Oral health in rural and remote Western Australian Indigenous communities: A two-year retrospective analysis of 999 people

Special needs dentistry in multidisciplinary head and neck cancer management - characterizing scope and complexity of patient care

AIMS

To describe the involvement and need for specialists in special needs dentistry (SND) in the multidisciplinary management of patients and to characterize the complexity of patients with special health care needs.

METHODS

Referrals for SND review from the Fiona Stanley Hospital head and neck cancer (HNC) multidisciplinary team between January 1 and December 31, 2019 were screened. Data recorded included demographic information, medical history, dental status, and dental treatment provided prior to HNC management.

RESULTS

In total 127 patients were referred to the SND clinic in 2019 of which 89.0% were males and 74.8% were aged 50-79. The mean waiting time for SND review was 19.6 days. On average patients had a decayed, missing, filled tooth (DMFT) score of 20.3. During the study period 407 extractions and 30 restorations were completed. Seventeen patients (13.4%) had all their teeth removed prior to HNC management. The majority of patients (79.6%) were categorized as either moderate or severe complexity. Increasing complexity was seen in older age groups.

CONCLUSIONS

Significant oral disease is seen in patients with HNC often requiring extensive dental treatment. Complexity is seen in patients requiring multidisciplinary care however characteristics that constitute complexity are varied given the spectrum encompassing 'special needs'.

Association between lack of dental service utilisation and caregiver-reported caries in Australian Indigenous children: A national survey

AIM

To investigate the association between the lack of dental service utilisation and dental caries in Australian Indigenous children.

METHODS

Data from the Longitudinal Study of Indigenous Children, which is a longitudinal population-based cross-sectional study in Australia were analysed. A total of 1258 children were included, consisting of the baby cohort and the child cohort at Wave 7. Logistic regression analysis was conducted to examine the association between caregiver-reported child dental caries and dental service utilisation. Multiple imputation using the fully conditional specifications approach was used to account for missing data.

RESULTS

Around one tenth (12.3%) of Indigenous children did not see a dentist when required. Lack of dental service utilisation was associated with an increased likelihood of caregiver-reported dental caries (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.5-3.8) and teeth removed due to dental caries (OR 2.3; 95% CI 1.1-4.7). These associations remained after adjusting for confounders (caregiver-reported dental caries OR 2.3; 95% CI 1.3-3.8; teeth removed due to dental caries OR 2.1; 95% CI 1.0-4.4). The reasons reported for not utilising dental services when required were the lack of an available dentist (31.4%), difficulties with physical access (19.8%), long waiting times (13.9%), financial issues with cost (5.8%) and feeling that 'they could cope' (4.6%).

CONCLUSIONS

Lack of dental service utilisation was associated with dental caries and extraction due to caries in Australian Indigenous children.

Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: A cross-sectional household-based survey

BACKGROUND

Tooth loss is an oral health condition with high prevalence and negative impact on quality of life. It is the result of the history of oral diseases and their treatment as well as provision of dental care and access to dental services. Socioeconomic characteristics are determinants of tooth loss and living in rural areas is also a risk factor for its incidence.

OBJECTIVE

To identify contextual and individual factors associated with self-reported tooth loss among adults and elderly people living in rural riverside areas.

METHODS

A cross-sectional household-based survey was conducted in 2019 with rural riverside communities on the left bank of the Rio Negro River, Manaus, Amazonas. These communities are covered by a fluvial health team and two riverside health teams. Interviews were conducted in a representative random sample of dwellers aged ≥ 18 years, using electronic forms to obtain information on oral health conditions, demographic and socioeconomic characteristics, and use of and access to health services. The outcome was self-reported tooth loss. After the descriptive analysis of the data, a multilevel Poisson regression analysis was performed to estimate the prevalence ratio for the outcome. Variables with p-value ≤0.20 in the bivariate analyses were included in the multiple analysis considering the hierarchy between individual and contextual variables in the multilevel model. Variables with p-value ≤0.10 were kept in the final model and the significance level adopted was 0.05.

