Effectiveness of the lay health advisor program on oral function and quality of life in aboriginal older adults: A randomized controlled trial

BACKGROUND

Aboriginal older adults residing in remote areas have poor oral function due to inadequate access to healthcare services. Lay health advisor (LHA) strategies can fill capacity shortages of healthcare professionals in rural communities and increase population acceptance of health care or healthy behaviours.

OBJECTIVE(S)

To evaluate the effectiveness the LHA program on oral function and oral health-related quality of life (OHRQoL) among older adults in aboriginal community.

METHODS

Participants were randomly assigned to an experimental group (EG; n = 122) and a control group (CG; n = 118). All participants performed oral exercises, and the EG received additional one-on-one 30-min lessons by an LHA over 4 weeks. Data were collected through face-to-face interview and oral examination. The generalized estimating equation model was used to analyse changes in outcomes over time.

RESULTS

The EG exhibited significantly greater improvement in swallowing (β = .63) at the 6-month follow-up and in masticatory performance (β = .52) and pronunciation of the syllable/pa/ (β = 2.65) at the 2-week follow-up than the CG did. The EG had a significantly lower plaque control record (β = -.14) and plaque index (β = -.30) at the 3-month follow-up than the CG did. Moreover, the OHRQoL was significantly increased at 6-months follow-up in the EG (p = .010).

CONCLUSION

The LHA program had positive effects on chewing, swallowing and plaque control in aboriginal older adults. LHA group also experienced positive long-term effect on OHRQoL after intervention.

Association between self-reported periodontitis and high-risk oral human papillomavirus infection among Indigenous South Australians: A cross-sectional study

Introduction

The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing globally, reflecting an increase in human papillomavirus (HPV)-related lesions. Indigenous populations are disproportionately affected by OPSCCs. Currently, testing for oral HPV is not recommended as a screening tool to permit early detection of OPSCCs due to the high population prevalence of HPV infection. Periodontitis may be a marker of oral HPV infection, but previous research evaluating this association has been inconclusive. Here we report a large population-based study examining the association between high-risk oral HPV infection and periodontitis among Indigenous South Australians.

Methods

We utilised a large convenience sample of Indigenous South Australians aged 18+ years recruited between February 2018 and February 2020. Of the original cohort (n = 1011), 748 (73.9%) participants participated in the 12 month follow-up. Detailed information on sociodemographic characteristics, health-related behaviours, and sexual history were collected at enrolment. Saliva samples were collected at 12 months and tested for the presence of oral HPV DNA using the optimized general primer (GP) + PCR system. The primary outcomes were the prevalence of any high-risk oral HPV DNA, and separately, HPV 16 and/or 18. Periodontitis was assessed at follow-up by using validated self-reported periodontitis screening questions. Logistic regression analyses were undertaken to assess the association between self-reported periodontitis and oral HPV infection with adjustment for potential sociodemographic and behavioural confounders, with estimates presented as odds ratios (OR) and 95% confidence interval (CI).

Results

Data on 673 participants (89.9% of the follow-up cohort) were available. Participants ranged in age from 18 to 80 (mean age 42.2, SD 14.7) and 31.5% were male. Overall, 115 (17.1%) participants had self-reported periodontitis, 40 (5.9%) had any high-risk oral HPV and 14 (2.1%) had HPV 16 and/or 18. Any high-risk HPV was detected among seven (17.5%) participants and HPV 16 and/or 18 was detected in three (21.4%) who self-reported periodontitis. In the regression analyses no significant association was found between self-reported periodontitis and high-risk oral HPV (adjusted OR: 1.10; 95% CI: 0.45–2.70) or HPV 16 and/or 18 (adjusted OR: 1.27; 95% CI: 0.32–5.03).

Conclusion

This study did not find any association between self-reported periodontitis and high-risk oral HPV among Indigenous South Australians. Further targeted studies with standardized clinical measures of periodontal disease are needed to clarify the link between high-risk oral HPV and periodontal disease. If confirmed this would add further weight to the importance of recommendations about the utility of periodontitis screening to identify individuals at risk of carrying high-risk oral HPV, who may benefit from more intensive screening and ongoing monitoring.

Prevalence of periodontal disease among Indigenous and non-Indigenous populations: protocol for systematic review and meta-analysis

BACKGROUND

Indigenous populations globally experience worse oral health than their non-Indigenous counterpart. Globally, the occurrence of periodontal diseases such as gingivitis and chronic periodontitis is high among Indigenous people. This systematic review aims to quantify, at a global level, the prevalence of periodontal disease among Indigenous populations compared to non-Indigenous populations.

