A. John Spencer

The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear

BackgroundBased on the hypothesis that a vicious cycle of dental fear exists, whereby the consequences of fear tend to maintain that fear, the relationship between dental fear, self-reported oral health status and the use of dental services was explored.MethodsThe study used a telephone interview survey with interviews predominantly conducted in 2002. A random sample of 6,112 Australian residents aged 16 years and over was selected from 13 strata across all States and Territories. Data were weighted across strata and by age and sex to obtain unbiased population estimates.ResultsPeople with higher dental fear visited the dentist less often and indicated a longer expected time before visiting a dentist in the future. Higher dental fear was associated with greater perceived need for dental treatment, increased social impact of oral ill-health and worse self-rated oral health. Visiting patterns associated with higher dental fear were more likely to be symptom driven with dental visits more likely to be for a problem or for the relief of pain. All the relationships assumed by a vicious cycle of dental fear were significant. In all, 29.2% of people who were very afraid of going to the dentist had delayed dental visiting, poor oral health and symptom-driven treatment seeking compared to 11.6% of people with no dental fear.ConclusionResults are consistent with a hypothesised vicious cycle of dental fear whereby people with high dental fear are more likely to delay treatment, leading to more extensive dental problems and symptomatic visiting patterns which feed back into the maintenance or exacerbation of existing dental fear.

Social inequality in perceived oral health among adults in Australia.

Objective: To establish population estimates of self‐assessed tooth loss and subjective oral health and describe the social distribution of these measures among dentate adults in Australia.

Water Fluoridation and the Association of Sugar-Sweetened Beverage Consumption and Dental Caries in Australian Children

OBJECTIVES We examined demographic and socioeconomic differences in the consumption of sugar-sweetened beverages (SSBs), its association with dental caries in children, and whether exposure to water fluoridation modifies this association. METHODS In a cross-sectional study, we used a stratified, clustered sampling design to obtain information on 16 508 children aged 5 to 16 years enrolled in Australian school dental services in 2002 to 2005. Dental staff assessed dental caries, and parents completed a questionnaire about their childs residential history, sources of drinking water, toothbrushing frequency, socioeconomic status (SES), and SSB consumption. RESULTS Children who brushed their teeth less often and were older, male, of low SES, from rural or remote areas consumed significantly more SSBs. Caries was significantly associated with greater SSB consumption after controlling for potential confounders. Finally, greater exposure to fluoridated water significantly reduced the association between childrens SSB consumption and dental caries. CONCLUSIONS Consumption of SSBs should be considered a major risk factor for dental caries. However, increased exposure to fluoridated public water helped ameliorate the association between SSB consumption and dental decay. These results reconfirm the benefits of community water fluoridation for oral health.

Cognitive vulnerability and dental fear

BackgroundThe Cognitive Vulnerability Model proposes that perceptions of certain characteristics of a situation are critical determinants of fear. Although the model is applicable to all animal, natural environment and situational fears, it has not yet been applied specifically to dental fear. This study therefore aimed to examine the association between dental fear and perceptions of dental visits as uncontrollable, unpredictable and dangerous.MethodsThe study used a clustered, stratified national sample of Australians aged 15 years and over. All participants were asked in a telephone interview survey to indicate their level of dental fear. Participants who received an oral examination were subsequently provided with a self-complete questionnaire in which they rated their perceptions of uncontrollability, unpredictability and dangerousness associated with dental visiting.Results3937 participants were recruited. Each of the three vulnerability-related perceptions was strongly associated with the prevalence of high dental fear. In a logistic regression analysis, uncontrollability and dangerousness perceptions were significantly associated with high dental fear after controlling for age and sex. However, unpredictability perceptions did not have a statistically significant independent association with dental fear after controlling for all other variables.ConclusionResults are mostly consistent with the Cognitive Vulnerability Model of the etiology of fear, with perceptions of uncontrollability, unpredictability and dangerousness each showing a strong bivariate relationship with high dental fear prevalence. However, more extensive measures of vulnerability perceptions would be valuable in future investigations.