RESULTS

603 individuals from 357 households were assessed (mean age 44.1 years). The average number of missing teeth was 11.2 (±11.6); 27.4% of individuals had lost more than 20 teeth (non-functional dentition) and 12.1% were completely edentulous. Contextual characteristic of primary healthcare offered was associated with the outcome. The tooth loss was lower in territories covered by riverside health teams. At individual level, tooth loss was greater in older individuals who had experienced dental pain over the past six months and whose sugar consumption was high. Black or brown individuals, individuals whose household income was higher, those who were on the Bolsa Família cash transfer program, those who consulted a dentist over the past year, and those who reported satisfaction with their teeth/oral health reported less tooth loss.

CONCLUSION

Tooth loss was associated with contextual territorial factors related to the healthcare service and individual demographic, behavioral, socioeconomic, and service-related characteristics as well as self-perceived oral health conditions. The findings suggest that actions focused on the oral health of these populations involve not only changes in the healthcare service organization, but also intersectoral policies that contribute to reducing social inequalities.

"Does this dental mob do eyes too?": perceptions and attitudes toward dental services among Aboriginal Australian adults living in remote Kimberley communities

BACKGROUND

Australian Aboriginal and Torres Strait Islander people continue to experience significant disparities in oral health and there remains an urgent need to improve services to rural and remote communities. Quantitative research has typically been used to highlight the disease burden and severity experienced by those living in remote communities, but this data does little to explore the lived reality and psychosocial nuances that impact on care. The Kimberley region of Western Australia is home to over 150 Aboriginal communities spread out across 400,000 square kilometres. The success and sustainability of oral health services to these remote communities relies on respect and reciprocity achieved through shared knowledge, decision making and involvement of Aboriginal people in discussions around oral health services and their delivery. This, study aimed to investigate the perceptions and attitudes toward dental services among Aboriginal Australian families living in remote Kimberley communities.

METHODS

Semi-structured interviews and yarning circles were carried out following purposive sampling of Aboriginal adults living in the East Kimberley region of Western Australia. Interviews were recorded, transcribed, and analysed guided by a constructivist grounded theory approach.

RESULTS

In total, 80 community members participated in the yarning process. Enablers to care included: promotion of existing services, integration with primary health services, using mobile dental services and volunteers to extend care. Barriers to care included transportation, cost of treatment, the complexity of appointment systems and shame associated with health-seeking behaviours.

CONCLUSIONS

Reassessing the prevailing operative model of dental care to remote Aboriginal communities is warranted to better address the overwhelming structural barriers that impact on oral health. Integration with existing primary health services and schools, the use of mobile units to extend care and increasing community engagement through clinical yarning are recommended in improving the current state of dental services to communities in the Kimberley.

Associations between dental care approachability and dental attendance among women pregnant with an Indigenous child: a cross-sectional study

Background

Oral health during pregnancy is vital for both mother and child. Indigenous Australians face many barriers in accessing dental care. Service approachability is one of the key domains in accessing health services. There is little empirical evidence of the association between service approachability and dental care attendance or oral health outcome. The aim of this study is to examine the relationship between dental service approachability on dental care attendance and self-reported gum disease among South Australian women pregnant with an Aboriginal child.

Methods

Four hundred and twenty-seven women pregnant with an Aboriginal child completed questionnaires in both metropolitan and regional health settings in South Australia in 2011. Four variables related to approachability of dental services: (1) perception of need; (2) service-related health literacy; (3) oral health beliefs and; (4) trust and expectation of dental service. The association between service approachability-related factors, dental utilisation and self-reported gum disease during pregnancy were assessed using Generalised Poisson regression models, after adjusting for age, remoteness, employment status and education. Estimates were presented as adjusted prevalence ratios (APR).

Results

Most participants (85.8%) reported a need for dental care, had positive oral health beliefs (88.3%) and had expectations towards dental care (86.2%). Dental service utilisation during pregnancy was low (35.7%). Many participants (78.0%) expressed knowing what to do if they needed dental care, while most (39.8%) doubted that dental care would be available the next day. Poor health service literacy was identified as a risk factor for non-optimal dental attendance (APR = 0.86, 95%CI 0.74–0.99). Perceived need for dental care was positively associated with self-reported gum disease (APR = 1.24, 95%CI 1.06–1.45).

Conclusion

Inability to navigate the dental care system was a risk factor for poor dental attendance among South Australian women pregnant with an Aboriginal child. Perceived need for dental care was associated with gum disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01816-5.