METHODS

This review will only consider studies that have reported the prevalence (%) of periodontal disease among Indigenous and compared against non-Indigenous populations. Studies that have no comparative population or data only on one particular population or lack of data on periodontal clinical assessment will be excluded. An electronic search will be conducted using keywords and appropriate MeSH terms across several databases capturing both published and unpublished articles. The search will be conducted from the time of database inception to February 2021. After the initial search, duplicates will be removed, and the remaining titles and abstracts will be assessed for eligibility. The full text of eligible studies will be assessed by two independent reviewers who will also complete the critical appraisals and data extraction. Outcomes measures would be the mean prevalence (%) and standard deviation of periodontal disease among Indigenous and non-Indigenous populations. From the selected studies, we will conduct a random-effects meta-analysis using standardized mean difference as the effect measure. Forest plots will be used for the visualization of differences in the prevalence of periodontitis. A subgroup analysis will be conducted based on the definition of periodontitis, age, publication type, and geographical location. Heterogeneity among studies will be assessed by I² and chi-square test. Egger's test and funnel plots will be used to assess publication bias.

DISCUSSION

Our systematic review and meta-analysis will facilitate an increased understanding of the magnitude of periodontal disease inequalities that exist globally for Indigenous populations through pooled prevalence estimates. The findings will be helpful to design selective targeted preventive and interventional strategies for periodontal disease for reducing oral health inequalities at a global level.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020188531.

A Global Perspective of Racial-Ethnic Inequities in Dental Caries: Protocol of Systematic Review

Though current evidence suggests that racial-ethnic inequities in dental caries persist over time and across space, their magnitude is currently unknown from a global perspective. This systematic review aims to quantify the magnitude of racial/ethnic inequities in dental caries and to deconstruct the different taxonomies/concepts/methods used for racial/ethnic categorization across different populations/nations. This review has been registered in PROSPERO; CRD42021282771. An electronic search of all relevant databases will be conducted until December 2021 for both published and unpublished literature. Studies will be eligible if they include data on the prevalence or severity of dental caries assessed by the decayed, missing, filled teeth index (DMFT), according to indicators of race-ethnicity. A narrative synthesis of included studies and a random-effects meta-analysis will be conducted. Forest plots will be constructed to assess the difference in effect size for the occurrence of dental caries. Study quality will be determined via the Newcastle-Ottawa Scale and the GRADE approach will be used for assessing the quality of evidence. This systematic review will enhance knowledge of the magnitude of racial/ethnic inequities in dental caries globally by providing important benchmark data on which to base interventions to mitigate the problem and to visualize the effects of racism on oral health.

Prevalence of dental caries among Indigenous populations compared to non-Indigenous populations: a quantitative systematic review protocol

OBJECTIVE

The objective of this review is to evaluate if the prevalence of dental caries is higher among Indigenous populations compared to non-Indigenous populations.

INTRODUCTION

Globally, Indigenous populations have experienced substantial inequalities in health, including oral health care, when compared to their non-Indigenous counterparts. Indigenous populations experience a higher prevalence of dental caries, but most of this data has been collected from convenience samples not involving non-Indigenous groups. This review will highlight differences in the prevalence of dental caries globally among Indigenous groups compared to non-Indigenous groups.

INCLUSION CRITERIA

The systematic review will include all studies that have compared the prevalence of dental caries (% of decayed teeth>0) and dental caries experience (mean score of decayed, missing, filled teeth) among Indigenous and non-Indigenous populations across all ages.

METHODS

Initially, articles will be searched in MEDLINE, followed by a more comprehensive search on Scopus, EBSCO (Dentistry and Oral Sciences Sources), Cochrane Database, and OpenGrey. The search will be conducted independently by two reviewers from database inception to September 2020. A reference list will be made identifying all eligible studies. Titles and abstracts will be reviewed, as well as the full text of articles that meet the inclusion criteria. To assess methodological quality, a standardized critical appraisal checklist for studies reporting prevalence will be selected, followed by standardized data extraction using the JBI tool. The results from included studies will be analyzed using JBI SUMARI.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020204311.

Periodontal disease inequities among Indigenous populations: A systematic review and meta-analysis

The prevalence of periodontal disease varies considerably between Indigenous and general populations. The aim of this systematic review was to assess the global prevalence of periodontal disease among Indigenous populations in comparison with non-Indigenous populations. A systematic electronic search of databases and grey literature sources was conducted of all records through to February 2021. Study selection criteria included original data that reported the prevalence of periodontal diseases among an Indigenous population and compared with a non-Indigenous population, without any restriction on age, sex, language or geographical location. Critical appraisal was conducted with the Joanna Briggs Institute (JBI) tool for prevalence studies. A random-effects model using standardised mean difference (SMD) as the effect measure was used to estimate the pooled prevalence of periodontitis. Subgroup analysis of study location and publication source was also performed. Publication bias was assessed using Egger's test, and funnel plots were used for visualisation. A total of 19 articles were included for descriptive and meta-analysis. The overall prevalence of periodontitis was 35% (95% CI: 0.18, 0.52) higher among the Indigenous population than the non-Indigenous population. The pooled prevalence of periodontitis was consistently higher among the Indigenous populations when stratified according to periodontitis definition employed, study location and publication source. Indigenous populations have a higher prevalence of periodontitis than non-Indigenous populations. To decrease oral health inequities, more emphasis should be given to oral health promotion and specific culturally safe interventions working in partnership with Indigenous populations.

