La Crocombe

Impact of dental visiting trajectory patterns on clinical oral health and oral health-related quality of life

BACKGROUND Previous studies have shown variation in long-term dental visiting but little is known about the oral health outcomes of such variation. OBJECTIVE The objective of this study is to determine the association of different dental visiting trajectories with dental clinical and oral health-related quality of life (OHRQoL) indicators. METHODS This study utilized data from the Dunedin Multidisciplinary Health and Development Study, a continuing longitudinal study of 1,037 babies born in Dunedin (New Zealand) between April 1, 1972 and March 31, 1973. Data presented here were collected at ages 15, 18, 26, and 32 years. Three categories of dental attendance were identified in earlier research, namely: regulars (n = 285, 30.9 percent of the cohort), decliners (441, 55.9 percent), and opportunistic users (107, 13.1 percent). RESULTS There was a statistically significant association between opportunistic dental visiting behavior and decayed missing and filled surfaces score (Beta = 3.9) as well as missing teeth because of caries (Beta = 0.7). Nonregular dental visiting trajectories were associated with higher Oral Health Impact Profile (OHIP-14) scores (Beta = 2.1) and lower self-rated oral health scores (prevalence ratio = 0.8). CONCLUSION Long-term, postchildhood dental attendance patterns are associated with oral health in adulthood, whether defined by clinical dental indicators or OHRQoL. Improving dental visiting behavior among low socioeconomic status groups would have the greatest effect on improving oral health and reducing oral health impacts.

Comparison of adult oral health in Australia, the USA, Germany and the UK

BACKGROUND Australian adults reportedly have poor oral health when compared to 28 other OECD countries. The Australian ranking was based on edentulism and caries experience data from selected age groups that apparently were collected in 1987-88. The objective of this study was to compare the oral health of Australian adults with that of three other western countries that have comprehensive oral health survey data. METHODS Published data were obtained from the NHANES 2003-2004, the Fourth German Oral Health Study 2005 and the UK Adult Dental Health Survey 1998. Data from the Australian NSAOH 2004-06 were analysed to generate comparable age-specific estimates using nine dental clinical indicators, two measures of oral hygiene behaviour and two of dental attendance. RESULTS Australia had the best oral health based on two clinical indicators, was equal first on three indicators and ranked second in the remaining clinical indicators. Australia ranked first or second based on dental flossing, use of mouthwash and frequency of dental attendance. CONCLUSIONS The oral health of the Australian adult population was among the best of the four nations studied.

The influence of dental attendance on change in oral health–related quality of life

BACKGROUND Few longitudinal studies have investigated the association between dental attendance and oral health-related quality of life (OHRQoL). These studies were limited to older adults, or to study participants with an oral disadvantage and did not assess if dental attendance had a different effect on OHRQoL for different people. OBJECTIVE This project was designed to test whether routine dental attendance improved the OHRQoL of survey participants and whether any patient factors influenced the effect of dental attendance on change in OHRQoL. METHODS Collection instruments of a service use log book and a 12 month follow-up mail self-complete questionnaire were added to the Tasmanian component of the National Survey of Adult Oral Health 2004/06. The dependent variable was change in OHIP-14 severity and the independent variable was dental attendance. Many putative confounders/effect modifiers were analysed in bivariate, stratified and three-model multivariate analyses. These included indicators of treatment need, sociodemographic characteristics, socioeconomic status, pattern of dental attendance and access to dental care. RESULTS None of the putative confounders were associated with both dental attendance and the change in mean OHIP-14 severity. The only statistically significant interaction for change in OHIP-14 severity was observed for dental attendance by residential location (P < 0.01). In multivariate analysis, there was a statistically significant association of dental attendance with change in mean OHIP-14 severity. It also showed that the difference in association of attendance between Hobart, the capital city of Tasmania, and other places was statistically significant based on the interaction between residential location and attendance (P < 0.05). CONCLUSION The effect of dental attendance on OHRQoL was influenced by a patients residential location.

Relative oral health outcome trends between people inside and outside capital city areas of Australia.