Cross-sectional analysis of dental treatment under general anaesthesia in hospitalised Western Australian children in 2018-19

Objective To date, there has been little research that has comprehensively analysed dental treatment under general anaesthesia (DGA) at Perth Children's Hospital (PCH) for dental emergencies (dental pain and sepsis). This cross-sectional descriptive analysis of the PCH dental department analysed the demographic of children admitted and the type of treatment used, and assessed the cost. Methods This was a retrospective descriptive study analysing the dental records of patients ranging from 2 to 16 years of age at PCH in Western Australia. Of the 310 cases randomly selected from the 2018-19 study period, 202 were admitted for DGA. Two outcome measures were derived: cumulative count of treatment mix and cost analysis. Results The mean (±s.d.) age at the time of admission was 6.2±2.6 years and the mean (±s.d.) decayed (d/D), missing, (m/M) and filled (f/F) teeth (dmft/DMFT) was 2.1±0.8. Of the 429 teeth affected, 282 were molars. Treatments were grouped therapeutically; of the 856 treatments performed, 465 were extractions (54%). The total cost, consisting of direct and indirect costs, was A$313823, and equated to an approximate mean (±s.d.) of A$1554±109 per case. Conclusion Untreated dental caries was the most common cause for hospital admission. Most cases presenting at the emergency department were young children (<7 years old) who underwent extractions under DGA. What is known about the topic? The Child Dental Benefits Schedule (CDBS) was introduced to improve access and affordability to oral health care for children without private dental insurance. However, a significant number of children are still being admitted to hospital for emergency dental treatment. What does this paper add? Despite the availability of the CDBS, untreated dental caries remains one of the most common reasons for dental emergency in the PCH. What are the implications for practitioners? Not only are direct costs a burden on the health budget, but indirect and intangible costs also affect children and their families.

Oral health of aboriginal people with kidney disease living in Central Australia

BACKGROUND

Associations between kidney disease and periodontal disease are not well documented among Aboriginal people of Australia. The purpose of this investigation was to report and compare demographic, oral health, anthropometric and systemic health status of Aboriginal Australians with kidney disease and to compare against relevant Aboriginal Australians and Australian population estimates. This provides much needed evidence to inform dental health service provision policies for Aboriginal Australians with kidney disease.

METHODS

Sample frequencies and means were assessed in adults represented in six datasets including: (1) 102 Aboriginal Australians with kidney disease residing in Central Australia who participated in a detailed oral health assessment; (2) 312 Aboriginal participants of the Northern Territory's PerioCardio study; (3) weighted estimates from 4775 participants from Australia's National Survey of Adult Oral Health (NSAOH); (4) Australian 2016 Census (all Australians); (5) National Health Survey 2017-2018 (all Australians) and; (6) Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-2012 (all Australians). Oral health status was described by periodontal disease and experience of dental caries (tooth decay). Statistically significant differences were determined via non-overlapping 95% confidence intervals.

RESULTS

Aboriginal Australians with kidney disease were significantly older, less likely to have a tertiary qualification or be employed compared with both PerioCardio study counterparts and NSAOH participants. Severe periodontitis was found in 54.3% of Aboriginal Australians with kidney disease, almost 20 times the 2.8% reported in NSAOH. A higher proportion of Aboriginal Australians with kidney disease had teeth with untreated caries and fewer dental restorations when compared to NSAOH participants. The extent of periodontal attachment loss and periodontal pocketing among Aboriginal Australians with kidney disease (51.0%, 21.4% respectively) was several magnitudes greater than PerioCardio study (22.0%, 12.3% respectively) and NSAOH (5.4%, 1.3% respectively) estimates.

CONCLUSIONS

Aboriginal Australians with kidney disease exhibited more indicators of poorer oral health than both the general Australian population and a general Aboriginal population from Australia's Northern Territory. It is imperative that management of oral health among Aboriginal Australians with kidney disease be included as part of their ongoing medical care.

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.

