Apgar score and dental caries risk in the primary dentition of five year olds

BACKGROUND

Conditions in utero and early life underlie risk for several childhood disorders. This study tested the hypothesis that the Apgar score predicted dental caries in the primary dentition.

METHODS

A retrospective cohort study conducted in 2003 examined associations between conditions at birth and early life with dental caries experience at five years. Dental examination data for a random sample of five-year-old South Australian children were obtained from School Dental Service electronic records. A questionnaire mailed to the parents obtained information about neonatal status at delivery (five-minute Apgar score, birthweight, plurality, gestational age) and details about birth order, weaning, and behavioural, familial and sociodemographic characteristics.

RESULTS

Of the 1398 sampled children with a completed questionnaire (response rate=64.6%), 1058 were singleton term deliveries among whom prevalence of dental caries was 40.1%. In weighted log-binomial regression analysis, children with an Apgar score of <=8 relative to a score of 9-10 had greater probability of dental caries in the primary dentition after adjusting for sociodemographic and behavioural covariates and water fluoridation concentration (adjusted PR=1.47, 95% CI=1.11, 1.95).

CONCLUSIONS

Readily accessible markers of early life, such as the Apgar score, may guide clinicians in identifying children at potentially heightened risk for dental caries and aid decision-making in allocating preventive services.

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.

Gender modifies effect of perceived stress on orofacial pain symptoms: National Survey of Adult Oral Health

AIMS

To determine in a representative sample of the Australian adult population the relationship between age, gender, and two components of perceived stress (distress and control) and to investigate whether the relationship of perceived stress and temporomandibular disorder (TMD)-related orofacial pain symptoms was modified by gender or age.

METHODS

Data were from the National Survey of Adult Oral Health conducted in Australia in 2004-2006 and were collected from 3,954 adults aged 18 to 91 years. TMD-related orofacial pain symptoms were evaluated using seven validated screening questions. Perceived stress was measured with the 14-item Perceived Stress Scale and was investigated to empirically test its two theoretical components (distress and sense of control), using principal components analysis.

RESULTS

Prevalence of TMD-related orofacial pain symptoms was 10.1% in the Australian adult population. Prevalence was higher in females than in males, inversely related to age, and positively related to distress and current cigarette smoking. Principal component analysis confirmed the theoretical presence of two factors labeled here as distress and control. An inverse relationship of age and distress was more pronounced in females than in males (P value for interaction = .005). In the adjusted binary logistic regression model, age, smoking, and distress remained positively associated with symptoms. A sense of control was protective against TMD-related orofacial pain symptoms, but only for males (P value for interaction = .040).

CONCLUSION

The higher prevalence of TMD-related orofacial pain symptoms in females was better explained by their lower perception of control than from a greater perception of distress.

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.

A comprehensive approach to health promotion for the reduction of dental caries in remote Indigenous Australian children: a clustered randomised controlled trial

AIM

To evaluate the effect of a community-oriented primary health care (CPHC) intervention on oral health behaviours of Indigenous preschool children living in remote communities of Australia's Northern Territory.

METHODS

The study was a community-clustered randomised controlled trial over two years, set in 30 remote Indigenous communities in the Northern Territory of Australia. Children aged 18-47 months at baseline were enrolled in the study. The intervention included fluoride varnish applications, training of primary care workers, and health promotion for oral health at an individual, family and community level. Intervention communities received six-monthly visits over two years and control communities were visited at baseline and two years later with no contact in the intervening period. The outcome measures reported in this paper are the impact of the intervention on two secondary endpoints: oral health promotion activities in the community and personal oral health practice of children.

RESULTS

The intervention did not produce any significant change in oral health behaviours, clinical measures of oral hygiene, or community programmes promoting oral health. Dental caries can be reduced but will continue to be a problem among young remote Indigenous children while they experience major social disadvantage.

Substance use and periodontal disease among Australian Aboriginal young adults

AIM

To investigate the effects of tobacco, marijuana, alcohol and petrol sniffing on periodontal disease among Australian Aboriginal young adults.

DESIGN

Cross-sectional nested within a long-standing prospective longitudinal study. Setting Aboriginal communities in Australia's Northern Territory.

PARTICIPANTS

Members of the Aboriginal Birth Cohort study who were recruited from birth between January 1987 and March 1990 at the Royal Darwin Hospital, Northern Territory, Australia. Data were from wave III, when the mean age of participants was 18 years.

MEASUREMENTS

Clinical dental examination and self-report questionnaire.

FINDINGS

Of 425 participants with complete data, 26.6% had moderate/severe periodontal disease. There was elevated risk of periodontal disease associated with tobacco [prevalence ratio (PR) = 1.59, 95% CI = 1.06-2.40], marijuana (PR = 1.44, 95% CI = 1.05-1.97) and petrol sniffing (PR = 1.83, 95% CI = 1.08-3.11), but not alcohol (PR = 0.92, 95% CI = 0.67-1.27). Stratified analysis showed that the effect of marijuana persisted among tobacco users (PR = 1.47, 95% CI 1.03-2.11). It was not possible to isolate an independent effect of petrol sniffing because all petrol sniffers used both marijuana and tobacco, although among smokers of both substances, petrol sniffing was associated with an 11.8% increased prevalence of periodontal disease.

