Loc G. Do

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.

Distribution of Caries in Children: Variations between and within Populations

The rapid changes in social and economic conditions in many populations may have significant impacts on health, including child oral health. Understanding trends and variations between and within countries will assist in the development of effective preventive programs. This review aims (1) to document time-trends in child caries experience of countries with different levels of social and economic development, and (2) to compare factors affecting the caries experience of children in two contrasting countries. A time-trend analytical approach of ecological data from countries with different levels of social and economic development and individual data of the two contrasting Vietnamese and Australian child populations were used. The analysis found a significant decline in caries experience of children, mostly driven by the improvement in populations with high social and economic development. Significant variations in caries experience and in associations with risk factors between and within countries were observed. Socio-economic inequality in child oral health existed within developed countries and between countries with different levels of development. Population programs aimed at improving upstream factors are of priority in further improving child oral health in different populations.

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.

Early childhood feeding practices and dental caries in preschool children : a multi-centre birth cohort study

BackgroundDental caries (decay) is an international public health challenge, especially amongst young children. Early Childhood Caries is a rapidly progressing disease leading to severe pain, anxiety, sepsis and sleep loss, and is a major health problem particularly for disadvantaged populations. There is currently a lack of research exploring the interactions between risk and protective factors in the development of early childhood caries, in particular the effects of infant feeding practises.Methods/DesignThis is an observational cohort study and involves the recruitment of a birth cohort from disadvantaged communities in South Western Sydney. Mothers will be invited to join the study soon after the birth of their child at the time of the first home visit by Child and Family Health Nurses. Data on feeding practices and dental health behaviours will be gathered utilizing a telephone interview at 4, 8 and 12 months, and thereafter at 6 monthly intervals until the child is aged 5 years. Information collected will include a) initiation and duration of breastfeeding, b) introduction of solid food, c) intake of cariogenic and non-cariogenic foods, d) fluoride exposure, and e) oral hygiene practices. Children will have a dental and anthropometric examination at 2 and 5 years of age and the main outcome measures will be oral health quality of life, caries prevalence and caries incidence.DiscussionThis study will provide evidence of the association of early childhood feeding practices and the oral health of preschool children. In addition, information will be collected on breastfeeding practices and the oral health concerns of mothers living in disadvantaged areas in South Western Sydney.

Risk-benefit balance in the use of fluoride among young children.

This study aimed to evaluate the risk-benefit balance of several fluoride exposures. Fluoride exposure history of randomly selected children was collected for calculation of exposure to fluoridated water, toothpaste, and other fluoride sources. We evaluated the risk-benefit balance of fluoride exposure by comparing dental fluorosis on maxillary central incisors, recorded at the time of the study with the use of the Thylstrup and Fejerskov Index, and deciduous caries experience, recorded at age six years, of the same group of South Australian children who were from 8 to 13 years old in 2002–03. Population Attributable Risk for fluorosis and Population Prevented Fraction for caries were estimated. Fluorosis prevalence was found to be 11.3%; caries prevalence, 32.3%; mean dmfs, 1.57 (SD 3.3). Exposure to fluoridated water was positively associated with fluorosis, but was negatively associated with caries. Using 1000-ppm-F toothpaste (compared with 400- to 550-ppm-F toothpaste) and eating/licking toothpaste were associated with higher risk of fluorosis without additional benefit in caries protection. Evaluation of the risk-benefit balance of fluoride exposure provides evidence to assist in the formulation of appropriate guidelines for fluoride use.

Is weight gain associated with the incidence of periodontitis? A systematic review and meta-analysis

AIM This study aimed to conduct a systematic review assessing the effects of weight gain on the incidence of periodontitis in adults. METHODS Electronic searches in four databases were performed up to and including February 2015. Only prospective longitudinal studies assessing the association between weight gain and the incidence of periodontitis in adults were eligible to be included in this study. All studies should state a clear description of nutritional status (Body Mass Index; Waist Circumference) as well as the case definition of periodontitis. Pooled relative risks (RR) for becoming overweight and obese on the incidence of periodontitis were estimated by meta-analysis. Quality was assessed with the Newcastle-Ottawa scale for cohort studies. RESULTS Five articles were included in this review and meta-analysis with 42,198 subjects enrolled. Subjects who became overweight and obese presented higher risk to develop new cases of periodontitis (RR 1.13; 95%CI 1.06-1.20 and RR 1.33 95%CI 1.21-1.47 respectively) compared with counterparts who stayed in normal weight. CONCLUSIONS A clear positive association between weight gain and new cases of periodontitis was found. However, these results are originated from limited evidence. Thus, more studies with longitudinal prospective design are needed.

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.

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.

Oral Health Status of Vietnamese Children: Findings From the National Oral Health Survey of Vietnam 1999

The National Oral Health Survey of Vietnam 1999 was conducted to inform policy development. Aims. The aims were to describe the oral health status, to analyze its socioeconomic distribution, and to evaluate change over time in the oral health of Vietnamese children. Methods. A multistaged stratified sampling process was employed. Children aged 6 to 17 years were examined by trained and calibrated dental examiners. A parental questionnaire was used. Drinking water was analyzed. Results. Preventive oral health behaviors and dental care utilization were infrequent. The decayed, missing, and filled surfaces referring to primary dentition (dmfs) and permanent dentition (DMFS) scores (SD) were 8.9 (11.3) and 2.5 (4.4), respectively. Primary caries experience was associated with fluoride level in drinking water, age, gender, residential status, and geographical location. Permanent caries was also associated with dental visiting and parental education. There was an increase in the prevalence of dental caries in the Vietnamese child population compared with 10 years earlier. Conclusion. The oral health of Vietnamese children was characterized by high level of dental caries with variation among socioeconomic groups. It suggests the need for a population oral health program that includes measures to target high-need children.

Effect of Periodontal Therapy on Arterial Structure and Function Among Aboriginal Australians: A Randomized, Controlled Trial

Observational studies and nonrandomized trials support an association between periodontal disease and atherosclerotic vascular disease. Both diseases occur frequently in Aboriginal Australians. We hypothesized that nonsurgical periodontal therapy would improve measures of arterial function and structure that are subclinical indicators of atherosclerotic vascular disease. This parallel-group, randomized, open label clinical trial enrolled 273 Aboriginal Australians aged ≥18 years with periodontitis. Intervention participants received full-mouth periodontal scaling during a single visit, whereas controls received no treatment. Prespecified primary end points measured 12-month change in carotid intima-media thickness, an indicator of arterial structure, and 3- and 12-month change in pulse wave velocity, an indicator of arterial function. ANCOVA used complete case data to evaluate treatment group differences. End points could be calculated for 169 participants with follow-up data at 3 months and 168 participants at 12 months. Intima-media thickness decreased significantly after 12 months in the intervention group (mean reduction=−0.023 [95% confidence interval {CI}, −0.038 to −0.008] mm) but not in the control group (mean increase=0.002 [95% CI, −0.017 to 0.022] mm). The difference in intima-media thickness change between treatment groups was statistically significant (−0.026 [95% CI, −0.048 to −0.003] mm; P=0.03). In contrast, there were no significant differences between treatment groups in pulse wave velocity at 3 months (mean difference, 0.06 [95% CI, −0.17 to 0.29] m/s; P=0.594) or 12 months (mean difference, 0.21 [95% CI, −0.01 to 0.43] m/s; P=0.062). Periodontal therapy reduced subclinical arterial thickness but not function in Aboriginal Australians with periodontal disease, suggesting periodontal disease and atherosclerosis are significantly associated.