Factors influencing the perceived importance of oral health within a rural Aboriginal and Torres Strait Islander community in Australia

BACKGROUND

Indigenous Australians suffer from higher rates of oral disease and have more untreated dental problems and tooth extractions than the general population. Indigenous Australians also have lower rates of accessing oral health services and are more likely to visit for a problem rather than a check-up. Multiple issues effect health service and prevention programs including: characteristics of health services such as distances to health services; existence of social and cultural barriers; available wealth and social support; and, characteristics of the individual and community including the importance given to the disease. This paper seeks to explore the perceived importance of oral health within a rural Indigenous community in Australia and the factors influencing this perception.

METHODS

The study used a phenomenology research design incorporating focus group discussions and in-depth interviews. It was undertaken in partnership with communities' Health Action Group who guided the focus, implementation and reporting of the research. A convenience sample was recruited from established community groups. Thematic analysis on the transcripts was completed.

RESULTS

Twenty-seven community members participated in three focus groups and twelve in-depth interviews. The study found that the community gives high priority to oral health. Factors influencing the importance include: the perceived severity of symptoms of oral disease such as pain experienced due to tooth ache; lack of enabling resources such as access to finance and transport; the social impact of oral disease on individuals including impact on their personal appearance and self-esteem; and health beliefs including oral health awareness. Participants also noted that the importance given to oral health within the community competed with the occurrence of multiple health concerns and family responsibilities.

CONCLUSION

This paper highlights the high importance this rural Indigenous community gives to oral health. Its findings suggest that under-utilisation of oral health services is influenced by both major barriers faced in accessing oral health services; and the number and severity of competing health and social concerns within the community. The study results confirm the importance of establishing affordable, culturally appropriate, community-based oral health care services to improve the oral health of rural Indigenous communities.

Oral health interventions in Australian Aboriginal communities: a review of the literature

Aboriginal Australians experience significant disparities in oral health with even poorer outcomes reported in rural and remote areas. The high rates of preventable dental disease in Aboriginal communities are a serious concern from a social standpoint and in terms of service provision and health care expenditure. In this review, primary research literature was comprehensively reviewed. Papers were selected if they reported designing or implementing an intervention or oral health programme specific to the needs of Aboriginal communities. Twenty-one publications fulfilled the inclusion criteria with 19 different interventions being described. Interventions were categorized using a classification adapted from the work of Whitehead (2002). The review identified interventions that aimed to reduce early childhood caries, increase services to remote communities, develop the role of Aboriginal health workers, improve oral health literacy, establish water fluoridation and provide periodontal therapy. Implementing successful oral health interventions in Aboriginal communities is a challenge that is compounded by the complex interplay between psychosocial and cultural determinants. Even interventions that follow a rigorous and consultative design have a high failure rate in Aboriginal communities if upstream determinants of health are not adequately understood and addressed.

Caries and periodontal disease in Indigenous adults in Australia: a case of limited and non-contemporary data

Objective The aim of the present study was to identify all evidence about the prevalence and severity of clinically measured caries and periodontal disease in Indigenous adults in Australia published in peer-reviewed journals and to summarise trends over time. In addition, we examined whether the studies investigated associations between putative risk factors and levels of caries and periodontal disease. Methods PubMed was searched in September 2014, with no date limitations, for published peer-reviewed articles reporting the prevalence rates and/or severity of caries and periodontal disease in Indigenous adults living in Australia. Articles were excluded if measurement was not based on clinical assessment and if oral disease was reported only in a specific or targeted sample, and not the general population. Results The search identified 18 papers (reporting on 10 primary studies) that met the inclusion criteria. The studies published clinical data about dental caries and/or periodontal disease in Australian Indigenous adults. The studies reported on oral health for Indigenous adults living in rural (40%), urban (10%) and both urban and rural (50%) locations. Included studies showed that virtually all Indigenous adults living in rural locations had periodontal disease. The data also showed caries prevalence ranged from 46% to 93%. Although 10 studies were identified, the peer-reviewed literature was extremely limited and no published studies were identified that provided statistics for a significant proportion of Australia (Victoria, Tasmania, Queensland or the Australian Capital Territory). There were also inconsistencies in how the data were reported between studies, making comparisons difficult. Conclusions This review highlights a lack of robust and contemporary data to inform the development of policies and programs to address the disparities in oral health in Indigenous populations living in many parts of Australia. What is known about the topic? Many studies report that Indigenous people in Australia have poorer general health compared with non-Indigenous people. What does this paper add? This paper documents the available caries and periodontal disease prevalence and experience for Indigenous adults in Australia published in peer-reviewed journals. It demonstrates significant limitations in the data, including no data in several large Australian jurisdictions, inconsistency with reporting methods and most data available being for Indigenous adults living in rural locations. Therefore, the oral health data available in the peer-reviewed literature do not reflect the situation of all Indigenous people living in Australia. What are the implications for practitioners? It is important for oral health practitioners to have access to current and relevant statistics on the oral health of Indigenous Australians. However, we have highlighted significant evidence gaps for this population group within the peer-reviewed literature and identified the limitations of the available data upon which decisions are currently being made. This paper also identifies ways to capture and report oral health data in the future to enable more meaningful comparisons and relevance for use in policy development.