BACKGROUND The aim of this study was to evaluate relative change over 17 years in clinical oral health outcomes inside and outside capital city areas of Australia. METHODS Using data from the National Oral Health Survey of Australia 1987-88 and the National Survey of Adult Oral Health 2004-06, relative trends in clinical oral health outcomes inside and outside capital city areas were measured by age and gender standardized changes in the percentage of edentate people and dentate adults with less than 21 teeth, in mean numbers of decayed, missing and filled teeth, and mean DMFT index. RESULTS There were similar reductions inside and outside capital city areas in the percentage of edentate people (capital city 63.7%, outside capital city 60.7%) and dentate people with less than 21 teeth (52.5%, 50.1%), in the mean number of missing teeth (34.3%, 34.5%), filled teeth (0.0%, increase of 5.5%), and mean DMFT index (21.2%, 19.2%). The reduction in mean number of decayed teeth was greater in capital city areas (78.0%) than outside capital city areas (50.0%). CONCLUSIONS Trends in four of the five clinical oral health outcomes demonstrated improvements in oral health that were of a similar magnitude inside and outside capital city areas of Australia.

The effect of lifetime fluoridation exposure on dental caries experience of younger rural adults.

BACKGROUND The aim of this study was to confirm whether the level of lifetime fluoridation exposure is associated with lower dental caries experience in younger adults (15-46 years). METHODS Data of the cohort born between 1960 and 1990 residing outside Australias capital cities from the 2004-2006 Australian National Survey of Adult Oral Health were analysed. Residential history questionnaires were used to determine the percentage of each persons lifetime exposure to fluoridated water (<50%/50+%). Examiners recorded decayed, missing and filled permanent teeth (DMFT). Socio-demographic variables, periodontal risk factors, and access to dental care were included in multivariable least-squares regression models. RESULTS In bivariate analysis, the higher level of fluoridation category had significantly lower DMFT (mean 6.01 [SE=0.62]) than the lower level of fluoridation group (9.14 [SE=0.73] p<0.01) and lower numbers of filled teeth (4.08 [SE=0.43], 7.06 [SE=0.62], p<0.01). In multivariate analysis, the higher number of full-time equivalent dentists per 100,000 people was associated with a lower mean number of missing teeth (regression coefficient estimate=-1.75, p=0.03), and the higher level of water fluoridation with a lower mean DMFT (-2.45, p<0.01) and mean number of filled teeth (-2.52, p<0.01). CONCLUSIONS The higher level of lifetime fluoridation exposure was associated with substantially lower caries experience in younger rural adults, largely due to a lower number of filled teeth.

Is poor access to dental care why people outside capital cities have poor oral health

BACKGROUND Why oral health status outside capital cities is poorer than that in capital cities has not been satisfactorily explained. The aim of this study was to determine if the reason was poorer access to dental care. METHODS Data were obtained from the Australian National Survey of Adult Oral Health (2004-06). Oral health status was measured by DMFT Index, and numbers of decayed, missing and filled teeth. A two-step analysis was undertaken: comparing the dependent variables by location, socio-demographic confounders and preventive dental behaviours, and then including six access to dental care variables. RESULTS Of the 14 123 people interviewed, 5505 were examined, and 4170 completed the questionnaire. With socio-economic parameters in the first regression model, non-capital city people had higher DMFT (regression coefficient = 1.15, p < 0.01), more decayed (0.42, p < 0.01) and missing teeth (0.85, p < 0.01), but not filled teeth (-0.11, p = 0.71), than capital city based people. In the second step analysis, non-capital city people still had a greater DMFT (1.01, p < 0.01), more decayed (0.27, p = 0.03) and missing teeth (0.74, p < 0.01), but not filled teeth (0.00, p = 0.99) than capital city based people. CONCLUSIONS Access to dental care was not the only reason why people outside capital cities have poorer oral health than people living in capital cities.

A Review of Mercury Exposure and Health of Dental Personnel

Considerable effort has been made to address the issue of occupational health and environmental exposure to mercury. This review reports on the current literature of mercury exposure and health impacts on dental personnel. Citations were searched using four comprehensive electronic databases for articles published between 2002 and 2015. All original articles that evaluated an association between the use of dental amalgam and occupational mercury exposure in dental personnel were included. Fifteen publications from nine different countries met the selection criteria. The design and quality of the studies showed significant variation, particularly in the choice of biomarkers as an indicator of mercury exposure. In several countries, dental personnel had higher mercury levels in biological fluids and tissues than in control groups; some work practices increased mercury exposure but the exposure levels remained below recommended guidelines. Dental personnel reported more health conditions, often involving the central nervous system, than the control groups. Clinical symptoms reported by dental professionals may be associated with low-level, long-term exposure to occupational mercury, but may also be due to the effects of aging, occupational overuse, and stress. It is important that dental personnel, researchers, and educators continue to encourage and monitor good work practices by dental professionals.

