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This review of the oral health of children in Australia, New Zealand, Canada and the USA demonstrates that significant oral health inequalities exist in each nation. Despite traditionally low levels of disease in Indigenous communities, dental caries is now highly prevalent and of increased severity among Indigenous children in comparison to their non-Indigenous counterparts. Early childhood caries is particularly prevalent. The high level of dental disease experience at an early age is associated with increased rates of general anaesthesia and greater risk of dental caries in later life. The rates and severity of dental caries experienced by young Indigenous children are even more alarming when we consider that dental caries is essentially a preventable disease. The success of specific preventive programmes is encouraging; these approaches should be further evaluated and implemented as part of broader health promotion programmes for Indigenous children and families in order to decrease current oral health disparities., (© 2010 The Authors. Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

This overview revealed that substantial oral health inequalities exist between Indigenous and non-Indigenous child and adult populations in the United States, Canada, Brazil, Australia and New Zealand, with evidence suggesting that these inequalities are increasing. Despite the marked differences in geography, culture, language and history experienced by these groups, it is notable how similar the oral health inequalities were. A number of reasons are discussed in the paper.

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

Objective: To compare clinical oral health outcomes between a birth cohort of young Australian Aboriginal adults and age-matched, national-level counterparts., Design, Setting and Participants: Comparison of outcomes between the dental component of Wave-3 of the Aboriginal Birth Cohort (ABC) study--a cross-sectional study conducted between January 2006 and December 2007, nested within a prospective longitudinal investigation in the Northern Territory's Top End--and the 2004-06 National Survey of Adult Oral Health (NSAOH), a representative survey of the Australian population. Data were analysed for 442 ABC study participants and 202 NSAOH participants aged 16-20 years., Main Outcome Measures: Severity and prevalence of clinical oral health outcomes., Results: The mean number of decayed teeth was 8.0 times higher among ABC study participants than NSAOH participants, while the prevalence of untreated decayed teeth was 3.1 times higher. ABC study participants experienced 10.8 times the prevalence of moderate or severe periodontal disease of NSAOH participants, and 1.9, 4.1 and 4.5 times the prevalence of calculus, plaque and gingivitis, respectively., Conclusion: Adverse clinical oral health outcomes were 2-11 times higher in a cohort of young Australian Aboriginal adults than their age-matched, nationally representative counterparts.

Aim: To investigate the effects of tobacco, marijuana, alcohol and petrol sniffing on periodontal disease among Australian Aboriginal young adults., Design: Cross-sectional nested within a long-standing prospective longitudinal study. Setting Aboriginal communities in Australia's Northern Territory., Participants: Members of the Aboriginal Birth Cohort study who were recruited from birth between January 1987 and March 1990 at the Royal Darwin Hospital, Northern Territory, Australia. Data were from wave III, when the mean age of participants was 18 years., Measurements: Clinical dental examination and self-report questionnaire., Findings: Of 425 participants with complete data, 26.6% had moderate/severe periodontal disease. There was elevated risk of periodontal disease associated with tobacco [prevalence ratio (PR) = 1.59, 95% CI = 1.06-2.40], marijuana (PR = 1.44, 95% CI = 1.05-1.97) and petrol sniffing (PR = 1.83, 95% CI = 1.08-3.11), but not alcohol (PR = 0.92, 95% CI = 0.67-1.27). Stratified analysis showed that the effect of marijuana persisted among tobacco users (PR = 1.47, 95% CI 1.03-2.11). It was not possible to isolate an independent effect of petrol sniffing because all petrol sniffers used both marijuana and tobacco, although among smokers of both substances, petrol sniffing was associated with an 11.8% increased prevalence of periodontal disease., Conclusions: This is the first time that substance use has been linked with periodontal disease in a young Australian Aboriginal adult population, and the first time that petrol sniffing has been linked with periodontal disease in any population. The role of substance use in periodontal disease among this, and other, marginalized groups warrants further investigation.

Objectives: To determine oral health literacy (REALD-30) and oral health literacy-related outcome associations, and to calculate if oral health literacy-related outcomes are risk indicators for poor self-reported oral health among rural-dwelling Indigenous Australians., Methods: 468 participants (aged 17-72 years, 63% female) completed a self-report questionnaire. REALD-30 and oral health literacy-related outcome associations were determined through bivariate analysis. Multivariate modelling was used to calculate risk indicators for poor self-reported oral health., Results: REALD-30 scores were lower among those who believed teeth should be infrequently brushed, believed cordial was good for teeth, did not own a toothbrush or owned a toothbrush but brushed irregularly. Tooth removal risk indicators included being older, problem-based dental attendance and believing cordial was good for teeth. Poor self-rated oral health risk indicators included being older, healthcare card ownership, difficulty paying dental bills, problem-based dental attendance, believing teeth should be brushed infrequently and irregular brushing. Perceived need for dental care risk indicators included being female and problem-based dental attendance. Perceived gum disease risk indicators included being older and irregular brushing. Feeling uncomfortable about oro-facial appearance risk indicators included problem-based dental attendance and irregular brushing. Food avoidance risk indicators were being female, difficulty paying dental bills, problem-based dental attendance and irregular brushing. Poor oral health-related quality of life risk indicators included difficulty paying dental bills and problem-based dental attendance., Conclusions: REALD-30 was significantly associated with oral health literacy-related outcomes. Oral health literacy-related outcomes were risk indicators for each of the poor self-reported oral health domains among this marginalised population.