Aboriginal and Torres Strait Islander oral health and its impact among adults: A cross-sectional study

BACKGROUND

Robust oral health epidemiological information for Aboriginal and Torres Strait Islander adults is scant. Set within a large urban population, this study describes self-reported oral health behaviours, status and impact assessed through computerized health checks (HC), stratified by age groups and sex, and identifies associations with dental appearance satisfaction.

METHODS

This was a cross-sectional study of Aboriginal and Torres Strait Islander adults (aged ≥20 years) attending the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care between 1 January 2014 and 31 December 2015 who had HC and provided research consent.

RESULTS

There were 945 patients, 466 (49.3%) female, with an average age of 41.3 years (range, 20-82). Overall, 97.3% owned a toothbrush and 56.2% brushed two or more times/day. Despite self-reporting a significant oral health burden, only 28.8% visited a dentist within 12 months, mostly due to problems (84.3%). Surprisingly, only 28.4% reported dental appearance dissatisfaction, likely a result of community normalization whereby people are resigned to poor oral health.

CONCLUSIONS

Under-utilization of dental services remains problematic for Aboriginal and Torres Strait Islander adults. To close the oral heath gap, culturally appropriate, acceptable and safe integrated primary health systems, with co-located dental services, demand consideration.

Oral Health Status and Treatment Needs of Paniya Tribes in Kerala

INTRODUCTION

The tribal communities of Kerala have been largely left out of the gains of the Kerala model of development.

AIM

The study was aimed to obtain baseline data of oral health status and treatment needs of Paniyas, in Kerala, India.

MATERIALS AND METHODS

A descriptive population based survey of adult Paniya belonging to index age groups of 35-44 years and 65-74 years was conducted. The study population comprised of 420 subjects drawn from three talukas by stratified cluster sampling. Modified version of WHO Oral Health Assessment Form (1997) was used to assess the oral health status.

RESULTS

Caries prevalence was 40%. The mean DMFT in the 35-44 years age group was 1.52±1.95 and in 65-74 age group it was 18.47 ± 13.10. Oral mucosal lesions were seen in 4.52% and 76.9% had periodontal disease. Tooth brushing was reported by 55.5% of the subjects. Paan chewing, with tobacco or without tobacco, habit was reported by 89.3%. Bi-variate analyses between the CPI scores and age groups showed high statistical significance. The maximum mean treatment requirement was for extraction (1.37 ± 4.01) and was observed in 65-74 age groups.

CONCLUSION

The lack of basic oral health care access is important for high oral disease burden in these populations. Efforts are to be done for basic oral health care facility to these marginal populations.

An assessment of dental caries among young Aboriginal children in New South Wales, Australia: a cross-sectional study

BACKGROUND

Limited research has been undertaken in Australia to assess the dental status of pre-school Aboriginal children. This cross-sectional study records the number of decayed, missing and filled teeth (dmft) and surfaces (dmfs) of pre-school Aboriginal children living in different locations in New South Wales (NSW), Australia.

METHODS

A convenience sample of young children from seven Aboriginal communities in rural, remote and metropolitan areas of NSW, was recruited. One calibrated examiner recorded the dmft/s of children with written parental consent.