Dental Health Inequalities among Indigenous Populations: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to document the disparity in dental caries experiences among indigenous and nonindigenous populations globally by measuring dental caries prevalence and severity. An electronic database (MEDLINE) was initially searched using relevant keywords. This was followed by use of the search string in the following electronic databases: Scopus, EBSCOhost, Cochrane, and Open Grey. Two independent reviewers conducted the study search and screening, quality assessment, and data extraction, which was facilitated using JBI SUMARI software. The primary outcome was the decayed missing filled teeth (DMFT) score and dental caries prevalence. Subgroup analysis was done by country of publication to identify causes of heterogeneity. Forest plots were used with the standardized mean difference (SMD) and publication bias was assessed using the Egger test with funnel plot construction. For the final review, 43 articles were selected and 34 were meta-analyzed. The pooled mean DMFT for both the permanent dentition (SMD = 0.26; 95% CI 0.13-0.39) and deciduous dentition (SMD = 0.67; 95% CI 0.47-0.87) was higher for the Indigenous population than for the general population. Indigenous populations experienced more decayed teeth (SMD = 0.44; 95% CI 0.25-0.62), a slightly higher number of missing teeth (SMD = 0.11< 95% CI -0.05 to 0.26), and lesser filled teeth (SMD = -0.04; 95% CI -0.20 to 0.13) than their nonindigenous counterparts. The prevalence of dental caries (SMD = 0.27; 95% CI 0.13-0.41) was higher among indigenous people. Globally, indigenous populations have a higher caries prevalence and severity than nonindigenous populations. The factors which have led to such inequities need to be examined.

Specific oral and maxillofacial identifiers in panoramic radiographs used for human identification

Radiographically assisted dental identification is an important means for individual identification. Specific identifiers help to quickly filter some of the possible corresponding AM and PM images at the beginning. The study seeks specific oral and maxillofacial identifiers in panoramic radiographs. A total of 920 panoramic radiographs from 460 live patients were used. The most recent radiograph served as the surrogate post-mortem (PM) record of an unidentified person, and the earliest radiograph served as the ante-mortem (AM) record of the same person. We evaluated the following four groups of identifiers of the images: (1) dental morphology, tooth number, and position; (2) dental treatment and pathology; (3) morphological identifiers of the jaw; and (4) pathological identifiers of the jaw. The ratio of each identifier being identified simultaneously in the AM and PM databases was determined. Specific identifiers were defined as those that appeared at low frequency (ratio: 0%-0.250%). A total of 18 specific oral and maxillofacial identifiers were determined. The specific identifiers were a retained deciduous tooth (0.011%), S-shaped deflection of a tooth root (0.012%), distal deflection of tooth root (0.017%), inverted impaction (0.018%), malposition (0.038%), supernumerary teeth (0.061%), mesial deflection of tooth root (0.092%), microdontia (0.136%), buccal/lingual impaction (0.188%), cementoma (0.002%), hypercementosis (0.002%), continuous crown (0.004%), pulp calcification (0.023%), attrition (0.030%), residual root (0.106%), root resorption (0.137%), implant (0.156%), and osteomyelitis (0.002%). Identifiers of the teeth and jaw can be used for human identification, and dental identifiers are more specific than identifiers of jaw.

Caries experience among adults in core Sámi areas of Northern Norway

OBJECTIVES

Dental caries is a major oral health problem among indigenous people worldwide, but knowledge on this issue among the indigenous Sámi people in Norway is scarce. The aim of the study was to describe dental caries experience in an adult population in core Sámi areas of Northern Norway and to assess the corresponding associations with socio-demographic, socioeconomic and oral health-related behavioural factors.

METHODS

This cross-sectional study is based on data from the Dental Health in the North study (2033 participants aged 18-75 years). A questionnaire was used to collect data on socio-demographic, socioeconomic and oral health-related behavioural factors. Clinical examinations were performed by dentists and dental hygienists at Public Dental Service (PDS) clinics in core Sámi areas of Northern Norway.

RESULTS

About 68% (n = 1380) of participants reported Sámi ethnicity, and the mean number of decayed (D), missed (M) and filled (F) teeth (T) was 16.2 (standard deviation [SD] = 6.7). The mean DMFT was 15.7 (SD = 6.7) among Sámi and 17.0 (SD = 6.7) among non-Sámi. The mean DT among Sámi was 1.0 (SD = 1.6), with a significant, higher prevalence among coastal Sámi (DT = 1.3, SD = 1.8) than inland Sámi (DT = 0.8, SD = 1.5). Living in the coastal region, consumption of sugary soft drinks several times a week or daily, toothbrushing less than daily and irregular dental visits were associated with DT.

