 (78%) reported an incremental cost‐effectiveness ratio. The economic perspective was clearly stated in 13 articles (57%). Twenty studies (87%) reported the discount rate, and 22 (96%) undertook sensitivity analysis. The reporting quality of studies, appraised by the CHEERS checklist, varied from 75% to 100% (median 92%). Conclusion: The use of CUAs in evaluation of oral health interventions has been increasing recently, especially from 2011 to 2016. The majority of CUA articles were of good reporting quality as assessed by the CHEERS checklist and were able to provide conclusions regarding the most cost‐effective intervention among the different options compared: this will assist in healthcare decision‐making and resource allocation. These positive outcomes of our study encourage wider use of CUAs within the dental and oral health professions. [ABSTRACT FROM AUTHOR]

Background: Parental-Caregiver Perception Questionnaire (P-CPQ) and Family Impact Scale (FIS) are commonly used measures to evaluate the parent's perception of the impact of children's oral health on quality of life and family respectively. Recently, shorter forms of P-CPQ and FIS have been developed. No study has sought to validate these short forms in other languages and cultures. This study aimed to evaluate the validity and reliability of FIS, 8 and 16-item P-CPQ in a Telugu speaking population of India.Methods: For this cross-sectional study, a multi-stage random sampling technique was used to recruit 11-13 year-old schoolchildren of Medak district, Telangana, India and their parents (n = 1342). Parents were approached with questionnaires through their children who underwent clinical examinations for dental caries, fluorosis and malocclusion. The translated versions underwent pilot testing (n = 40), test-retest reliability was also assessed (n = 161).Results: The overall summary scale and subscales of the short forms of P-CPQ and FIS failed to discriminate between the categories of dental caries severity. Also, malocclusion status was not related to the domain or overall scores of both the short forms of P-CPQ. There were significant differences in subscale and overall scores of 16 and 8-item P-CPQ and FIS between the fluorosis categories. Both 16 and 8-item P-CPQ summary scales were significantly related to parent's global rating of oral health (16-item, r = 0.30, p < 0.01; 8-item, r = 0.28, p < 0.01) and overall wellbeing (16-item, r = 0.22, p < 0.01; 8-item, r = 0.22, p < 0.01), thereby exhibiting good construct validity. However, the correlation of emotional and social wellbeing scales of short forms of P-CPQ and FIS with global ratings was of low strength. Cronbach's alphas for FIS, 16-items and 8-items P-CPQ scales were 0.78, 0.83 and 0.71 respectively, while the Intra-Class Correlation coefficients were 0.752, 0.812 and 0.816 respectively. Cronbach's alphas for most of the subscales of short forms of P-CPQ were less than 0.7.Conclusions: The overall scales of 16 and 8-items P-CPQ scales demonstrated good construct validity while the construct validity of FIS was questionable. Discriminant validity of all the three instruments was good only in relation to fluorosis. Overall scales of all three short forms exhibited acceptable internal consistency and reliability on repeated administrations. [ABSTRACT FROM AUTHOR]

Sri Lanka’s Veddas/ Vanniya- laeto, are a small Indigenous group today with little information on their oral health status. This report is to provide an overview on oral health status of Veddas. Oral health status was recorded by the principal investigator after obtaining consent, using World Health Organization criteria, at an initial screening point before sending the person for any necessary treatment. Total participants were 194: 78% were males>35 years. Mean decayed, missing, filled teeth was 0.9 and 3% had pockets <3.5mm. Three had oral potentially malignant disorders (OPMDs), while three were treated for oral cancer. While the prevalence of dental caries and periodontal conditions was low, oral cancer and OPMDs is a serious concern. The Veddas have a culturally specific health system based on herbal medicinal knowledge. Thus, it is challenging to introduce and implement a preventive and curative oral health care system that would be culturally acceptable to this community. [ABSTRACT FROM AUTHOR]

Background: Considerable global variation in the incidence of lip, of oral cavity and of pharyngeal cancers exists. Whilst this reflects regional or population differences in risk, interpretation is uncertain due to heterogeneity of definitions of sites and of sub-sites within this anatomically diverse region. For Australia, limited data on sub-sites have been published. This study examines age-standardised incidence trends and demography from 1982 to 2008, the latest data available.Methods: Numbers of cases within ICD10:C00-C14 were obtained from the Australian Institute of Health and Welfare, recorded by sex, age, and sub-site. Raw data were re-analysed to calculate crude, age-specific and age-standardised incidence using Segi's world-standard population. Time-trends were analysed using Joinpoint regression.Results: Lip, Oral Cavity and Pharyngeal (excluding nasopharynx) cancers, considered together, show a biphasic trend: in men rising 0.9% pa from 1982 to 1992, and declining 1.6% pa between 1992 and 2008. For females: rises of 2.0% pa 1982-1997; declines of 2.8% pa 1997-2008. Lip cancer is declining especially significantly. When the Oropharynx is considered separately, steadily increasing trends of 1.2% pa for men and 0.8% pa for women were observed from 1982 to 2008.Conclusions: Although overall rates of lip/oral/oropharyngeal cancer are declining in Australia, these are still high. This study revealed steady increases in cancers of the oropharynx, beginning in the late 1990s. Continued efforts to reduce the burden of these cancers are needed, focused on reduction of the traditional risk factors of alcohol and tobacco, and with special emphasis on the possible role of human papillomavirus and sexual hygiene for cancers of the oropharynx. [ABSTRACT FROM AUTHOR]