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Considerable information exists on the changing pattern of dental caries over the last two decades, however, little longitudinal information exists on changes in the pattern of periodontal diseases. This study measured the prevalence and severity of periodontal conditions in a sample of adults from Melbourne, Australia. Data were recorded by a small team of calibrated examiners for 200 subjects who were examined in 1985, re-examined in 1990, then successfully matched. The prevalence and severity of periodontal conditions decreased in subjects over the five-year study period. Over all sites, bleeding decreased from 51.2 per cent of sites examined in 1985 to 41.9 per cent of sites examined in 1990. The proportion of sites with attachment loss of 6 mm or more, decreased from 6.9 per cent to 3.2 per cent over the five-year period. In 1985, 25.6 per cent of sites had a CPITN score of 0, in 1990, 39.8 per cent of subjects presented with the same score. Notwithstanding the limitations of the measurement parameters used in the study, on average, the adult periodontal health of the sample suggested a trend to improvement over the five-year period.

The FDI/WHO JWG6 Computer Program is a needs-based, demand-weighted method of workforce prediction. Using this program and recent Victorian epidemiological data the objectives of the investigation were: to calculate the current state of community need for dental services and personnel in the State of Victoria; to forecast community service and personnel needs for the years 2000 and 2020; and to report qualitatively on the program's value as a workforce planning tool. High, low and moderate estimates of workforce requirements for the year 1988 were obtained by modifying certain variables related to needs/demands. The moderate estimate was used to calculate the number of operators needed within the population, and this demonstrated a required operator to population ratio of 1:2,019. Results for the year 2000 predicted the operator to population ratio required in Victoria will be 1:1,988 and for the year 2020, 1:2,165. Conclusions concerning the WHO program are firstly that it suggests a present under-supply of oral health care providers which is likely to increase by the year 2020 and secondly that it is a useful tool for workforce planning and monitoring.

The CPITN is used widely in estimating periodontal treatment needs and, in many cases also to make generalizations about periodontal disease. It is therefore imperative that the hierarchical scoring method used to allocate CPITN scores is validated, and that the presentation of CPITN data reflect the true distribution of periodontal conditions. Data from one study carried out in Melbourne, Australia and one in Jakarta, Indonesia were used to compare CPITN scores on a mouth, sextant and tooth basis. Clinical periodontal components were compared with CPITN scores to establish the validity of the CPITN hierarchical scoring method. The distributions of CPITN scores varied widely on a mouth, sextant and tooth basis, and CPITN scores frequently differed from those indicated by the periodontal components. It was concluded that CPITN data should be presented not only as the % of subjects with each score, but also as the % of sextants, and, if possible, the % of tooth sites with each CPITN score. It was also concluded that there is an advantage in measuring components (calculus and bleeding) as well as CPITN in order to limit the overestimation of treatment needs, particularly for anterior teeth.

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

Background: Differences between blacks and whites have been reported in the incidence of several forms of cardiovascular disease, including hypertension and stroke. We examined racial differences in the incidence of cardiac arrest in a large urban population and in subsequent survival., Methods: We collected data on all nontraumatic, out-of-hospital cardiac arrests in Chicago from January 1, 1987, through December 31, 1988, and compared the incidence and survival rates for blacks and whites. We examined the association between survival and race and seven other known risk factors by logistic-regression analysis. We computed incidence rates by coupling our data with U.S. Census population data., Results: Our study population comprised 6451 patients: 3207 whites, 2910 blacks, and 334 persons of other races. The incidence of cardiac arrest was significantly higher for blacks than for whites in every age group. The survival rate after cardiac arrest was 2.6 percent in whites, as compared with 0.8 percent in blacks (P < 0.001). Blacks were significantly less likely to have a witnessed cardiac arrest, bystander-initiated cardiopulmonary resuscitation, or a "favorable" initial rhythm or to be admitted to the hospital. When they were admitted, blacks were half as likely to survive. The association between race and survival persisted even when other recognized risk factors were taken into account. We did not find important differences between blacks and whites in the response times of the emergency medical services., Conclusions: The black community in our study was at higher risk for cardiac arrest and subsequent death than the white community, even after we controlled for other variables.

Indonesia is a developing country with few dental services and a population at risk to deteriorating oral health. Five hundred and ninety-one 12 and 15 year-old children drawn from a low fluoride (F- less than 0.1 ppm) urban area of Jakarta, Indonesia were examined for dental caries, fluorosis, and periodontal diseases. In addition, a questionnaire was administered investigating socio-demographic background, use of dental services, and preventive oral care. Although the severity of dental caries experience was moderate, untreated caries on the occlusal surface formed the highest proportion of the dental caries experience. CPITN examination revealed a large proportion of the subjects had calculus as their highest score, combined with a substantial number of sites which exhibited bleeding on probing. Questionnaire data revealed a high home use of fluoridated toothpaste by the subjects but a predominant use of dental services for pain relief. Findings from this study suggest a need for primary preventive programmes focusing on occlusal sealants and plaque control.