Objectives: The objective of this study was to determine risk factors for a summary measure of oral health impairment among 18- to 34-year-olds in Australia., Methods: Data were from Australia's National Survey of Adult Oral Health, a representative survey that utilized a three-stage, stratified, clustered sampling design. Oral health impairment was defined as reported experience of toothache, poor dental appearance, or food avoidance in the last 12 months. Multivariate Poisson regression models were used to evaluate effects of sociodemographic characteristics, self-perceived oral health, dental service utilization, and clinical oral disease indicators on oral health impairments. Effects were quantified as prevalence ratios (PR)., Results: The estimated percent of 18- to 34-year-olds with oral health impairment was 42.4 [95 percent confidence interval (CI) 37.7-47.2]. In the multivariate model, oral health impairment was associated with untreated dental decay (PR 1.38, 95 percent CI 1.13-1.68) and presence of periodontal pockets 4 mm+ (PR 1.29, 95 percent CI 1.03-1.61). In addition to those clinical indicators, greater prevalence of oral health impairment was associated with trouble paying a $100 dental bill (PR 1.37, 95 percent CI 1.12-1.68), usually visiting a dentist because of a dental problem (PR 1.46, 95 percent CI 1.15-1.86), reported cost barriers to dental care (PR 1.46, 95 percent CI 1.16-1.85), and dental fear (PR 1.43, 95 percent CI 1.18-1.73)., Conclusions: Oral health impairment was highly prevalent in this population. The findings suggest that treatment of dental disease, reduction of financial barriers to dental care, and control of dental fear are needed to reduce oral health impairment among Australian young adults.

Background: Oral health impairment comprises three conceptual domains; pain, appearance and function. This study sought to: (1) estimate the prevalence of severe oral health impairment as assessed by a summary oral health impairment measure, including aspects of dental pain, dissatisfaction with dental appearance and difficulty eating, among a birth cohort of Indigenous Australian young adults (n = 442, age range 16-20 years); (2) compare prevalence according to demographic, socio-economic, behavioural, dental service utilisation and oral health outcome risk indicators; and (3) ascertain the independent contribution of those risk indicators to severe oral health impairment in this population., Methods: Data were from the Aboriginal Birth Cohort (ABC) study, a prospective longitudinal investigation of Aboriginal individuals born 1987-1990 at an Australian regional hospital. Data for this analysis pertained to Wave-3 of the study only. Severe oral health impairment was defined as reported experience of toothache, poor dental appearance and food avoidance in the last 12 months. Logistic regression models were used to evaluate effects of demographic, socio-economic, behavioural, dental service utilisation and clinical oral disease indicators on severe oral health impairment. Effects were quantified as odds ratios (OR)., Results: The percent of participants with severe oral health impairment was 16.3 (95% CI 12.9-19.7). In the multivariate model, severe oral health impairment was associated with untreated dental decay (OR 4.0, 95% CI 1.6-9.6). In addition to that clinical indicator, greater odds of severe oral health impairment were associated with being female (OR 2.0, 95% CI 1.2-3.6), being aged 19-20 years (OR 2.1, 95% CI 1.2-3.6), soft drink consumption every day or a few days a week (OR 2.6, 95% 1.2-5.6) and non-ownership of a toothbrush (OR 1.9, 95% CI 1.1-3.4)., Conclusions: Severe oral health impairment was prevalent among this population. The findings suggest that public health strategies that address prevention and treatment of dental disease, self-regulation of soft drink consumption and ownership of oral self-care devices are needed if severe oral health impairment among Indigenous Australian young adults is to be reduced.

There are a limited number of longitudinal investigations that examine the progression of dental disease in an indigenous population. Dental examinations of a cohort of indigenous Australians born in Darwin (Australia) between 1987 and 1990 were conducted at ages 6-8 and 11-13 years as part of the Child Dental Health Survey, and 18-20 years as part of the longstanding prospective Aboriginal Birth Cohort (ABC) study. Data was available at all ages for 145 participants. The percent DMFT >0 increased from 17.2 to 44.1 to 81.4%, representing a linear trajectory, whereas mean DMFT increased from 0.3 to 1.0 to 5.6, representing an exponential trajectory. Both trends were significant. At age 18-20 years, the percent DMFT >0 among ABC study participants was 1.2 times that of their counterparts at a national level. The differences were more marked when dental caries severity was considered, with mean DMFT among 18- to 20-year-old ABC study participants being 1.7 times that of similarly aged adults at a national level. Most of this disparity was constituted by the decayed component, with ABC study participants having eight times the mean DT of their national-level counterparts. The findings indicate that Aboriginal young adults in this birth cohort experience a disproportionate amount of dental disease relative to their non-indigenous counterparts, and that this pattern is consistent across the life course., (Copyright 2010 S. Karger AG, Basel.)

