Crossbow Injuries: Predictors of Mortality

INTRODUCTION

Crossbow injuries are rare but carry significant morbidity and mortality, and there is limited evidence in the medical literature to guide care. This paper reviews the case reports and case series of crossbow injuries and looks for trends regarding morbidity and mortality based on the type of arrow, anatomic location of injury, and intent of injury.

METHODS

Multiple databases were searched for cases of crossbow injuries and data were abstracted into a spreadsheet. Statistics were done in SPSS.

RESULTS

358 manuscripts were returned in the search. After deduplication and removal of nonclinical articles, 101 manuscripts remained. Seventy-one articles describing 90 incidents met the inclusion criteria. The mean age was 36.5 years. There were 10 female and 79 male victims. Fatality was 36% for injuries by field tip arrows and 71% for broadhead arrows, p  =  .024. Assaults were fatal in 84% of cases, suicides in 29%, and accidental injuries in 17%, p < .001. Mortality was similar for wounds to the head and neck (41%), chest (42%), abdomen (33%), extremities (50%), and multiple regions, p  =  .618.

CONCLUSIONS

Crossbows are potentially lethal weapons sold with fewer restrictions than firearms. Injuries caused by broadhead arrows are more likely to be fatal than injuries from field tip arrows. The anatomic location of injury does not correlate with fatality. More than half of crossbow injuries are due to attempted suicide, with a high case-fatality rate.

Early Childhood Exposures to Fluorides and Child Behavioral Development and Executive Function: A Population-Based Longitudinal Study

It is important to both protect the healthy development and maintain the oral health of the child population. The study examined the effect of early childhood exposures to water fluoridation on measures of school-age executive functioning and emotional and behavioral development in a population-based sample. This longitudinal follow-up study used information from Australia's National Child Oral Health Study 2012-14. Children aged 5 to 10 y at baseline were contacted again after 7 to 8 y, before they had turned 18 y of age. Percent lifetime exposed to fluoridated water (%LEFW) from birth to the age 5 y was estimated from residential history and postcode-level fluoride levels in public tap water. Measures of children's emotional and behavioral development were assessed by the Strength and Difficulties Questionnaire (SDQ), and executive functioning was measured by the Behavior Rating Inventory of Executive Function (BRIEF). Multivariable regression models were generated to compare the associations between the exposure and the primary outcomes and controlled for covariates. An equivalence test was also conducted to compare the primary outcomes of those who had 100% LEFW against those with 0% LEFW. Sensitivity analysis was also conducted. A total of 2,682 children completed the SDQ and BRIEF, with mean scores of 7.0 (95% confidence interval, 6.6-7.4) and 45.3 (44.7-45.8), respectively. Those with lower %LEFW tended to have poorer scores of the SDQ and BRIEF. Multivariable regression models reported no association between exposure to fluoridated water and the SDQ and BRIEF scores. Low household income, identifying as Indigenous, and having a neurodevelopmental diagnosis were associated with poorer SDQ/BRIEF scores. An equivalence test confirmed that the SDQ/BRIEF scores among those with 100% LEFW were equivalent to that of those who had 0% LEFW. Exposure to fluoridated water during the first 5 y of life was not associated with altered measures of child emotional and behavioral development and executive functioning.

Oral health-related self-efficacy and fatalism in a regional South Australian Aboriginal population

OBJECTIVES

To assess the psychometric properties, including face, content, criterion and known-groups validity and reliability, of scales to measure oral health-related self-efficacy and fatalism in a regional Aboriginal adult population in Australia.

METHODS

Four hundred Aboriginal adults (aged 18-82 years, 67% female) completed a self-report questionnaire including items pertaining to oral health-related self-efficacy and fatalism. Structural validity was determined in exploratory factor analysis (EFA) with principal components analysis for each scale. Criterion validity was assessed between the instruments and theoretically related variables. Known-groups validity was investigated by comparing the scores in different population groups according to age, sex, education and employment. Reliability of the scales was assessed through internal consistency.

RESULTS

The EFA confirmed a single factor structure for self-efficacy and fatalism scales, with Cronbach's alphas of 0.93 and 0.89 respectively. The two scales were not correlated. Oral health-related self-efficacy was associated with toothbrush ownership and brushing the previous day supporting criterion validity. Oral health-related fatalism was associated with previous extractions and perceived need for extractions also supporting criterion validity. Both measures were associated with social impact of oral health as measured by the OHIP-14, supporting their criterion validity. Mixed findings were observed in terms of known-groups validity.

