Kiran A. Singh

Effects of Water Fluoride Exposure at Crown Completion and Maturation on Caries of Permanent First Molars

Pre-eruptive fluoride exposure has been shown to be important for caries prevention. This paper aimed to determine the relative effects of water fluoride exposure during crown completion (CC) and maturation on caries experience in first permanent molars. Parental questionnaires covering residential history were linked to oral examinations of 19,885 6- to 15-year-old Australian children conducted in 1992 by the School Dental Services of South Australia and Queensland. The percentage of lifetime exposed to optimally fluoridated water at CC, maturation (MAT) and post-eruption (POST) was calculated. Combined exposure variables describing different levels of CC, maturation and post-eruption were created using a threshold exposure of 50%. Compared to the reference of CC <50%/MAT <50%/POST <50%, the categories CC ≧50%/MAT <50%/POST ≧50% [rate ratio (RR) 0.52], CC ≧50%/MAT ≧50%/POST <50% (RR 0.61) and CC ≧50%/MAT ≧50%/POST ≧50% (RR 0.67) had the strongest caries-preventive effect, followed by CC ≧50%/MAT <50%/POST <50% (RR = 0.79) and CC <50%/MAT ≧50%/POST ≧50% (RR = 0.81) in negative binomial regression models (p < 0.05). The categories CC <50%/MAT ≧50%/POST <50% (RR = 0.85) and CC <50%/MAT <50%/POST ≧50% (RR = 0.84) had weaker, non-significant caries-preventive effects. In conclusion a high exposure at CC was important for caries prevention irrespective of the effect of exposure at maturation and post-eruption. The strongest caries-preventive effect was produced by a high exposure at CC supplemented by a high exposure at maturation and/or post-eruption, but the latter two phases could not produce a significant caries-preventive effect on their own. Since most of the caries occurred on pit and fissure surfaces, the findings relate to this class of lesion.

Chewing disability in older adults attributable to tooth loss and other oral conditions.

BACKGROUND This study evaluates associations between oral health-related factors and chewing ability, and quantifies the risk contributed by each factor. MATERIALS AND METHODS Chewing ability and information on number of teeth, dentures and dental problems over the last 12 months were collected by mailing questionnaires to a random sample of 60- to 71-year-olds from Adelaide, South Australia. Logistic regression was used to model oral status and oral symptoms as predictors of chewing disability, and to estimate the population-attributable fraction. RESULTS A total of 444 persons responded (response rate = 68.8%). Among dentate subjects, 10.3% were chewing-deficient, with chewing disability more prevalent (p < 0.05) among those with <21 teeth (26.4%), dentures (20.4%), painful aching in the mouth (25.4%), pain in the face (16.7%), broken/chipped teeth (15.6%), sensitive teeth (14.1%), loose teeth (37.1%), and sore gums (18.0%). Adjusted Odds ratios (OR) showed inadequate dentition (OR = 4.20), painful aching in the mouth (OR = 4.88), and presence of loose teeth (OR = 4.70) were associated with chewing disability (p < 0.01), and their population attributable fractions were 18.5%, 15.1% and 7.8% respectively. CONCLUSIONS Loose teeth, number of teeth and pain in the mouth were associated with chewing disability, with an inadequate dentition and pain in the mouth contributing most to chewing disability in this population.

Dietary, self-reported oral health and socio-demographic predictors of general health status among older adults

ObjectivePoor dietary habits and nutritional intake are associated with a range of chronic diseases. Oral health may be directly associated with general health status, as well as related to diet. The aims are to assess dietary, self-reported oral health and socio-demographic predictors of general health status among older adults.DesignCross-sectional mailed survey.ParticipantsA random sample of adults in Adelaide, South Australia aged 60–71 years in 2008.MeasurementsHealth status was measured using the EuroQol (EQ-5D). Compliance with dietary guidelines was measured using a 16-item index of grocery purchasing. Oral health was measured by self-reported number of teeth, oro-facial pain and sore gums. Socio-demographics included age, sex, birth place and subjective social status.ResultsResponses were collected from n=444 persons (response rate = 68.8%). The average EQ-5D score was 0.80 (se=0.01). Unadjusted analyses showed (p<0.05) EQ-5D scores were lower in the bottom tertile of compliance with dietary guidelines, for those reporting oro-facial pain, sore gums and fewer teeth, and for the lower social status group. Multivariate analyses showed (p<0.05) lower compliance with dietary guidelines was associated with poorer general health (beta=−0.10), as was oro-facial pain (beta=−0.11), sore gums (beta=−0.17), and lower social status (beta=−0.28).ConclusionsSocio-economic status, oral symptoms and compliance with dietary guidelines were associated with general health status.

