Kaye Roberts-Thomson

Epidemiology of Oral Cancer in Asia in the Past Decade- An Update (2000-2012)

The prevalence of oral cancers (OC) is high in Asian countries, especially in South and Southeast Asia. Asian distinct cultural practices such as betel-quid chewing, and varying patterns of tobacco and alcohol use are important risk factors that predispose to cancer of the oral cavity. The aim of this review is to provide an update on epidemiology of OC between 2000 and 2012. A literature search for this review was conducted on Medline for articles on OC from Asian countries. Some of the articles were also hand searched using Google. High incidence rates were reported from developing nations like India, Pakistan, Bangladesh, Taiwan and Sri Lanka. While an increasing trend has been observed in Pakistan, Taiwan and Thailand, a decreasing trend is seen in Philippines and Sri Lanka. The mean age of occurrence of cancer in different parts of oral cavity is usually between 51-55 years in most countries. The tongue is the leading site among oral cancers in India. The next most common sites in Asian countries include the buccal mucosa and gingiva. The 5 year survival rate has been low for OC, despite improvements in diagnosis and treatment. Tobacco chewing, smoking and alcohol are the main reasons for the increasing incidence rates. Low socioeconomic status and diet low in nutritional value lacking vegetables and fruits contribute towards the risk. In addition, viral infections, such as HPV and poor oral hygiene, are other important risk factors. Hence, it is important to control OC by screening for early diagnosis and controlling tobacco and alcohol use. It is also necessary to have cancer surveillance at the national-level to collect and utilise data for cancer prevention and control programs.

Dental service patterns among private and public adult patients in Australia

BackgroundWhile the majority of dental care in Australia is provided in the private sector those patients who attend for public care remain a public health focus due to their socioeconomic disadvantage. The aims of this study were to compare dental service profiles provided to patients at private and public clinics, controlling for age, sex, reason for visit and income.MethodsData were collected in 2004–06, using a three-stage, stratified clustered sample of Australians aged 15+ years, involving a computer-assisted telephone interview (CATI), oral examination and mailed questionnaire. Analysis was restricted to those who responded to the CATI.ResultsA total of 14,123 adults responded to the CATI (49% response) of whom 5,505 (44% of those interviewed) agreed to undergo an oral epidemiological examination. Multivariate analysis controlling for age, sex, reason for visit and income showed that persons attending public clinics had higher odds [Odds ratio, 95%CI] of extraction (1.69, 1.26–2.28), but lower odds of receiving oral prophylaxis (0.50, 0.38–0.66) and crown/bridge services (0.34, 0.13–0.91) compared to the reference category of private clinics.ConclusionSocio-economically disadvantaged persons who face barriers to accessing dental care in the private sector suffer further oral health disadvantage from a pattern of services received at public clinics that has more emphasis on extraction of teeth and less emphasis on preventive and maintenance care.

Smoking-attributable periodontal disease in the Australian adult population.

BACKGROUND The extent to which periodontitis is attributable to smoking in Australia has not been examined. OBJECTIVES To investigate the smoking-periodontitis relationship and to estimate the public health impact of smoking on periodontitis in Australia. MATERIAL AND METHODS The National Survey of Adult Oral Health 2004-2006 collected nationally representative oral epidemiologic data for the Australian adult population. Examiners measured probing pocket depth (PPD) and gingival recession at three sites per tooth to compute clinical attachment level (CAL). Moderate-severe cases were defined as having: >/=2 interproximal sites (not on same tooth) with >/=4 mm CAL or with >/=5 mm PPD. Smoking status was defined as never-, former- or current-smoker. Current-smokers were further classified into light-, moderate- or heavy-smoker using calculated pack-years. Age, sex and socioeconomic position were examined as potential confounders. RESULTS Twenty-three per cent were former-smokers and 15% were current-smokers. Prevalence of periodontitis was 23%. In unadjusted analyses, former- and current-smokers had significantly higher periodontitis prevalence than never-smokers. Relative to non-smokers, adjusted prevalence ratios (95% confidence interval) for periodontitis were as follows: former-smokers: 1.22 (1.03-1.46), moderate-smokers: 1.63 (1.16-2.30); and heavy-smokers: 1.64 (1.27-2.12). The population attributable fraction of smoking for moderate-severe periodontitis was 32% (equivalent to 700,000 adults). CONCLUSION Smoking has a significant impact on periodontal health of the Australian adults.

