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

The impact of different determinants on the dental caries experience of children living in Australia rural and urban areas

AIMS

Evidence suggests there are geographical variations in child oral health and this has prompted research into determinants of that variation. This study aimed to investigate factors attributable to the difference in child oral health between urban and rural areas in Australia.

METHOD

Data were from the National Child Oral Health Study 2012-14, a population-based study of 5- to 14-year-old children, who underwent oral epidemiological examinations by trained examiners. Caries prevalence (dmfs/DMFS > 0) and experience (dmfs/DMFS count) in the primary dentition (5- to 8-year-old) and permanent dentition (9- to 14-year-old) were calculated. Children were grouped by residential location (urban or rural areas). A parental questionnaire collected information on family socio-economic factors, and individual health behaviours (dental access, sugar consumption and toothbrushing). Residential history was used to calculate lifetime exposure to water fluoridation (WF). Analyses were weighted to produce population-representative estimates. The primary outcomes were assessed separately for the two groups in regression models with robust standard error estimation to estimate prevalence ratios and mean ratios and their 95% confidence intervals. Population Attributable Fractions were calculated using the population distribution of the exposures and their adjusted estimates.

RESULTS

10 581 5- to 8-year-old and 14 041 9- to 14-year-old children were included. Caries prevalence was higher in rural than in urban areas. In multivariable models, exposure to fluoridation, reason for dental visit and consumption of sugary beverages were consistently associated with caries prevalence and experience. WF coverage attributed to differences in caries prevalence (10% vs 21%) and experience (14% vs 35%) in the permanent dentition. High consumption of sugary beverages attributed to a higher primary and permanent dental caries experience in rural than in urban areas. Dental access was also attributed to the differences between the two areas.

CONCLUSION

Factors at both community and individual levels attributed to the observed differences in child caries prevalence and experience between urban and rural areas.

Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study

Background: The growing immigration to Germany led to more patients whose medical needs are divergent from those of the domestic population. In the field of dental health care there is a debate about how well the German health system is able to meet the resulting challenges. Data on asylum-seekers' dental health is scarce. This work is intended to reduce this data gap. Methods: We conducted this retrospective observational study in Halle (Saale), Germany. We included all persons who were registered with the social welfare office (SWO) in 2015 and received dental treatments. From the medical records, we derived information such as complaints, diagnoses, and treatments. Results: Out of 4107 asylum-seekers, the SWO received a bill for 568 people. On average, there were 1.44 treatment cases (95%-CI: 1.34-1.55) and 2.53 contacts with the dentist per patient (95%-CI: 2.33-2.74). Among those, the majority went to the dentist because of localized (43.2%, 95%-CI: 38.7-47.7) and non-localized pain (32.0%, 95%-CI: 27.8-36.2). The most widespread diagnosis was caries (n = 469, 98.7%, 95%-CI: 97.7-99.7). Conclusion: The utilization of dental care is lower among asylum-seekers than among regularly insured patients. We assume that the low prevalence rates in our data indicate existing access barriers to the German health care system.

Evidence of the effect of rural background on rural practise in Australian dental practitioners: Does gender play a role?

BACKGROUND

People residing outside the capital cities have poorer oral health than their city counterparts. Health workforce shortages and stability issues can have negative health effects on rural populations. There has been an increasing proportion of women entering the dental practitioner workforce in Australia. This study investigated whether dental practitioners who have a rural background are more likely to work in a rural area than those who do not have a rural background; and whether the gender of dental practitioners plays a role.

METHODS

A self-administered questionnaire was sent to a sample of dental practitioners via their professional dental associations. Practice location was assigned as either 'urban' or 'rural' using the Australian Standard Geographical Classification - Remoteness Area categories and measured with demographic characteristics of the respondents. Prevalence ratios (PR) were estimated using Poisson regression with robust standard errors.

RESULTS

Participants with a rural background were more than twice as likely (male PR = 2.23, 95% confidence interval (CI) = 0.79-6.26; female PR = 2.82, 95% CI = 1.35-5.87) to practise in a rural area than those with an urban background.

CONCLUSIONS

Dental practitioners with rural backgrounds were more than twice as likely to work in a rural practice as their urban counterparts.

Views of Australian dental practitioners towards rural recruitment and retention: a descriptive study

Background

Despite an increase in the supply of dental practitioners in Australia in recent years, there remains an unequal distribution of dental practitioners with more dental practitioners working in city areas. This is in part due to difficulties in attracting and retaining dental practitioners to rural practice. The aim of this study was to investigate the attitudes of Australian dental practitioners towards what may attract them to rural areas and why they may remain in them.

Method

A descriptive study, utilising telephone, semi-structured interviews with dental practitioners across Australia. Dental practitioners were recruited through their professional associations. Data were analysed using content and thematic analysis.

Results

Fifty participants; 34 dentists, eight oral health therapists, and eight dental prosthetists working in rural and urban areas of Australia. Four main themes were identified: Business Case: concerns related to income and employment security, Differences in Clinical Practices: differences in clinical treatments and professional work, Community: fitting in and belonging in the area in which you live and work, and Individual Factors: local area provision for lifestyle choices and circumstances. The most influential of these themes were business case and individual factors. Smaller rural areas, due to low populations and being unable to provide individuals with their lifestyle needs were considered unappealing for dental practitioners to live. Previous experience of rural areas was highly influential.

Conclusions

The main factors influencing rural recruitment and retention were income sustainability and employment security, and individual factors. Dental practitioners felt that it was harder to earn a sustainable income and provide quality lifestyles for their family in rural areas. Previous experience of rural areas was influential towards long-term rural retention. These factors should be considered in order to develop effective strategies to address the unequal distribution of dental practitioners.

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 Australia's 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 person's 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.

How readable are Australian paediatric oral health education materials?

BACKGROUND

The objective of this study was to analyse the readability of paediatric oral health education leaflets available in Australia.

METHODS

Forty paediatric oral health education materials were analysed for general readability according to the following parameters: Thoroughness; Textual framework; Terminology; and Readability (Flesch-Kincaid grade level (FKGL), Gunning Fog index (Fog) and Simplified Measure of Gobbledygook (SMOG)).

RESULTS

Leaflets produced by the industry were among the hardest to read with an average readability at the 8th grade (8.4 ± 0.1). The readability of leaflets produced by the commercial sector was at the 7th grade (7.1 ± 1.7) and the government at the 6th grade (6.3 ± 1.9). The FKGL consistently yielded readabilities 2 grades below the Fog and SMOG indexes. In the content analyses, 14 essential paediatric oral health topics were noted and Early Childhood Caries (ECC) was identified as the most commonly used jargon term.

CONCLUSION

Paediatric oral health education materials are readily available, yet their quality and readability vary widely and may be difficult to read for disadvantaged populations in Australia. A redesign of these leaflets while taking literacy into consideration is suggested.

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.