General health and oral health self‐ratings, and impact of oral problems among older adults

The aim was to assess associations of general and oral health perceptions, and the impact of general and oral health functional problems on general health perceptions. Data were collected from adults, 60-71 yr of age in 2008, and included global self-ratings of general and oral health, Oral Health Impact Profile (OHIP-14) scores, and health problem scores [using the five items from the EuroQol instrument (EQ-5D)]. Responses were collected from 444 subjects (response rate = 68.8%). Self-rated general and oral health showed fair to good agreement (kappa = 0.47). Adjusted estimates of self-rated general health showed that worse ratings were associated with lower social status [prevalence ratio (PR) = 0.42] and with more health problems (PR = 0.64). Adjusted estimates of self-rated oral health also showed that worse ratings were associated with lower social status (PR = 0.48) and with more health problems (PR = 0.63), as well as with higher OHIP scores (PR = 0.21). The interaction of health problems and OHIP scores was significant for self-rated general health, with self-rated general health being worse when both health problems and OHIP score were higher. For older adults, general health and oral health were associated, although oral health impact was only associated with general health for those with more health problems, indicating that those in worse health suffer more impact from oral health problems.

Compliance with dietary guidelines in grocery purchasing among older adults by chewing ability and socio-economic status.

BACKGROUND Dietary guidelines promote good nutrition through healthy eating. Chewing deficiencies may hinder food intake while lower socio-economic status (SES) may restrict food purchasing. The aim was to examine compliance of grocery purchasing behaviour with dietary guidelines by chewing ability and SES. METHODS Adults aged 60-71 years in Adelaide, South Australia were surveyed in 2008. Dietary guideline compliance was measured using 16 grocery purchasing items. Chewing ability was based on a 5-item Chewing Index. SES was assessed using a subjective social status rating representing where people stand in society. RESULTS Responses were collected from n = 444 persons (response rate = 68.8%). Among dentate persons, 10.3% were chewing deficient and 21.3% were in the lower SES group. Prevalence ratios (PR: 95% CI) controlling for SES showed chewing deficiency was related to (p < 0.05) non-compliance with dietary guidelines in relation to bread (1.7: 1.1-2.5), juice (2.7: 1.6-4.5), tinned fruit (2.9: 1.5-5.6), yoghurt (2.1: 1.2-3.7) and tinned fish (1.5: 1.2-1.9). CONCLUSIONS Chewing deficiency was associated with lower compliance with dietary guidelines in relation to fibre, sugar, fat and salt. Chewing deficiency may have a direct effect on diet as well as reflect a clustering of risk in relation to a range of health behaviours.

Health system values and social values of dental practitioners

OBJECTIVES To describe the social and health system values of dentists, examine the associations of essential and instrumental health system values and social values with health system values. METHODS A random sample of Australian dentists was surveyed by mailed self-complete questionnaires in 2004 (response rate=72%, n=191). RESULTS A minority agreed with egalitarian social values (19%), while the majority endorsed the essential health system values of fair access (84%), quality of care (93%), efficiency (82%), respect for patients (90%) and patient advocacy (81%). A minority agreed with the instrumental health system values of personal responsibility (48%) and social solidarity (45%), but a majority agreed with social advocacy (73%), provider autonomy (95%), consumer sovereignty (91%) and personal security (65%). The strongest associations between essential values and instrumental values (P<0.05) were observed between the essential value of fair access and the instrumental values of social advocacy (rho=0.51) and social solidarity (rho=0.43). Egalitarian values were associated with [odds ratio; 95% CI] the essential value of fair access (2.35; 1.24-4.45) and the instrumental value of social solidarity (2.39; 1.31-4.34). CONCLUSIONS Dentists endorsed essential health system values, but varied in their support for instrumental health system values. A minority endorsed egalitarian values, which were positively associated with the essential value of fair access and the instrumental value of social solidarity. It is important to consider the role of values of key stakeholders such as providers and patients in health policy development.

Practice activity trends among oral and maxillofacial surgeons in Australia.

BackgroundThe aim of this study was to describe practice activity trends among oral and maxillofacial surgeons in Australia over time.MethodsAll registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires.ResultsData were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). The rate of provision of services per visit changed over time with increased rates observed overall (from 1.43 ± 0.05 services per visit in 1990 to 1.66 ± 0.06 services per visit in 2000), reflecting increases in pathology and reconstructive surgery. No change over time was observed in the provision of services per year (4,521 ± 286 services per year in 1990 and 4,503 ± 367 services per year in 2000). Time devoted to work showed no significant change over time (1,682 ± 75 hours per year in 1990 and 1,681 ± 94 hours per year in 2000), while the number of visits per week declined (70 ± 4 visits per week in 1990 to 58 ± 4 visits per week in 2000).ConclusionsThe apparent stability in the volume of services provided per year reflected a counterbalancing of increased services provided per visit and a decrease in the number of visits supplied.

Water Fluoridation Has a Pre-eruptive Effect in Preventing Caries in Children

Article Title and Bibliographic Information Systemic effect of water fluoridation on dental caries prevalence. Cho H-J, Lee H-S, Paik D-I, Bae K-H. Community Dent Oral Epidemiol 2014;42(4):341–8 Reviewer Kiran A. Singh, PhD Purpose/Question To determine if water fluoridation has a pre-eruptive effect in reducing the prevalence of caries Source of Funding Government- Health Promotion Fund, Ministry of Health, Welfare and Family Affairs, Republic of Korea (Policy Project 11-15) Type of Study/Design Cross-sectional study Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Not applicable