CONCLUSIONS

There was initial evidence that measures of oral health-related self-efficacy and fatalism displayed adequate psychometric properties in this Aboriginal community. These constructs could have implications for approaches for improving oral health among Aboriginal people.

Self-rated oral and general health among Aboriginal adults in regional South Australia

BACKGROUND

In Australia, Aboriginal adults experience higher levels of poor oral and general health than the non-Aboriginal population. This study compared self-rated oral and general health among Aboriginal adults in regional South Australia with participants in the National Survey of Adult Oral Health (NSAOH).

METHODS

Data were obtained from the Indigenous Oral Health Literacy Project (IOHLP) based in South Australia. Three sub-populations from the NSAOH were utilised for comparison: National Aboriginal, National non-Aboriginal and South Australian Regional Non-Aboriginal adults. All data were standardised by age group and sex, utilising Census data.

RESULTS

Just over 70% of South Australian Regional Aboriginal participants gave a rating of 'excellent, very good or good' for general health, more than 17% lower than each of the other groups. Just over 50% rated their oral health highly, 20% fewer than the proportion for each other group. Stratifying by key socio-demographic factors did not account for all differences.

CONCLUSIONS

Proportionally fewer South Australian Regional Aboriginal adults had high ratings of oral and general health than the Aboriginal and non-Aboriginal adults from the national survey, indicating that national-level data might underestimate the proportion of regional Aboriginal Australians with poor oral health.

Excess Risk of Dental Caries from Higher Free Sugars Intake Combined with Low Exposure to Water Fluoridation

The study aimed to quantify the excess risk of interaction between high free sugars (sugars) intake and lack of exposure to water fluoridation on child dental caries. Data from the Australian National Child Oral Health Study, a population-based survey of 24,664 children aged 5 to 14 y, were collected using parental questionnaires and oral epidemiological examinations by trained examiners. Information on socioeconomic status, dental health behaviors, and dental service use was used as covariates. The number of servings of sugars-containing foods and drinks consumed in a usual day was assessed as the main exposure, categorized into 5 groups. Residential history was used to calculate lifetime exposure to fluoridated water (LEFW), categorized as low (<25%), medium (25% to <75%), or high (75%-100%). Caries prevalence (dmfs/DMFS >0) and experience (dmfs/DMFS) in the primary (ages 5-10 y) and permanent (ages 8-14 y) dentitions were the main dependent variables. The association of sugars intake and LEFW with each outcome was estimated in multivariable log-Poisson regression models with robust standard error estimation, adjusted for covariates. The relative excess risk due to interaction (RERI) between sugars intake and LEFW was estimated. Strong positive gradients in all outcomes were observed across sugars intake groups. Relative to the lowest intake group, the 3 highest intake groups had significantly higher adjusted prevalence ratios for having caries and higher adjusted mean ratios of caries experience in both dentitions, after controlling for all covariates. LEFW strongly and consistently attenuated the effects of all levels of sugars intake on the outcomes. RERI estimates indicated that a combination of lack of exposure to fluoridated water and high sugars intake resulted in greater excess risk of primary and permanent caries than if there was no interaction. Evidently, children with high sugars intakes and low exposure to water fluoridation are at disproportionately higher risk of dental caries.

A Causative Approach to Demographic and Socioeconomic Factors Affecting Parental Ratings of Child Oral Health

INTRODUCTION

Many studies have investigated associations between demographic, socioeconomic status (SES), behavioral, and clinical factors and parental ratings of child oral health. Caries experience, pain, missing teeth, malocclusions, and conditions and treatments likely to negatively affect the child or family in the future have been consistently associated with poorer parental ratings. In contrast, effect sizes for associations between demographic and SES indicators (race/ethnicity, country of birth, family structure, household income, employment status, and parental education levels) and parental ratings vary greatly.

OBJECTIVES

The primary objectives of this study were to estimate effect sizes for associations between demographic and SES variables and parental ratings of child oral health and then to consider possible causal implications.

METHODS

This article uses a nationally representative data set from 24,664 Australian children aged 5 to 14 y, regression analyses guided by a directed acyclic graph causal model, and sensitivity analyses to investigate effects of demographic and SES factors on parental ratings of oral health.

RESULTS

One in 8 children had oral health rated as fair or poor by a parent. Indigenous children, older boys, young children with a migrant parent, children from single-parent families, low-income households and families where no parent worked full-time, and children whose parents had lower education levels were much more likely to receive a fair or poor parental oral health rating in crude and adjusted models.