Effect of health promotion and fluoride varnish on dental caries among Australian Aboriginal children: results from a community-randomized controlled trial

Objectives We tested a dental health program in remote Aboriginal communities of Australias Northern Territory, hypothesizing that it would reduce dental caries in preschool children. Methods In this 2-year, prospective, cluster-randomized, concurrent controlled, open trial of the dental health program compared to no such program, 30 communities were allocated at random to intervention and control groups. All residents aged 18–47 months were invited to participate. Twice per year for 2 years in the 15 intervention communities, fluoride varnish was applied to childrens teeth, water consumption and daily tooth cleaning with toothpaste were advocated, dental health was promoted in community settings, and primary health care workers were trained in preventive dental care. Data from dental examinations at baseline and after 2 years were used to compute net dental caries increment per child (d3mfs). A multi-level statistical model compared d3mfs between intervention and control groups with adjustment for the clustered randomization design; four other models used additional variables for adjustment. Results At baseline, 666 children were examined; 543 of them (82%) were re-examined 2 years later. The adjusted d3mfs increment was significantly lower in the intervention group compared to the control group by an average of 3.0 surfaces per child (95% CI = 1.2, 4.9), a prevented fraction of 31%. Adjustment for additional variables yielded caries reductions ranging from 2.3 to 3.5 surfaces per child and prevented fractions of 24–36%. Conclusions These results corroborate findings from other studies where fluoride varnish was efficacious in preventing dental caries in young children.

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.

Effects of Fluoridated Drinking Water on Dental Caries in Australian Adults

Systematic reviews produce conflicting conclusions regarding dental caries-preventive effects of water fluoridation in adults. The authors investigated the relationship using data from the nationally representative 2004−2006 Australian National Survey of Adult Oral Health. Effects were compared between the pre-fluoridation cohort born before 1960 (n = 2,270) and the cohort born between 1960 and 1990 (n = 1,509), when widespread implementation of fluoridation increased population coverage from < 1% to 67%. Residential history questionnaires determined the percentage of each person’s lifetime exposed to fluoridated water. Examiners recorded decayed, missing, and filled teeth (DMF-Teeth) and decayed and filled tooth surfaces (DF-Surfaces). Socio-demographic and preventive dental behaviors were included in multivariable least-squares regression models adjusted for potential confounding. In fully adjusted models, > 75% of lifetime exposure to fluoridation relative to < 25% of lifetime exposure was associated with 11% and 10% fewer DMF-Teeth in the pre-1960 (p < .0001) and 1960–1990 cohorts (p = .018), respectively. Corresponding reductions in DF-Surfaces were 30% (p < .001) and 21% (p < .001). Findings for intermediate fluoridation exposure suggested a dose-response relationship. Results were consistent in sensitivity analyses accounting for missing data. In this nationally representative sample of Australian adults, caries-preventive effects of water fluoridation were at least as great in adults born before widespread implementation of fluoridation as after widespread implementation of fluoridation.

Ten principles relevant to health research among Indigenous Australian populations

riting in the Journal about Indigenous health in 2011, Sir Michael Marmot suggested that the challenge was to conduct research, and to ultimately apply findings from that research, to enable Indigenous Australians to lead more flourishing lives that they would have reason to value. 1 As committed Indigenous health researchers in Australia, we reflect Marmot’s ideal — to provide the answers to key questions relating to health that might enable Indigenous Australians to live the lives that they would choose to live. As a group, we have over 120 collective years’ experience in Indigenous health research. Over this time, particularly in recent years as ethical guidelines have come into play, there have been many examples of research done well. However, as the pool of researchers is constantly replenished, we hold persisting concerns that some emerging researchers may not be well versed in the principles of best practice regarding research among Indigenous Australian populations. Implementing any research methodology among Indigenous Australian groups will work best when the following 10 principles are met. These principles are reflected in the many documents related to working and researching with Indigenous Australians; for example, the National Health and Medical Research Council (NHMRC) ethical guidelines for research among Aboriginal and Torres Strait Islander people. 2 In this article, we set out these principles in one short, accessible document. Essential principles

Risk indicators for severe impaired oral health among indigenous Australian young adults

BackgroundOral 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.MethodsData 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).ResultsThe 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).ConclusionsSevere 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.

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.

Trend of Income-related Inequality of Child Oral Health in Australia

It is important that we monitor socio-economic inequality in health. Inequality in child oral health has been expected to widen because of widening socio-economic inequality. This study aimed to evaluate trends in income-related inequality in caries experience of Australian children. Cross-sectional studies in 1992/93 and 2002/03 collected data on deciduous caries experience of 5- to 10-year-olds and permanent caries experience of 6- to 12-year-olds. Household composition and income was used to calculate quartiles of equivalized income. Slope Index of Inequality (SII), Concentration Index (CI), and regression-based rate ratios were used to quantify income-related inequality and to evaluate trends. Income-related inequality in caries experience was evident regardless of time and dentition. The three indicators of inequality indicate a significant increase in income-related inequality in child deciduous caries experience during the decade. The income inequality in permanent caries experience did not change significantly. Income inequalities increased in deciduous teeth, but not in permanent teeth, among Australian children.