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

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

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

Two hundred and sixty-seven Australian dentists from the State of Victoria, representing members of the Australian Society of Dentistry for Children (AusSDC) and randomly selected practitioners, responded to a survey on attitudes and practices in the management of anxious children or children with behavior problems. The most common strategies used by dentists in this study were: permitting the child to exercise some form of control over terminating the treatment, if they were experiencing difficulties; furnishing waiting areas with play materials; and using a Tell-Show-Do approach to the provision of dental care. Members of the Australian Society of Dentistry for Children differed from general dentists by more frequently teaching anxious children a technique of relaxation and also by more frequently using a mouth prop or rubber dam during the delivery of care. Younger dentists tended to use behavioral strategies more frequently than older practitioners. Women dentists more frequently than male dentists, used strategies including: spending more time with the child before entering the operatory; setting shorter appointment sessions; and permitting the child to hold a toy or a mirror during dental treatment. In contrast to North American studies, few of the Australian dentists used the Hand-Over-Mouth technique to control hysteria. Australian dentists appeared to rely more frequently than their North American colleagues on setting shorter appointment sessions as a major strategy in managing children with anxiety or other behavioral difficulties.

This article discusses the historical shifts between the treatment-oriented, instructional and primary preventive approaches to oral health promotion, especially in school-based programs in New Zealand and Australia. While in the past much effort has been put into treatment-oriented and instructional programs, their impact has been limited. Among those primary preventive activities that have demonstrated clear benefits are various types of fluoridation and adhesive sealants for the occlusal surfaces of teeth. Further emphasis on primary prevention over treatment is needed to better insure the success of school-based oral health promotion programs. In addition, more effort needs to be put into policy direction, linkages within the educational system, planning, and evaluation.

This study tested a path-analytic model linking three general classes of dentists' characteristics (demographic variables, structural descriptors of the dental practice, and attitudinal factors) to 20 forms of patient management strategy. Information was obtained from 267 dentists from Victoria, Australia. The attitudinal factors were extracted by factor analysis of the responses to a self-report questionnaire. Two of the four attitudinal factors (Authoritarian and Etiology) had sufficient reliability to be included in the path-analytic model. The results of the linear structural relationships modeling (LISREL) indicated that gender, membership of the Australian Society of Dentistry for Children, two attitudinal factors, and the perceived socioeconomic level of the dentist's clientele constituted the strongest determinants of management strategies used by the dentists.

Concern has been expressed about the level of sugars in baby foods. It has been suggested that high levels of sucrose consumption during infancy and early childhood have been related not only to direct deleterious effects on health and teeth but also to the acquisition of taste patterns which lead to established sweet preferences in later life. This study was undertaken to determine the sugar content of a variety of commercially available New Zealand infant food using the para-hydroxybenzoic acid hydrazide colorimetric reaction. Twenty-eight different foods were assayed, and five baby desserts studied in detail. All infant desserts contained sucrose. Estimates of the total sugar content of desserts ranged from 16 to 47 percent. Sucrose levels varied from less than 1, to 23 percent. The level of sugars in commercial baby foods appeared unnecessarily high. It is suggested that New Zealand manufacturers seriously examine the need to add sucrose to such products.

In this study of 200 New Zealand schoolchildren aged 7-13 years, a questionnaire interview was used to gain information related to estimating dental anxiety and general illness anxiety. Information related to sociodemographic differences, belief differences, and an estimate of potential health behaviour was also collected. Oral examinations were performed and the number of dental restorations present recorded. Dental anxiety was associated with memory of pain during a dental visit. The number of restorations present, and a history of pain during a dental visit, were important predictors of illness anxiety. Neither dental anxiety nor illness anxiety operating alone provided an estimate of future dental health behaviour. Dental anxiety and illness anxiety operated through a complex interplay of variables. A stepwise multiple regression technique was used to determine the possible pathways to potential dental health behaviour. Perceived vulnerability to dental caries and perceived severity of dental disease were important in the prediction of potential denture wearing; school attended and ethnic background were useful predictors of potential extraction seeking; and school grade and level of perceived internal control were predictors of potential preventive visitation.

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

This study of the relationship between dental anxiety and psychological and behavioral variables suggests that the most important factor in explaining the variance in children's perceived dental anxiety is their level of general anxiety. The negative relationship found among the frequency of dental visits, deciduous diseased, missing, and filled teeth (dmft), and dental anxiety implies that dental anxiety does not develop through simple exposure to dental settings. Perceived locus of control and perceived health vulnerability did not appear to be associated in any significant way with dental anxiety. The results indicate that dental anxiety may reflect a more general class of anxiety behaviors, rather than fears learned in response to a specific situation.