CONCLUSION

This cross-sectional study helps to clarify inconsistent findings from previous research and shows many demographic and SES variables to be strong determinants of parental ratings of child oral health, consistent with the effects of these variables on other health outcomes. Sensitivity analyses and consideration of the potential for chance and bias to have affected these findings suggest that many of these associations may be causal.

KNOWLEDGE TRANSFER STATEMENT

Based on regression analyses driven by a directed acyclic graph causal model, this research shows a strong impact of demographic and socioeconomic determinants on parental ratings of child oral health, consistent with associations between these variables and other oral and general health outcomes. Many of these associations may be causal. We demonstrate the value of causal models and causal thinking when analyzing complex multilevel observational data.

Private Dental Care Benefits Non-Indigenous Children More Than Indigenous Children

INTRODUCTION

Various arrangements for funding health care facilities can have different levels of performance of care provision on different groups of people. Such differential performance of oral care is not previously known concerning Indigenous communities.

OBJECTIVE

This study aimed to assess the effect of visiting a public or private dental care facility on the performance of oral care experienced by Indigenous versus non-Indigenous children in Australia.

METHODS

Data from the National Child Oral Health Survey were used with a representative sample of children from all the states and territories of Australia. The performance of oral care was measured with the Child Oral Care Performance Assessment Scale (COPAS), which contains 37 items from 9 domains (Effective, Appropriate, Efficient, Responsive, Accessible, Safe, Continuous, Capable, and Sustainable) with a score ranging from 0 to 148. Mixed effects models that accounted for stratum and sampling weights were used for the stratified analyses (Indigenous vs. non-Indigenous) that assessed the effect of public versus private care on the COPAS. Relative excess risk due to interaction was calculated to assess effect modification.

RESULTS

Among the Indigenous children, private care was similar to public care (regression coefficient [RC] = -1.27, 95% CI = -9.5 to 6.97), whereas private care was higher than public care among non-Indigenous children (RC = 4.60, 95% CI = 3.67 to 6.18). This trend was similar among the 9 domains of the COPAS as well, except for Effectiveness, which was similar for private and public facilities among non-Indigenous children (RC = -0.03, 95% CI = -0.29 to 0.23). Based on the continuous COPAS score, effect modification was 4.46 (95% CI = 0.11 to 8.82) on the additive scale and 1.06 (1.01, 1.13) on the multiplicative scale. The relative excess risk due to interaction reported an excess chance of 1.17 (95% CI = 0.01 to 0.33), which was consistent with the stratified analyses and effect modification measured with the continuous score.

CONCLUSION

Thus, this study found a higher performance of oral care in private care locations among non-Indigenous children versus Indigenous children.

KNOWLEDGE TRANSFER STATEMENT

The findings caution policy makers and other stakeholders that moving oral care from public to private care facilities can increase the inequity faced by Indigenous children in Australia.

Fluoridated Water Modifies the Effect of Breastfeeding on Dental Caries

Breastfeeding is important for health and development. Yet, the interaction between breastfeeding duration and usage of fluoridated water on caries experience has not been investigated. This study examined exposure to fluoridation as an effect modifier of the association between breastfeeding duration and caries. The 2012 to 2014 national population-based study of Australian children involved parental questionnaires and oral epidemiological assessment. Children were grouped by parent-reported breastfeeding duration into minimal (none or <1 mo), breastfed for 1 to <6 mo, breastfed for 6 to 24 mo, and sustained (>24 mo). Residential history and main water source used for the first 2 y of life were collected to group children into exposed (WF) and nonexposed (NF) to fluoridation. Socioeconomic status, infant formula feeding, and sugar-sweetened beverage (SSB) consumption data were collected. The prevalence and severity of caries in children aged 5 to 6 y were primary outcomes. Multivariable regression models with robust error estimation were generated to compute prevalence ratios (PRs) and mean ratios (MRs) for 3 breastfeeding groups against the reference (breastfed for 6-24 mo). Of the 5- to 6-y-old children, 2,721 were in the WF and 1,737 were in the NF groups. The groups had comparable distributions of socioeconomic factors, infant formula feeding, and SSB consumption. There were U-shape distributions of caries experience among breastfeeding groups, being more pronounced among NF children. Among NF children, the minimal and sustained breastfeeding groups had significantly higher PR (1.4 [1.1-1.9] and 1.8 [1.4-2.4]) and MR (2.1 [1.4-3.3] and 2.4 [1.4-4.1]) than the reference group. However, among the WF children, this association between breastfeeding duration and caries attenuated after adjustment for other factors. The study contributes evidence of a nonlinear (U-shape) association between breastfeeding duration and dental caries. Early life exposure to fluoridated drinking water attenuated the potential cariogenic effect of both lack of and sustained breastfeeding.