Dimensions of oral health related quality of life measured by EQ-5D+ and OHIP-14

BackgroundThe aims of the study were to compare the dimensions of oral-health-related quality-of-life measured by a generic health state measure, the EuroQol, and a specific oral health measure, the Oral Health Impact Profile.MethodsData were collected in 2001–02 from a random sample of South Australian dentists using mailed self-complete questionnaires. Dentists recorded the diagnosis of dental problems and provided patients with self-complete questionnaires to record the nature, severity and duration of symptoms using the EuroQol (EQ-5D+) and 14-item version of the Oral Health Impact Profile (OHIP-14) instruments.ResultsData were available from 375 patients (response rate = 72%). The EuroQol items of mobility, self care and usual activities formed a separate cluster of variables, as did anxiety/depression and cognition, while pain clustered with items from the OHIP physical pain subscale. OHIP items tended to form clusters consistent with the subscales of social disability, physical disability, physical pain, functional limitation and psychological discomfort. The OHIP handicap items clustered between the OHIP social disability and physical disability subscales. The OHIP psychological disability items split between the social disability and psychological discomfort subscales.ConclusionsThe observed clusters of variables empirically supported most of the conceptual dimensions of the OHIP. Both instruments covered symptom experience of pain indicating overlapping domains. However there was partial separation of the generic and specific items, EuroQol covered daily activities such as self-care and usual activities and OHIP covered oral health-specific aspects of functional limitation and physical disability as well as psychological and social aspects of disability and handicap.

Tooth loss and chewing capacity among older adults in Adelaide

Abstract: This study aimed to identify sociodemographic factors associated with edentulism (loss of all teeth) and the average number of teeth lost, and to investigate relationships between tooth loss and chewing capacity. Data were obtained in 1991–92 from a cross‐sectional oral epidemiological survey of Adelaide residents aged 60+ years. Interviews with 1160 participants provided information on edentulism while oral examinations among 560 dentate participants and 313 edentulous participants provided information on the number of missing teeth. People were asked if they could chew or bite six common foods. Some 41.1 per cent of persons were edentulous, and nearly half the natural teeth (mean 15.2) were missing among dentate people. Multivariate analyses revealed higher rates of edentulism (P≤ 0.05) for people who were older, female, Australian‐born, or holders of pensioner health benefit cards, and for people who left school at an early age, or who did not own their residence. Among dentate people there were more (P≤ 0.05) missing teeth among those who were older, Australian‐born, health benefit card holders, and who left school at an early age. Some 37.9 per cent of people reported difficulty chewing at least one food, although 57 per cent of dentate people and virtually all edentulous people wore dentures. Difficulty chewing was associated with tooth loss: 6.1 per cent of people with fewer than nine missing teeth reported difficulty compared with S8.6 per cent of edentulous people (P < 0.01). The findings show substantially compromised oral health among older adults, particularly the oldest‐old and disadvantaged groups.

Factors influencing the use of public dental services: An application of the Theory of Planned Behaviour

BackgroundThere is limited evidence of the influence of psychosocial factors and health beliefs on public dental patients patterns of service use in Australia. The research aims were to examine associations between dental attitudes and beliefs of public dental service users and dental visiting intention and behaviour using the Theory of Planned Behaviour.Methods517 randomly selected adult public dental patients completed a questionnaire assessing dental attitudes and beliefs which was matched with electronic records for past and future dental service use. A questionnaire measured intentions, attitudes, subjective norms and perceptions of behavioural control and self-efficacy in relation to visiting public dentists. A measure of dental attendance at public dental clinics was obtained retrospectively (over 3 1/2 years) and prospectively (over a one year period following the return of the questionnaire) by accessing electronic patient clinical records.ResultsParticipants had positive attitudes, subjective norms and self-efficacy beliefs towards dental visiting but perceived a lack of control over visiting the dentist. Attitudes, subjective norms, self-efficacy and perceived control were significant predictors of intention (P < 0.05). Intentions, self-efficacy and past dental attendance were significant predictors of actual dental attendance (P < 0.05).ConclusionPublic dental patients held favourable attitudes and beliefs but perceived a lack of control towards dental visiting. Reducing structural barriers may therefore improve access to public dental services.