Background: A prospective Aboriginal Birth Cohort (ABC) study has been underway in Australia's Northern Territory since 1987. Inclusion of oral epidemiological information in a follow-up study required flexible and novel approaches with unconventional techniques. Documenting these procedures may be of value to researchers interested in including oral health components in remotely-located studies. The objectives are to compare and describe dental data collection methods in wave III of the ABC study with a more conventional oral health investigation., Methods: The Australian National Survey of Adult Oral Health (NSAOH) was considered the 'conventional' study. Differences between this investigation and the dental component of the ABC study were assessed in terms of ethics, location, recruitment, consent, privacy, equipment, examination, clinical data collection and replication. In the ABC study, recording of clinical data by different voice recording techniques were described and assessed for ease-of-use portability, reliability, time-efficiency and cost-effectiveness., Results: Conventional investigation recruitment was by post and telephone. Participants self presented. Examinations took place in dental clinics, using customised dental chairs with standard dental lights attached. For all examinations, a dental assistant recorded dental data directly onto a laptop computer. By contrast, follow-up of ABC study participants involved a multi-phase protocol with reliance on locally-employed Indigenous advocates bringing participants to the examination point. Dental examinations occurred in settings ranging from health centre clinic rooms to improvised spaces outdoors. The dental chair was a lightweight, portable reclining camp chair and the dental light a fire-fighter's head torch with rechargeable batteries. The digital voice recorder was considered the most suitable instrument for clinical dental data collection in the ABC study in comparison with computer-based voice-recording software., Conclusion: Oral health examinations among indigenous populations residing in predominantly remote locations are more logistically challenging than are surveys of the general population. However, lack of resources or conventional clinical infrastructures need not compromise the collection of dental data in such studies. Instead, there is a need to be flexible and creative in establishing culturally-sensitive environments with available resources, and to consider non-conventional approaches to data gathering.

Objective: To describe rates of hospitalisation for head injury due to assault among Indigenous and non-Indigenous Australians., Design, Setting and Participants: Secondary analysis of routinely collected hospital morbidity data for 42,874 inpatients at public and private hospitals in Queensland, Western Australia, South Australia and the Northern Territory for the 6-year period 1 July 1999--30 June 2005., Main Outcome Measures: Rates per 100,000 population of head injury due to assault by Indigenous status, age, sex and location of residence., Results: The overall rate of head injury due to assault was 60.4 per 100,000 population (95% CI, 59.8-60.9). The rate among the Indigenous population was 854.8 per 100,000 (95% CI, 841.0-868.9), 21 times that among the non-Indigenous population (40.7 per 100,000; 95% CI, 40.2-41.2). Most Indigenous (88%) and non-Indigenous (83%) victims of head injury due to assault were aged between 15 and 44 years. The peak incidence among the Indigenous population was in the 30-34-year age group, whereas that among the non-Indigenous population was in the 20-24-year age group. Indigenous females experienced 69 times the injury rate experienced by non-Indigenous females., Conclusions: Indigenous people, particularly women, were disproportionately represented among those hospitalised for head injury due to assault. Head injury imposes a substantial burden of care on individuals and communities. Along with the costs of treating head injury, these are good reasons to strengthen efforts to prevent head injury generally, with special attention to high-risk population segments.

Background: Adults receive dental general anaesthetic (DGA) care when standard dental treatment is not possible. Receipt of DGA care is resource-intensive and not without risk. This study explores DGA receipt among 15+-year-old Australians by a range of risk indicators., Methods: DGA data were obtained from Australia's Hospital Morbidity Database from 1998-1999 to 2004-2005. Poisson regression modeling was used to examine DGA rates in relation to age, sex, Indigenous status, location and procedure., Results: The overall DGA rate was 472.79 per 100,000 (95% CI 471.50-474.09). Treatment of impacted teeth (63.7%) was the most common reason for DGA receipt, followed by dental caries treatment (12.4%), although marked variations were seen by age-group. After adjusting for other covariates, DGA rates among 15-19-year-olds were 13.20 (95% CI 12.65-13.78) times higher than their 85+-year-old counterparts. Females had 1.46 (95% CI 1.45-1.47) times the rate of their male counterparts, while those living in rural/remote areas had 2.70 (95% CI 2.68-2.72) times the rate of metropolitan-dwellers. DGA rates for non-Indigenous persons were 4.88 (95% CI 4.73-5.03) times those of Indigenous persons. The DGA rate for 1+ extractions was 461.9 per 100,000 (95% CI 460.6-463.2), compared with a rate of 23.6 per 100,000 (95% CI 23.3-23.9) for 1+ restorations., Conclusion: Nearly two-thirds of DGAs were for treatment of impacted teeth. Persons aged 15-19 years were disproportionately represented among those receiving DGA care, along with females, rural/remote-dwellers and those identifying as non-Indigenous. More research is required to better understand the public health implications of DGA care among 15+-year-olds, and how the demand for receipt of such care might be reduced.