CONCLUSIONS

Caries experience among adults in core Sámi areas of Northern Norway was common. Dental caries were more common in the coastal than the inland region, with minor differences in caries experience between Sámi and non-Sámi people within these regions.

Addressing disparities in oral disease in Aboriginal people in Victoria: where to focus preventive programs

The aim of this study is to determine where Aboriginal people living in Victoria attend public oral health services; whether they access Aboriginal-specific or mainstream services; and the gap between dental caries (tooth decay) experience in Aboriginal and non-Aboriginal people. Analysis was undertaken on routinely collected clinical data for Aboriginal patients attending Victorian public oral health services and the distribution of Aboriginal population across Victoria. Approximately 27% of Aboriginal people attended public oral health services in Victoria across a 2-year period, with approximately one in five of those accessing care at Aboriginal-specific clinics. In regional Victoria, 6-year-old Aboriginal children had significantly higher levels of dental caries than 6-year-old non-Aboriginal children. There was no significant difference in other age groups. This study is the first to report where Aboriginal people access public oral health care in Victoria and the disparity in disease between Aboriginal and non-Aboriginal users of the Victorian public oral healthcare system. Aboriginal people largely accessed mainstream public oral healthcare clinics highlighting the importance for culturally appropriate services and prevention programs to be provided across the entire public oral healthcare system. The findings will guide development of policy and models of care aimed at improving the oral health of Aboriginal people living in Victoria.

Yarning about oral health: perceptions of urban Australian Aboriginal and Torres Strait Islander women

BACKGROUND

Many factors influence how a person experiences oral health and how such experiences may facilitate supportive oral health behaviours. Women in particular face different challenges due to their environment, responsibilities and physiological differences to men. Within Australia, Aboriginal and Torres Strait Islander women are reported to have poorer oral health and are faced with additional barriers to supporting their oral health compared with non-Indigenous women. The objective of this paper is to report the experiences and perceptions of oral health from the perspective of urban, Aboriginal and Torres Strait Islander women.

METHODS

The present data derive from a descriptive study that used yarning circles and face-to-face interviews with women who were mothers/carers of urban, Aboriginal and/or Torres Strait Islander children. This was a qualitative study to investigate the impact of child oral health on families. Participants used the opportunity to share their own personal experiences of oral health as women, thus providing data for the present analyses. Information collected was transcribed and analysed thematically.

RESULTS

Twenty women shared their personal narratives on the topic of oral health which were reflective of different time points in their life: growing up, as an adult and as a mother/carer. Although women are trying to support their oral health across their life-course, they face a number of barriers, including a lack of information and the costs of accessing dental care. The teenage years and pregnancy were reported as important time periods for oral health support.

CONCLUSIONS

To improve the oral health of Indigenous Australian women, policymakers must consider the barriers reported by women and critically review current oral health information and services. Current oral health services are financially out of reach for Indigenous Australian women and there is not sufficient or appropriate, oral information across the life-course.

Oral Health Knowledge and Behavior among Adults in the United Arab Emirates

Background

The prevalence of periodontal diseases is increasing in the United Arab Emirates (UAE) despite a worldwide decline in the prevalence of dental caries among children and adolescents. The aims of this study were to determine the levels of oral health knowledge and health-related behavior in adult UAE residents, and the relationship between these variables and oral health.

Methods

A descriptive cross-sectional survey with nonprobability sampling was used in this study. A sample of 630 adults residing in the UAE completed an oral health survey to assess their oral health knowledge and behavior. Mean oral health knowledge and behavior scores were calculated and correlated with population demographic and behavioral variables.

Results

Participants were found to have an acceptable oral health knowledge score (OHKS) of 10.50 (2.36) where 62 % of participants answered the questions correctly. Results showed that age, gender, nationality, smoking, and physical activity were significantly associated with the knowledge score. However, only gender, nationality, and smoking predicted oral health knowledge scores after further regression analysis. On the other hand, the mean oral health behavior score (OHBS) for all participants was 8.91 (2.29); 98% of all participants practiced at least an acceptable level of oral behavior and 53% practiced a good to perfect level. Age, gender, educational level, employment status, insurance status, marital status, nationality, smoking, and physical activity showed significant statistical association with the score of behaviors related to oral health. Only gender, number of diabetes sessions attended, and health information sources used remained significant after further regression analysis.

Conclusion

Further efforts are required to spread awareness about oral health and encourage the UAE population to develop healthy oral habits. Such programs will decrease the occurrence and burden of many chronic oral diseases especially periodontal diseases.