CONCLUSIONS

This is the first time that substance use has been linked with periodontal disease in a young Australian Aboriginal adult population, and the first time that petrol sniffing has been linked with periodontal disease in any population. The role of substance use in periodontal disease among this, and other, marginalized groups warrants further investigation.

Professional charges not reimbursed to dentists in the U.S.: evidence from Medical Expenditure Panel Survey, 1996

OBJECTIVES

This cross-sectional study examined professional charges not paid to dentists.

METHODS

This analysis used logistic regression in SUDAAN examining the 1996 MEPS data from 12,931 adults.

RESULTS

Among people incurring dental care charges, 13.6% had more than $50 of unpaid charge (UC). The percapita UC was $53.30. Total UC was higher for highest income group [45.4% of total] compared to lowest income group [26.0%]. The percapita UC of $76.70 for low income group was significantly greater than for high income group ($47.80, P < 0.01). More Medicaid recipients (52% vs. non-recipients: 12%) incurred at least $50 in UC (P < 0.01). Adjusted odds of incurring UC were greater for those employed (OR = 1.3, 95% CI: 1.0-1.7), and for those with private insurance (OR: 1.5, CI: 1.3-1.9). Number of dental procedure types modified the association between Medicaid recipient and UC (OR = 13.6 for Medicaid recipients undergoing multiple procedure types; OR: 2.3 for Medicaid non-recipients with multiple procedure types; OR: 1.9 for Medicaid recipients receiving single dental procedure.

CONCLUSIONS

Having private insurance, being unemployed and being Medicaid insured undergoing multiple procedure were strongest predictors of UC.

Physical activity, inflammatory biomarkers in gingival crevicular fluid and periodontitis

AIMS

To examine the associations of physical activity with interleukin 1-beta (IL-1beta), C-reactive protein (CRP) and periodontitis and to investigate whether any relationship between physical activity and inflammatory mediators differs between periodontitis cases and non-cases.

MATERIAL AND METHODS

In this population-based case control study of Australians aged 18+ years, dentists conducted oral epidemiologic examinations identifying cases with moderate or severe periodontitis and periodontally healthy controls. Gingival crevicular fluid samples collected during examinations were analysed for inflammatory biomarkers. Subject-completed questionnaires assessed leisure-time physical activity. Exposure odds ratios (ORs) were estimated in multivariable logistic regression models adjusting for periodontitis risk indicators.

RESULTS

Of 751 subjects (359 cases, 392 controls), those meeting a prescribed threshold for leisure-time physical activity had lower adjusted odds of elevated IL-1beta: OR=0.69, (95% CI=0.50-0.94) and detectable CRP: OR=0.70 (0.50-0.98) than less active adults. Physical activity was not associated with periodontitis: OR=1.14 (0.80-1.62). Periodontitis modified the association between levels of physical activity and detectable CRP. Increasing quartiles of physically activity were associated with decreasing probability of detectable CRP, but the effect was limited to periodontitis cases and was not apparent among non-cases.

CONCLUSION

Leisure-time physical activity may protect against an excessive inflammatory response in periodontitis.

Are people with dental fear under-represented in oral epidemiological surveys?

BACKGROUND

Dental phobia is associated with poorer dental attendance so epidemiological surveys requiring participants to undertake a dental examination may result in an under-representation of participants with high dental fear.

METHOD

We compared the dental fear distribution of participants and non-participants in an oral examination component of a national epidemiological survey of oral health. Of 12,606 in-scope dentate people aged 15+ who completed a structured computer-assisted telephone interview (CATI) survey, 5,505 (43.7%) participated in the oral examination. Dental fear was assessed with a single-item measure in the CATI.

RESULTS

There was a significant difference between the percentages of participants and non-participants who rated themselves as "extremely" afraid, although the absolute difference (1.9%) was small. The association between extreme dental fear and participation was significant (OR = 0.66, 95% CI = 0.56-0.77) in multivariate analyses after controlling for possible confounders. Females with extreme dental fear were also significantly less likely to undertake an oral examination.

CONCLUSION

Even though people with dental fear and phobia may delay or avoid dental visits, they do not appear to be appreciably under-represented in oral epidemiological surveys.

A cross-national comparison of income gradients in oral health quality of life in four welfare states: application of the Korpi and Palme typology

BACKGROUND

The extent to which welfare states may influence health outcomes has not been explored. It was hypothesised that policies which target the poor are associated with greater income inequality in oral health quality of life than those that provide earnings-related benefits to all citizens.