Indigenous Australians experience poor oral health. Oral health perceptions among a group of rural-dwelling Indigenous Australians were explored so that a culturally appropriate, community-owned oral health promotion initiative might be developed. Focus group methodology was used, with prompt questions including oral health knowledge, oral health's role in general health, how community oral health had changed in recent times, the causes of poor oral health and ways to prevent poor oral health at a community level. Some 34 participants took part; age range 21-72 years. A core category emerged from the data and was labelled 'cultural adaptation'. Five sub-categories were also identified; 'lifestyle changes', 'oral health behaviours', 'barriers to dental care', 'impact of poor oral health' and 'oral health literacy'. Participants felt that historical legacy impacted on the oral health of community members, through continued practices of being told what to do, where to live and what oral health services were available to them. Participants perceived they had little power over their oral health or oral health care decisions. Findings from the focus group discussions were used in the development of a context-specific, oral health promotion initiative, which involved construction of an audiovisual tool in Phase I and a series of interactive, context-specific seminars focused on key issues raised in the focus groups in Phase II. Oral health promotion initiatives among rural-dwelling Indigenous Australians may be more successful if perceptions of the anticipated audience are considered in the design stage of such strategies.

Objectives: To identify associations between material and behavioral factors in relation to health among Mäori, Pacific, and New Zealand European or other (NZEO) children in New Zealand., Design: Cross-sectional using a two-stage random clustered sampling procedure., Participants: 3,275 children: 37.4% Mäori, 32.3% Pacific, and 30.3% NZEO., Main Outcome Measures: Prevalence of demographic, socioeconomic, food security, physical/lifestyle, dietary, and dental factors by ethnic group., Results: Proportionally more Mäori and Pacific children, respectively, lived in large households, and approximately one quarter of each group had an annual household income < dollar 20,000. Approximately one fifth of Mäori and Pacific households respectively relied on food banks when they did not have enough money for food, and more Pacific household occupants felt stressed when food could not be provided for social occasions. A higher proportion of Pacific children were obese. Approximately 40% of Mäori and NZEO children did not play physically active games, and almost four fifths of Mäori children had watched television every night the previous week. A higher proportion of Pacific children ate breakfast on the way to school or purchased their school lunch. More than half the Mäori and Pacific children had consumed a chocolate bar or soda > or = 4 times the previous month, and a higher proportion of Pacific children added sugar to hot beverages. Proportionally more Mäori children had received a restoration or experienced dental pain at night, and a higher proportion of Pacific children had received an extraction due to dental caries., Conclusions: Marked differences were found in material and behavioral outcomes in relation to child health when ethnicity was considered.

Aim: To examine dental service use and dental care receipt by a range of factors among Maori, Pacific and New Zealand European or Other children in New Zealand., Methods: Data were from the 2002 National Children's Nutrition Survey. Bivariate associations were calculated between three dental service use and dental care receipt measures, and 48 personal characteristics in five domains. Analyses took into account the complex sampling design., Results: Some 3275 children participated; 37.4% Maori, 32.3% Pacific and 30.3% New Zealand European or Other. Irregular dental attendance was associated with children who were 11-14 years, Pacific, had not always lived in New Zealand, lived in rented accommodation, frequently watched television, consumed breakfast on the way to school, purchased lunch, consumed sugar-containing products or had food security issues. A higher proportion of children who were aged 11-14 years, Maori, had low household income, lived with 4+ children, regularly watched television, consumed breakfast on the way to school, frequently consumed high-sugar foods, had food security issues, experienced dental pain at night or had received dental care under a general anaesthetic had received a restoration. Extraction receipt was associated with children who were Pacific, had low household income, had a disability, purchased their lunch, regularly consumed high-sugar-containing products, had food security issues, had experienced dental pain at night or received dental care under a general anaesthetic., Conclusions: Material and behavioural factors all play a role in New Zealand child use of dental services and receipt of dental care.

Objective: To explore rates of hospitalized head injury among older Australians by a range of risk indicators., Design: Head injury data for 60+-year-olds were obtained from the Australian Institute of Health and Welfare Hospital Morbidity Database from 1998/1999 to 2004/2005. Poisson regression modeling was used to examine head injury rates in relation to age, sex, Indigenous status, location, and injury type., Results: Rates of hospitalized head injury among the older population increased 1.4-fold between 1998/1999 (582.8 per 100,000) and 2004/2005 (844.3 per 100,000) (p<0.001). Those aged 85+ years had 10.8 times the rate of their 60-64-year-old counterparts (95% CI 10.6 to 11.0) after adjustment for other covariates. Men had 1.1 times the rate of women (95% CI 1.1 to 1.2), and those living in rural/remote areas had 3.1 times the rate of their metropolitan-dwelling counterparts (95% CI 3.0 to 3.1). Those identifying themselves as Indigenous had 1.7 times the rate of non-Indigenous persons (95% CI 1.6 to 1.8). The most prevalent injuries were open wounds of the head (38.0%), followed by superficial injuries (24.7%) and intracranial trauma (18.3%). Falls accounted for 81.4% of all head injury admissions., Conclusions: The oldest old were disproportionately represented among those sustaining hospitalized head injuries, along with men, those living in rural/remote areas, and Indigenous persons. Given the increasing proportion of older people in Western societies and the costs of treating hospitalized head injuries, the ability to reduce risk of such trauma in this age group is of critical public health importance.