Clinical oral health of Australia's rural children in a sample attending school dental services

OBJECTIVE To examine the association between childrens clinical oral health status and their residential location using the latest available data (2009) and to ascertain whether poor oral health among rural children is related to being Indigenous, having less access to fluoridated water or being of lower socioeconomic status (SES), than children from urban areas. DESIGN Cross-sectional survey. SETTING AND PARTICIPANT Data were collected on 74, 467 children aged 5-12 years attending school dental services in Australia (data were not available for Victoria or New South Wales). MAIN OUTCOME MEASURES Clinical oral health was determined by the mean number of permanent teeth with untreated caries, missing and filled permanent teeth, and the mean decayed, missing and filled permanent teeth index (DMFT) of 8 to 12-year-old-children and the mean number deciduous teeth with untreated caries, missing and filled deciduous teeth, and the mean decayed, missing and filled deciduous teeth index (dmft) of 5-10-year-olds. RESULTS The multivariable models that included coefficients on whether the child was Indigenous, from an area with fluoridated water and SES, were controlled for age and sex. The mean DMFT of 8-12-year-old children and the mean dmft of 5-10-year-old-children were significantly higher in rural areas compared with urban centres after accounting for Indigenous status, fluoridated water and SES. CONCLUSION Childrens oral health was poorer in rural areas than in major city areas.

Will improving access to dental care improve oral health‐related quality of life?

BACKGROUND The aim of this study was to determine if Australian Defence Force (ADF) members had better oral health-related quality of life (OHRQoL) than the general Australian population and whether the difference was due to better access to dental care. METHODS The OHRQoL, as measured by OHIP-14 summary indicators, of participants from the Defence Deployed Solomon Islands (SI) Health Study and the National Survey of Adult Oral Health 2004-06 (NSAOH) were compared. The SI sample was age/gender status-adjusted to match that of the NSAOH sample which was age/gender/regional location weighted to that of the Australian population. RESULTS NSAOH respondents with good access to dental care had lower OHIP-14 summary measures [frequency of impacts 8.5% (95% CI = 5.4, 11.6), extent mean = 0.16 (0.11, 0.22), severity mean = 5.0 (4.4, 5.6)] than the total NSAOH sample [frequency 18.6 (16.6, 20.7); extent 0.52 (0.44, 0.59); severity 7.6 (7.1, 8.1)]. The NSAOH respondents with both good access to dental care and self-reported good general health did not have as low OHIP-14 summary scores as in the SI sample [frequency 2.6 (1.2, 5.4), extent 0.05 (0.01, 0.10); severity 2.6 (1.9, 3.4)]. CONCLUSIONS ADF members had better OHRQoL than the general Australian population, even those with good access to dental care and self-reported good general health.

Is clinical oral health poorer in regional areas compared with major city areas

OBJECTIVE To determine if clinical oral health outcomes differ between people who reside in major city, inner regional and outer regional areas of Australia. DESIGN Data from the National Survey of Adult Oral Health 2004-06 that used a clustered stratified random sampling design with telephone interviews, standardised oral epidemiological examinations and self-complete questionnaires were used to compare the clinical oral health. MAIN OUTCOME MEASURES Decayed, missing and filled permanent teeth. PARTICIPANTS Australians aged 15 years or more. Data were weighted by age, sex and regional location to the Estimated Resident Population, bivariate analysis undertaken to determine confounders and multivariate analysis completed with dental caries clinical measures as dependent variables. RESULTS Inner regional people had a significantly higher decayed, missing and filled teeth than people from major cities (Estimate = 1.15, P < 0.01), but there was no difference between inner and regional areas. Older people had higher outcomes for decayed, missing and filled teeth (15.42, P < 0.01) and missing teeth (9.66, P < 0.01), but less decayed teeth (-0.37, P < 0.01), and people with the highest incomes had lower dental caries experience (-1.34, P < 0.01) and missing teeth (-1.42, P < 0.01). CONCLUSION Dental caries experience was greater in inner regional areas than in major city areas, but not outer regional areas. Dental caries experience was similar in outer regional and major city areas.