METHODS

Data were from nationally representative surveys in the UK (n = 4064), Finland (n = 5078), Germany (n = 1454) and Australia (n = 2292) conducted from 1998 to 2002. The typology of Korpi and Palme classifies these countries into four different welfare states. In each survey, subjects completed the Oral Health Impact Profile (OHIP-14) questionnaire, which evaluates the adverse consequence of dental conditions on quality of life. For each country, survey estimation commands were used to create linear regression models that estimated the slope of the gradient between four quartiles of income and OHIP-14 severity scores. Parameter estimates for income gradients were contrasted across countries using Wald chi(2) tests specifying a critical p value of 0.008, equivalent to a Bonferroni correction of p<0.05 for the six pairwise tests.

RESULTS

Statistically significant income gradients in OHIP-14 severity scores were found in all countries except Germany. A global test confirmed significant cross-national differences in the magnitude of income gradients. In Australia, where a flat rate of benefits targeted the poor, the mean OHIP-14 severity score reduced by 1.7 units (95% CI -2.15 to -1.34) with each increasing quartile of household income, a significantly steeper gradient than in other countries.

CONCLUSION

The coverage and generosity of welfare state benefits appear to influence levels of inequality in population oral health quality of life.

Impact of oral disease on quality of life in the US and Australian populations

The US National Health and Nutrition Examination Survey (NHANES 2003-2004) evaluated oral health quality of life for the first time using a previously untested subset of seven Oral Health Impact Profile (OHIP) questions, i.e. the NHANES-OHIP.

OBJECTIVES

(i) To describe the impact of dental conditions on quality of life in the US adult population; (ii) to evaluate construct validity and adequacy of the NHANES-OHIP in NHANES 2003-2004 and a comparable Australian survey.

METHODS

In the cross-sectional NHANES 2003-2004 survey of a nationally representative sample of US adults (n=4907), prevalence was quantified as the proportion of adults who reported experiencing one or more impacts fairly often or very often within the past year. Construct validity was tested by comparing prevalence estimates across categories of sociodemographic, dental health and utilization characteristics known to vary in oral health. In 2002, Australian cross-sectional survey of a nationally representative sample of adults (n=2644), adequacy of the NHANES-OHIP questions were tested with reference to a slightly modified version of the OHIP-14 questions.

RESULTS

NHANES-OHIP prevalence estimates were markedly similar in the United States (15.3%) and Australia (15.7%). In the US construct, validity was evidenced by higher NHANES-OHIP scores among groups with greater levels of tooth loss, perceived treatment need and problem-oriented visiting and with lack of private dental insurance and low income. In Australia, prevalence for the NHANES-OHIP closely resembled prevalence estimates of the modified OHIP-14. Both varied to a similar degree across levels of tooth loss, perceived treatment need, problem-oriented visiting, and private dental insurance and income, demonstrating adequacy of the NHANES-OHIP as a brief independent instrument.

CONCLUSIONS

There was acceptable construct validity and adequacy of the NHANES-OHIP questionnaire. In the United States, the impact of oral disease disproportionately affected disadvantaged groups, a finding that supports application of the US Healthy People 2010 major goals of improved quality of life and reduced health disparities.

Affluent neighborhoods reduce excess risk of tooth loss among the poor

The effect of neighborhood on health may vary according to the characteristics of the residents. We tested the hypothesis that, in affluent neighborhoods, low-income adults retain more teeth than their income-equivalent peers in poor neighborhoods. In 2003, the Adelaide Small Area Dental Study collected sociodemographic and tooth retention information from 2860 adults in 60 neighborhoods. Neighborhood socio-economic position was a census-based composite measure. Using multilevel modelling, we fitted a series of two-level random intercept variance component models. Findings revealed significant main effects for individual and neighborhood predictors and a significant interaction between neighborhood disadvantage and low income. In affluent areas, disparities in tooth retention were negligible, but in poor neighborhoods, substantial variation in tooth retention between individuals was found based on their level of income. Low-income adults appeared to benefit from living in affluent areas, while wealthier adults living in poor neighborhoods did not lose their oral health advantage.

Orthodontic Treatment, Genetic Factors and Risk of Temporomandibular Disorder

Traditionally, four groups of factors have been identified in the etiology of temporomandibular disorder (TMD): anatomical variation in the masticatory system; psychosocial characteristics; pain in other body regions; and demographics. Orthodontic treatment has been variously cited both as a protective and harmful factor in TMD etiology. Recently, a search has begun for a genetic influence on TMD etiology. Genetic markers can be of additional value in identifying gene-environment interactions, that is, isolating population sub-groups, defined by genotype in which environmental influences play a relatively greater or lesser etiological role. This paper reviews concepts and study design requirements for epidemiological investigations into TMD etiology. Findings are presented from a prospective cohort study of 186 females that illustrate an example of gene-environment interaction in TMD onset. Among people with a variant of the gene encoding catechol-O-methyl-transferase, an enzyme associated with pain responsiveness, risk of developing TMD was significantly greater for subjects who reported a history of orthodontic treatment compared with subjects who did not (P=0.04). While further studies are needed to investigate TMD etiology, this genetic variant potentially could help to identify patients whose risk of developing TMD is heightened following orthodontic treatment, hence serving as a risk marker useful in planning orthodontic care.