Introduction: Indigenous children in Australia have higher dental caries levels than their non-Indigenous counterparts. Indigenous communities in South Australia's mid-north region have identified dental health as one of their top health priorities. In response to this, an oral health program based at the Pika Wiya Health Service in Port Augusta was established, with a dentist providing care for adults, and a dental therapist providing care for children, 2 days per week each. The purpose of this article is to compare the socio-demographic and oral health characteristics of children attending for care at the Pika Wiya Health Service Dental Clinic with those of their counterparts attending the general Port Augusta School Dental Service (SDS). Both Indigenous and non-Indigenous children were included., Methods: Data were obtained from the South Australian Dental Service (SADS), which routinely collects socio-demographic and dental information from patients seen through their system. Examinations were conducted by SADS-employed dental professionals. A full enumeration of children attending for care at Pika Wiya and the Port Augusta SDS from March 2001 to March 2006 was included. Surface level tooth data was captured using the EXACT treatment charting and management information system. The Socio-Economic Indices For Areas (SEIFA) were used to determine socio-economic status, and the dmft (sum of decayed, missing and filled teeth in the deciduous dentition) and DMFT (sum of decayed, missing and filled teeth in the permanent dentition) indices were used to assess oral health outcomes. Both measures were used for children aged 6-10 years because in such age groups children have a mixed dentition (both primary and permanent teeth are present). Caries prevalence (dmft/DMFT>0) and severity (mean dmft/DMFT) were calculated, as well as the Significant Caries Index (SiC) and Significant Caries Index 10 (SiC 10). The SiC is the mean dmft/DMFT of the one-third of the sample with the highest caries score; while the SiC 10 is the mean dmft/DMFT of the one-tenth of the sample with the highest caries score., Results: In the 5 year observation period, 760 children were seen at the Pika Wiya Dental Service while over 6800 were seen at the Port Augusta SDS. A higher proportion of pre-school children attended for care at Pika Wiya, while proportionally more children aged > or = 11 years attended for care at the Port Augusta SDS. More females attended for care at Pika Wiya. Almost all children (99%) attending for care at Pika Wiya lived in the most disadvantaged areas according to the SEIFA scale. Children attending for care at Pika Wiya had three-times the mean number of decayed deciduous and permanent teeth than their counterparts attending the Port Augusta SDS. Over 75% of children attending for care at Pika Wiya aged 10 years or less had dental caries experience in the primary dentition compared with just over 50% of children attending for care at the Port Augusta SDS. Children attending for dental care at Pika Wiya aged 10 years or less had 1.8 times the mean dmft, 1.4 times the SiC and 1.4 times the Sic 10 of their counterparts attending for care at Port Augusta SDS. Over half the children aged > or = 6 years who attended Pika Wiya for dental care had caries experience in the permanent dentition compared with 38% of their Port Augusta SDS-attending counterparts. Children aged > or = 6 years who attended Pika Wiya for dental care had 1.9 times the mean DMFT, 1.8 times the SiC and 1.6 times the SiC 10 of their similarly-aged Port Augusta SDS-attending counterparts., Conclusions: Children attending for care at the Pika Wiya Dental Service were more likely to be pre-school-aged, female, Indigenous and living in a socially disadvantaged area, in comparison with children attending the Port Augusta SDS. Pika Wiya-attending children had 1.5-3 times the dental caries prevalence and severity in both the primary and permanent dentition of children attending for care at the Port Augusta SDS. The higher levels of dental caries experience, untreated disease and social disadvantage of children attending Pika Wiya provides further evidence for the need to address the health inequalities for Aboriginal children living in South Australia's mid-north region. While the Pika Wiya Oral Health Program is attempting to address some of these needs, a much broader focus to address the social and health inequalities will be required to improve the oral health characteristics of this population. It is hoped that through the Pika Wiya Dental Service's dedication to increasing Aboriginal child dental service participation rates, the proportion of untreated decay will diminish.

Aim: To compare the dental disease experience of Indigenous and non-Indigenous children in South Australia's mid-north region (regional area) and to assess Indigenous oral health differences at a regional- and state-level., Methods: Data were collected from a School Dental Service based in an Aboriginal-owned medical health service and standard school dental clinics in the regional area from March 2001 to March 2006. State-level data were obtained over a 12-month period in 2003. Caries prevalence (per cent dmft or DMFT >0) and severity (mean dmft or DMFT, SiC and SiC10) measures were used to assess dental disease experience., Results: In the regional area, Indigenous children aged <10 years had 1.6, 1.9, 1.6 and 1.4 times the percent dmft >0, mean dmft, SiC primary and SiC(10) primary, respectively, of their non-Indigenous counterparts, while Indigenous children aged 6+ years had 1.3, 1.7, 1.7 and 1.6 times the percent DMFT > 0, mean DMFT, SiC permanent and SiC10 permanent, respectively, of non-Indigenous children. Indigenous children in the regional area had significantly higher caries prevalence and severity than Indigenous children at a state-level., Conclusion: Indigenous children in South Australia's mid-north region are dentally disadvantaged in comparison with their non-Indigenous counterparts and with the general South Australian Indigenous child population.