Dental health education attempts to change behaviour by altering an individual's knowledge, attitudes, and beliefs about health matters. Perception of vulnerability to illness and dental disease is a central, but poorly understood, health belief. In this study of 303 New Zealand and 297 Australian schoolchildren perceived vulnerability was measured by the degree of expectancy to which subjects believed they would contract health problems. The pattern of health problem expectancy was consistent across age groups, cultures, and other demographic divisions. High expectancies of general health problems and dental caries were associated with potential preventive dental visits and with potential denture wearing. New Zealand schoolchildren, and children from lower socioeconomic backgrounds, had higher expectancies of general health problems and dental caries than Australian or middle class children.

Social and psychological factors associated with dental care were examined in two groups of children ages 6-8 and 9-11 years. Level of surface plaque, measures of dental health status (that is, total number of primary teeth decayed, missing, and filled [dmft] and total number of permanent teeth decayed, missing, and filled [DMFT] ), and frequency of dental visits were used as indicators of preventive behavior. The importance of social and psychological factors associated with these indicators was shown to vary with age group and with the specific preventive behavior indicator. Perceived level of dental anxiety and dental vulnerability were significantly associated with dental care, with dental anxiety being an important factor only in the lower group. Accessibility to a free school dental service was an important predictor of dental health status (DMFT) in the older age group, however, the data indicate that only when this service was offered within an organized structure of referral and transport was there an optimal effect on subsequent dental health.

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

Three hundred and ten children from three schools were examined before and after a dental health promotion program targeted at one of the schools. Parents of subjects at the experimental school were visited at home by a community health worker who provided individualized information on dental services and preventive strategies. Parents of subjects at the control school were provided with similar information by way of general written documentation, not tailored to specific needs, and distributed as part of the traditional school take home system. The experimental hypothesis proposed that, at re-examination, subjects from the experimental school would show a measurable improvement in caries increment, and a reduced plaque index over subjects from the control schools. Although the individualized social intervention strategy did not demonstrate a major shift in use of dental services or improvement in health status some improvement in caries experience was obtained in the target group. The multifactorial nature of dental disease and the limited contact of the health worker with the families involved would account for the low success rate of this strategy.

This study compared the oral health status of 600 6-16-yr-old young persons: 297 from Heidelberg, Victoria, Australia (an area of recent water fluoridation and a predominantly marketplace delivery system) and 303 from Dunedin, New Zealand (an area with established water fluoridation and a long-standing school based public delivery system). A greater proportion of Heidelberg subjects, in each of three age groups, were caries free. Level of dental plaque varied both with study area and with age group. Dunedin subjects in the younger age groups had lower mean levels of plaque than their Heidelberg peers. The New Zealand dental service delivery system was consistently closer, in each age group, to meeting defined dental needs than the Australian system. The similarities and contrasts between this study and the WHO-ICS illustrate the importance for planners to consider carefully differences in local conditions which may affect service and morbidity projections.

Since 1975 more than 100,000 Indochinese refugees have settled in Australia. This study compared the dental health knowledge, attitudes, and behaviors of 131 Indochinese and 107 Australian-born adolescents from a state high school in Melbourne, Victoria. The Australian-born subjects demonstrated the highest level of dental knowledge, and the Kampuchean/Laotian subjects the least. Of the three birthplace groups (Australia, Vietnam, Kampuchea/Laos), the Kampuchean/Laotian group were more likely to believe that their dental health was controlled by external forces. The Kampuchean/Laotian group presented the highest proportion of subjects believing they needed dental treatment. In contrast, however, the Kampucheans and Laotians had the lowest perceived value of preventive dental visits with the Australian-born adolescents presenting the highest proportion. The dental health behaviors of the Kampucheans and Laotians were generally the least favorable and those of the Australian-born subjects the most favorable, although all groups were well short of the conventional ideal. One-third of the Kampuchean and Laotian subjects said they had never been to the dentist before. Few Indochinese subjects claimed to be regular visitors to the dentist. Analysis of data using the framework of the Health Belief Model provided little explanatory power in predicting preventive behaviors. A greater understanding of cultural variations between ethnic groups and targeted dental health education programs would appear to be beneficial strategies for improving oral health of high risk adolescents.

There have been few epidemiological studies in China which have randomly selected subjects for examination. This study randomly selected 240 subjects aged 6 and 12 years from six schools in the Haidian District of Beijing, China. Examiners were calibrated and used standardised light sources and methods. Five per cent of the 6 year old children and 54 per cent of the 12 year old children were caries free. The dental caries treatment needs for 6 year old children were substantially greater in quantity and complexity than the needs of those aged 12 years. School based preventive and treatment programmes directed against the differing requirements of the age groups and supported by community-wide strategies for prevention appear as dental health matters of urgency in China.