RESULTS

196 children were invited to participate and 173 children aged two to five years were examined, a response rate of 88.3%. Forty percent (n = 69) of the children were diagnosed with dental caries with a mean of 2.1 (SD = 3.6). The dmft scores were significantly higher in remote locations when compared to rural (p = <0.0001) and metropolitan areas (p = 0.0155). Children 4-5 years old living in remote NSW had a mean dmft of 3.5 and mean dmfs of 8.0 compared with children living in rural areas who had a dmft and dmfs of 1.5 and 4.2 respectively. Untreated dental caries was the primary contributor to the scores, and children who had previously received dental treatment still had active carious lesions.

CONCLUSION

There was a high prevalence of untreated dental caries among the Aboriginal children, particularly for those in remote locations.

Disparities in dental insurance coverage among hospitalised Western Australian children

OBJECTIVES

We sought to understand disparities in dental insurance coverage among hospitalised Western Australian children and associated factors.

METHODS

This study analysed the data obtained for 43,937 child patients under the age of 15 years hospitalised for an oral-health related condition, as determined by principal diagnosis (ICD-10AM). Primary place of residency, age, gender, Indigenous status and socioeconomic status were also analysed.

RESULTS

Of our sample, 47.3% reported lack of dental insurance coverage. Non-Indigenous children were more likely to have dental insurance than Indigenous children. When insurance status was considered, Indigenous children were less likely to be hospitalised for dental treatment. Rural children were more likely to be uninsured than urban children. Lack of health insurance coverage was strongly associated with children living in very remote areas. These disparities were exacerbated among rural indigenous children. Disparities in dental insurance coverage and dental care are also evident by socioeconomic status.

CONCLUSIONS

Better understanding of disparities in access to care among children, socioeconomic divide in oral health insurance coverage and subsequent development of intervention programmes, will be critical to improving Australian children's oral health.

A dental public health approach based on computational mathematics: Monte Carlo simulation of childhood dental decay

This study developed a Monte Carlo simulation approach to examining the prevalence and incidence of dental decay using Australian children as a test environment. Monte Carlo simulation has been used for a half a century in particle physics (and elsewhere); put simply, it is the probability for various population-level outcomes seeded randomly to drive the production of individual level data. A total of five runs of the simulation model for all 275,000 12-year-olds in Australia were completed based on 2005-2006 data. Measured on average decayed/missing/filled teeth (DMFT) and DMFT of highest 10% of sample (Sic10) the runs did not differ from each other by more than 2% and the outcome was within 5% of the reported sampled population data. The simulations rested on the population probabilities that are known to be strongly linked to dental decay, namely, socio-economic status and Indigenous heritage. Testing the simulated population found DMFT of all cases where DMFT<>0 was 2.3 (n = 128,609) and DMFT for Indigenous cases only was 1.9 (n = 13,749). In the simulation population the Sic25 was 3.3 (n = 68,750). Monte Carlo simulations were created in particle physics as a computational mathematical approach to unknown individual-level effects by resting a simulation on known population-level probabilities. In this study a Monte Carlo simulation approach to childhood dental decay was built, tested and validated.

A phase II clinical trial of a dental health education program delivered by aboriginal health workers to prevent early childhood caries

Background

Early Childhood Caries (ECC) is a widespread problem in Australian Aboriginal communities causing severe pain and sepsis. In addition dental services are difficult to access for many Aboriginal children and trying to obtain care can be stressful for the parents. The control of dental caries has been identified as a key indictor in the reduction of Indigenous disadvantage. Thus, there is a need for new approaches to prevent ECC, which reflect the cultural norms of Aboriginal communities.

Methods/Design

This is a Phase II single arm trial designed to gather information on the effectiveness of a dental health education program for Aboriginal children aged 6 months, followed over 2 years. The program will deliver advice from Aboriginal Health Workers on tooth brushing, diet and the use of fluoride toothpaste to Aboriginal families. Six waves of data collection will be conducted to enable estimates of change in parental knowledge and their views on the acceptability of the program. The Aboriginal Health Workers will also be interviewed to record their views on the acceptability and program feasibility. Clinical data on the child participants will be recorded when they are 30 months old and compared with a reference population of similar children when the study began. Latent variable modeling will be used to interpret the intervention effects on disease outcome.

Discussion

The research project will identify barriers to the implementation of a family centered Aboriginal oral health strategy, as well as the development of evidence to assist in the planning of a Phase III cluster randomized study.

Trial registration

ACTRN12612000712808