Objectives: To explore the prevalence and severity of Indigenous and non-Indigenous child dental disease in relation to age, sex, residential location and socio-economic status in three Australian states and territories., Design: Children aged 4-14 years who were enrolled in a school dental or screening service in New South Wales, South Australia and the Northern Territory, Australia, were randomly selected to take part in this cross-sectional study. Bivariate and multivariate analyses were used to assess outcomes., Results: A total of 328,042 children were included, of which 10,517 (3.2%) were Indigenous. Some 67.1% of Indigenous children lived in rural areas and 47.3% lived in areas of high disadvantage. About 37.5% of 4- to 10-year-old Indigenous children had no experience of dental disease in the primary dentition while 70.7% of 6- to 14-year-old Indigenous children had caries-free permanent dentitions. The mean number of decayed, missing and filled primary teeth (dmft) of Indigenous 4- to 10-year-old children was 2.9 (SD; 3.4) while the mean DMFT of Indigenous 6- to 14-year-old children was 0.8 (SD; 1.6). Across all age-groups, Indigenous children living in the most deprived areas had higher dmft and DMFT levels than their more socially advantaged counterparts, while rural-dwelling Indigenous children had higher levels of dental disease experience than metropolitan-dwelling Indigenous children. After adjusting for potential confounding, Indigenous children aged 4-10 years were over twice as likely to have caries in the deciduous dentition than similarly aged non-Indigenous children (OR: 2.25, CI: 2.14-2.36), and 6- to 14-year-old Indigenous children were over one and a half times more likely to have decay in the permanent dentition (OR: 1.68, CI: 1.60-1.77) than their non-Indigenous counterparts., Conclusion: Indigenous children experienced higher caries prevalence and severity than non-Indigenous children, irrespective of other socio-demographic factors. Factors concerning Indigenous social capital may have influenced our findings.

Background: Children receive dental general anaesthetic (DGA) care when standard dental treatment is not possible. Receipt of DGA care is resource-intensive and not without risk. This study examines trends in receipt of DGA care among Australian children., Methods: Child DGA data were obtained from the Australian Institute of Health and Welfare Hospital Morbidity Database for 1993-2004. Poisson regression modelling was used to examine DGA rates in relation to age, sex, Indigenous status, location, year and procedure., Results: There was a 3-fold increase in DGA rates from 1993-1994 (215.8 +/- 2.9 per 100,000) to 2003-2004 (731.4 +/- 5.3 per 100,000) (P < 0.001). Across all years, children who were aged 0-4 years, male or rural/remote-dwelling had higher DGA rates than their 5-9-year-old, female or metropolitan-dwelling counterparts respectively. There was a 7.0-fold increase in the rate of Indigenous admissions from 1993-1994 (116.5 +/- 10.2 per 100,000) to 2003-2004 (806.6 +/- 25.7 per 100,000). Extraction rates increased 4.9-fold from 1993-1994 (109.2 +/- 2.9 per 100,000) to 2003-2004 (540.0 +/- 4.5 per 100,000), while restoration rates increased 3.3-fold in the same observation period (139.5 +/- 2.3 per 100,000 in 1993-1994 to 462.6 +/- 4.2 per 100,000 in 2003-2004). For admissions in which one or more extractions were received, Indigenous rates were 47% greater than non-Indigenous rates after adjusting for other covariates., Conclusion: Child DGA rates in Australia are increasing. Children who are pre-school-aged, male, Indigenous or living in a rural/remote location are disproportionally represented among those receiving such care. There are higher rates of extractions as opposed to more conservative procedures, particularly among Indigenous children.

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

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

The gauging of unerupted deciduous canine teeth occurs in approximately one in three children in some areas of Uganda. It is believed that such teeth are 'maggots' that cause fever, diarrohea and vomiting. Traditional healers use knitting needles, bicycle spokes, scissors or broken glass to extract the teeth. Post-ebino extraction complications include septicaemia, anaemia, difficulties in feeding and pain. Some children require hospitalization. Health is further compromised when multiple ebino extractions occur at one time, increasing the risk of human immunodeficiency virus/acquired immunodeficiency syndrome transmission. An ebino education initiative was developed in the southwest Ugandan province of Rukungiri, based on the findings of five community-based focus group discussions. The initiative involved role-plays, didactic presentations and discussion/debate workshops to 23 women's groups in 15 communities (total number of women exposed = 1874). After 1.5 years of the programme's inception, community awareness of the scientific causes and alternatives to ebino extractions had increased (as gauged by follow-up focus group discussion findings) and the number of hospital admissions for traditional tooth extraction complications had reduced. The appropriateness of the model in exploring and addressing ebino extraction beliefs and attitudes is discussed, as are implications of the strategy in its implementation in other communities where ebino extractions are prevalent.