Factors influencing caries experience among adults with physical and intellectual disabilities

BACKGROUND There is limited and inconsistent evidence on the influence of residential setting on caries experience of adults with physical and intellectual disabilities (PID), described here as care-recipients. OBJECTIVE To examine caries experience and associated factors among adults with PID. METHODS Mailed questionnaire survey (2005-2006) of carers of adults with PID (18-44 years) in South Australia from family homes, community housing, and institutions, and oral examinations of care-recipients recording decayed (D), missing (M) and filled (F) teeth (DMFT). RESULTS Carers completed questionnaires for 485 care-recipients, 267 of whom were examined (completion rate=55.1%). The prevalence of decay (D>0) was 16.9% and 76.3% had caries experience (DMFT>0). In unadjusted analysis, care-recipients at institutions had a significantly higher mean DMFT than other settings. After adjusting for carer and care-recipient characteristics, there was no difference in any of the DMFT components among residential settings. However, there were statistically significant associations (OR+/-95% CI excluding unity) between decayed teeth and moderate and high intake of sweet drinks and frequency of dental visits. Higher odds of missing teeth were associated with type of disability, general anaesthetic requirement for dental treatment and low and high carer-contact. Higher odds of filled teeth were associated with age, no oral hygiene assistance (OHA) and high carer-contact. Higher odds of caries experience were associated with age and no OHA. CONCLUSIONS Residential setting was not associated with caries experience. Modifiable risk factors were diet, frequency of dental visits, no OHA and carer-contact hours.

Changing risk factors for fluorosis among South Australian children

BACKGROUND Research in the last decade has shown changing exposure patterns to discretionary fluorides and declining prevalence of fluorosis among South Australian children, raising the question of how risk factors for fluorosis have changed. OBJECTIVE To examine and compare risk factors for fluorosis among representative samples of South Australian children in 1992/1993 and 2002/2003. METHODS Similar sampling strategies and data collection methods were employed in the Child Fluoride Study (CFS) Marks 1 (1992/1993) and 2 (2002/2003). Participants in each CFS round were examined for fluorosis using the Thylstrup and Fejerskov (TF) Index. Exposure history was collected for fluoride in water, toothpaste, fluoride supplements and infant formula, allowing for a fluorosis risk assessment analysis. Data were re-weighted to represent the child population at each time. Changes in prevalence of fluorosis, defined as having a TF score of 1+ on maxillary central incisors, fluoride exposure and risk factors between the two rounds were evaluated. RESULT A total of 375 and 677 children participated in the 1992/1993 and 2002/2003 rounds respectively. Prevalence of fluorosis declined significantly from 45.3% to 25.9%. Reduced use of fluoride supplements and increased use of 400-550-ppm children F toothpaste were the most substantial fluoride exposure changes. Early toothpaste use, residence in fluoridated areas and fluoride supplement use were the risk factors in 1992/1993. Early toothpaste use and fluoride supplement use were not risk factors, leaving fluoridated water as the only risk factor among the common variables in 2002/2003. In an analysis stratified by the type of fluoridated toothpaste in 2002/2003, the large amount of toothpaste used was a risk factor in those who used 1000-ppm fluoridated toothpaste, and eating/licking toothpaste when toothpaste use started was a risk factor among children who used either 1000-ppm or 400-550-ppm fluoridated toothpaste. CONCLUSION Introduction of the 400-550-ppm F toothpaste and use of smaller amount of toothpaste restricted risk associated with early toothpaste use. Less use and possibly a stricter fluoride supplements regimen also restricted fluorosis risk. Periodic monitoring of risk of fluorosis is required to adjust guidelines for fluoride use in caries prevention.

Caries experience among children in fluoridated Townsville and unfluoridated Brisbane

Abstract: Fluoridation of community water supplies constitutes the main public health strategy for prevention of dental caries in Australia. In recent years questions have been raised about the effectiveness of water fluoridation. The aim of this paper was to examine differences in caries experience of children aged 5 to 12 years who were lifetime residents either of Brisbane (the unfluoridated Queensland capital) or Townsville (fluoridated since 1965). Children from each city were sampled from patients of the school dental service. Dental therapists and dentists from the school dental service recorded data describing dental caries experience and parents were asked to complete a questionnaire about their childrens residential history and exposure to other fluorides. Of the 18 348 children sampled, 10 195 (55.6 per cent) provided completed questionnaires, and 4588 were lifetime residents of their respective cities. Caries rates were significantly lower (P < 0.01) among children in Townsville than in Brisbane, both in the deciduous dentition (according to age, 32 to 55 per cent fewer tooth surfaces affected) and permanent dentition (20 to 65 per cent fewer tooth surfaces affected). Significantly lower rates in Townsville persisted (P < 0.01) in multivariate analyses that controlled for oral hygiene practices, exposure to fluoride supplements and household income. Water fluoridation appears to provide a substantial public health benefit for children in Townsville.