Objectives: To predict experience of dental pain and hospital dental general anesthetic receipt among Mäori, Pacific and New Zealand European or Other (NZEO) children in New Zealand., Methods: Data were from the 2002 National Child Nutrition Survey. Models representing demographic, socio-economic status (SES), lifestyle, dietary, food security and oral health paradigms were tested using logistic regression., Results: Some 3275 children participated; 37.4% Mäori, 32.3% Pacific and 30.3% NZEO. Mäori children had higher odds of dental pain experience than NZEO children after adjusting for age, sex and length of time lived in New Zealand and with addition of household SES or physical factors. There were no differences in Pacific and NZEO child dental pain experience when the same factors were accounted for. The prevalence of dental general anesthetic receipt was similar among Mäori, Pacific and NZEO children after adjusting for demographic, lifestyle, dietary, food security and dental factors in separate models. When such factors were investigated together, Pacific children were less likely to have received a dental general anesthetic than NZEO children., Conclusions: Mäori children were more likely to experience dental pain and Pacific children were less likely to have received a dental general anesthetic than NZEO children after accounting for various behavioral and material factors. The latter may reflect issues pertaining to access and culturally insensitive services rather than demand for care per se.

Introduction: Indigenous children in remote communities carry a disproportionate amount of the dental disease burden among Australian 4-12 year-olds. However, there have been no reports of dental service use, dental self-care or dietary characteristics among remote-living Indigenous children. This information may provide insight into behaviours linked with the high levels of dental disease observed. The purpose of this study was to examine such behaviours among Indigenous children in three remote communities in the Top End of the Northern Territory of Australia. The study is part of a wider investigation involving the implementation and monitoring of water fluoridation plants in two of the communities, and the collection of clinical dental data from children in these three and other remote communities., Methods: In 2003, small-scale fluoridation plants were installed in two remote communities (Communities A and B) in the Top End of the Northern Territory with naturally low fluoride levels in the water and with a high prevalence of child dental disease. Another community (Community C) was selected as a comparison site (natural levels of water fluoride low). A convenience sample of carers of children from all communities completed a questionnaire that sought information on carer education and their children's age, sex, use of dental services, dental self-care behaviours, dietary characteristics, household water source and water consumption. The questionnaires were administered by a project worker and community residents once consent had been obtained. Data were analysed using SPSS version vers.13.0 (SPSS Inc; Chicago, IL, USA)., Results: Some 214 carers completed the questionnaire for 409 children aged 4-12 years; 131 (32.0%) from Community A, 158 (38.6%) from Community B and 120 (29.3%) from Community C. The response rates for the child survey based on Census data (generally regarded as an undercount) was 55% across the three communities. Approximately one-third of carers had had no secondary schooling or could not recall their level of educational attainment. Child age was reasonably spread over the target age-range and there were no significant differences between communities by sex. Approximately one-third of children were reported to have had their teeth checked every year by a dental therapist and most children were reported to use a toothbrush. While most children were also reported to use toothpaste, only 20% of such children reportedly used it every day. Time of toothpaste use was evenly distributed between morning and evening, with a small proportion of children reportedly using it twice a day. The most common age that toothpaste use began was 4 years and most children had never taken fluoride supplements. Over three-quarters of children who reportedly consumed softdrinks, cordial, milk or flavoured milk in the evenings drank such beverages at least a few evenings each week. Over 90% of children across the three communities who reportedly drank tea, and approximately three-quarters of those who consumed sweet snacks, did so at least a few evenings each week. Almost all houses were connected to the community water supply. Most children sourced their drinking water from a tap and approximately two-thirds were reported to drink more than 4 cups of water a day., Conclusions: Our study showed there were low levels of preventive dental care, irregular use of dentrifices, negligible implementation of alternative fluoride sources, high consumption of sweetened snacks and drinks in the evenings, and almost universal connection of houses to the public water supply among remote-dwelling Indigenous children. The findings provide some insights into factors contributing to the poor and declining state of such children's dental health, and should aid in the planning and implementation of oral health promotion initiatives.

Objective: To examine the role of location in Indigenous and non-indigenous child oral health in three Australian states and territories. The association of Indigenous status and residential location with caries prevalence, severity and unmet treatment need was examined., Methods: Data were collected as part of a national monitoring survey of 4-14-year-old children enrolled in school dental services in New South Wales, South Australia and the Northern Territory, Australia., Results: Of the 326,099 children examined, 10,473 (3.2%) were Indigenous. Fewer 4-10-year-old rural Indigenous children were caries-free in the deciduous dentition than their non-indigenous counterparts and rural Indigenous children had almost twice the mean number of decayed, missing and filled teeth (dmft) of rural non-indigenous children. The % d/dmft was higher among rural Indigenous children than rural nonIndigenous children. Fewer 6-14-year-old rural Indigenous children were caries-free in the permanent dentition than their non-indigenous counterparts and rural Indigenous children had almost twice the mean DMFT of rural non-Indigenous children. The % D/DMFT was higher in rural Indigenous than rural non-indigenous children. Living in a rural location was the strongest indicator of caries prevalence, severity and unmet treatment need in the deciduous dentition of Indigenous 4-10-year-olds while being socially disadvantaged was the strongest indicator of poor oral health outcomes among older Indigenous and all non-Indigenous children., Conclusions: Living in a rural location exhibited the strongest association with poor oral health outcomes for young Indigenous children but was also associated with poorer oral health among older Indigenous and non-Indigenous children.

Objectives: To describe adult oral health inequalities using an area-based and household-based measure of socioeconomic status (SES)., Methods: Self-report questionnaires (seeking information on sociodemographic, oral health and oral self-care) were sent to a random sample of adults from the Dunedin South Electorate, New Zealand. Household- and area-based SES measures were collected. The main outcome measures were edentulism prevalence, average-poor self-rated oral health and not having visited a dentist for 2+ years. Data were weighted to produce population-based estimates., Results: The response rate was 78.2%; the sample mean age was 47 years (sd, 17; range 18-92 years) and females comprised 54.0%. Edentulism was most prevalent among those from low-SES households who were resident in high-deprivation areas (P<0.0001). Poor self-rated oral health (P<0.0001) and 2+ years since the last dental visit (P<0.0001) were also most prevalent among these same individuals. In contrast, respondents from high-SES households located in the least deprived areas had the lowest prevalence of edentulism, poor self-reported oral health or 2+ years since their last dental visit. Those from the other household/area SES combinations occupied intermediate positions., Conclusions: There may be added value to dental public health in using a dual socio-economic measurement approach to population research, with greater oral health gains perhaps being possible by concentrating resources and clinical effort on people living in low-SES households in highly-deprived areas, rather than those living in low-SES households in areas that are not deprived.

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

Objectives: To examine the self-reported and clinical oral health of Chatham Islanders., Design: A cross-sectional oral health survey., Setting: The Chatham Islands community., Participants and Methods: The investigation involved completion of dental self-report questionnaires by children who attended Chatham Islands schools, and adults who responded to a dental flyer., Results: Eighty-seven children and 189 adults took part, all of whom had oral health examinations. Among the children, the prevalence of dental caries in the deciduous dentition was 67.8 percent, and the mean dfs, mean DFS and mean number of missing deciduous teeth due to caries were 5.9 (sd, 6.2), 0.5 (sd, 1.1) and 0.3 (sd, 0.8) respectively. Caries severity was higher in children who were episodic dental attenders, who had irregular brushing habits or whose dental experiences had had a negative impact on their lives. In adults, the prevalence of caries was 81.5 percent. The mean DFS and mean number of missing permanent teeth due to caries were 37.9 (sd, 13.1) and 4.7 (sd, 3.8) respectively. On average, caries severity was higher among infrequent and episodic dental attenders, irregular brushers and those for whom dental problems had had a negative life impact., Conclusions: While the oral health of Chatham Islands children is comparable with that of children in New Zealand, Chatham Islands adults may be dentally disadvantaged due to limited access to dental resources. The findings have important implications for the planning of dental health services for this remote area, and may provide a useful framework from which further investigations of remote community-dwellers' oral health may be developed.

Objectives: The objective was to determine whether the Dental Neglect and Dental Indifference scales measure similar constructs and have similar associations in the same population sample., Methods: A random sample of 600 residents in the Dunedin South Electorate were sent a self-report questionnaire containing the Dental Neglect scale and the Dental Indifference scale. Socio-demographic and dental service-use data were also collected., Results: In all, 478 people (78.2%) returned the questionnaire. The mean Dental Neglect score was 12.4 (SD 4.4). The mean Dental Indifference scale score was 3.1 (SD 1.9). The association between the scales' scores was moderate (r = 0.58; P < 0.01), and there was only a moderate degree of concordance between the two. The two scales had largely similar associations with socio-demographic, oral care and self-care, and oral health impact characteristics, although slightly more associations were found with the Dental Indifference scale. The Dental Neglect scale was found to be easier to use than the Dental Indifference scale because it did not require a complex algorithm to compute scale scores., Conclusions: The degree of concordance between the Dental Neglect and Dental Indifference scales was not as high as expected, which suggests that the scales may measure different constructs. However, the largely similar associations with important oral health and socio-demographic variables of the scales suggest the opposite. Although the Dental Indifference scale was slightly more discriminative, the Dental Neglect scale was easier to use in practice.

Considerable social and economic changes have occurred since New Zealand's last national oral health survey over 13 years ago. The effects of those changes on adult oral health and the use of dental services remain largely unknown. The aims of this study were to examine self-reported oral health and the use of dental services in an adult Dunedin population sample, and to examine their associations with dental neglect using an established scale. A descriptive survey of a random sample of 600 residents in the Dunedin South Electorate resulted in a 78.2 percent response rate (14 questionnaires were returned "address unknown"). Of the 458 respondents, nearly two-thirds were female, and almost all were European. Of the 385 dentate respondents (84.1 percent), 62.5 percent usually visited a dentist for a check-up, and 66.6 percent had visited a dentist within the previous year. The mean dental neglect score for dentate respondents was 12.4 (sd, 4.4), and was higher among younger people and those in the lowest occupational group. Compared with past national and regional oral health surveys, a higher proportion of respondents rated their oral health poorly, did not pay for their last dental treatment, and received their last dental care from a public dental service. Although the study was small in scale, and was conducted in an area in which there is access to low-cost dental care through the School of Dentistry, University of Otago, the findings are considered a useful contribution to the overall picture of the use of dental services by New Zealanders.