Roles for librarians in systematic reviews: a scoping review

Objective

What roles do librarians and information professionals play in conducting systematic reviews? Librarians are increasingly called upon to be involved in systematic reviews, but no study has considered all the roles librarians can perform. This inventory of existing and emerging roles aids in defining librarians’ systematic reviews services.

Methods

For this scoping review, the authors conducted controlled vocabulary and text-word searches in the PubMed; Library, Information Science & Technology Abstracts; and CINAHL databases. We separately searched for articles published in the Journal of the European Association for Health Information and Libraries, Evidence Based Library and Information Practice, the Journal of the Canadian Heath Libraries Association, and Hypothesis. We also text-word searched Medical Library Association annual meeting poster and paper abstracts.

Results

We identified 18 different roles filled by librarians and other information professionals in conducting systematic reviews from 310 different articles, book chapters, and presented papers and posters. Some roles were well known such as searching, source selection, and teaching. Other less documented roles included planning, question formulation, and peer review. We summarize these different roles and provide an accompanying bibliography of references for in-depth descriptions of these roles.

Conclusion

Librarians play central roles in systematic review teams, including roles that go beyond searching. This scoping review should encourage librarians who are fulfilling roles that are not captured here to document their roles in journal articles and poster and paper presentations.

Restorative treatment for initial, cavitated and gross coronal carious lesions

BACKGROUND

Treatment patterns for caries have been shown to reflect high rates of restorative services. The objective of this study was to investigate types of restorative treatment provided to patients with a main diagnosis of coronal caries in relation to the severity of the caries lesion.

METHODS

A random sample of Australian dentists was surveyed by mailed questionnaires in 2009-2010 (response rate 67%). Data on types of restorative treatment, patient characteristics and main diagnosis were collected from a service log.

RESULTS

Models of service rates adjusted for age, gender, insurance status and reason for visit showed that compared to the reference category of initial caries lesions, there were lower rates [Rate Ratio, 95% CI] of adhesive anterior restorative services [0.57, 0.34-0.95] and lower rates of adhesive posterior restorations [0.56, 0.40-0.79] for gross lesions.

CONCLUSIONS

Treatment of coronal caries was characterized by high rates of adhesive posterior restorative services, but gross lesions had lower rates of both anterior and posterior adhesive restorations. Types of restorative treatment for coronal caries were similar between initial and cavitated lesions. This could indicate scope for the adoption of more minimum intervention approaches to the management of initial carious lesions.

Development of life story experience (LSE) scales for migrant dentists in Australia: a sequential qualitative-quantitative study

INTRODUCTION

The integration of qualitative and quantitative approaches introduces new avenues to bridge strengths, and address weaknesses of both methods.

OBJECTIVE

To develop measure(s) for migrant dentist experiences in Australia through a mixed methods approach.

METHODS

The sequential qualitative-quantitative design involved first the harvesting of data items from qualitative study, followed by a national survey of migrant dentists in Australia. Statements representing unique experiences in migrant dentists' life stories were deployed the survey questionnaire, using a five-point Likert scale. Factor analysis was used to examine component factors.

RESULTS

Eighty-two statements from 51 participants were harvested from the qualitative analysis. A total of 1,022 of 1,977 migrant dentists (response rate 54.5%) returned completed questionnaires. Factor analysis supported an initial eight-factor solution; further scale development and reliability analysis led to five scales with a final list of 38 life story experience (LSE) items. Three scales were based on home country events: health system and general lifestyle concerns (LSE1; 10 items), society and culture (LSE4; 4 items) and career development (LSE5; 4 items). Two scales included migrant experiences in Australia: appreciation towards Australian way of life (LSE2; 13 items) and settlement concerns (LSE3; 7 items).

CONCLUSION

The five life story experience scales provided necessary conceptual clarity and empirical grounding to explore migrant dentist experiences in Australia. Being based on original migrant dentist narrations, these scales have the potential to offer in-depth insights for policy makers and support future research on dentist migration.

Longitudinal Changes in Proportions of Dental Services Provided by Australian Dentists, 1983 to 2010

The objective of the study was to estimate the longitudinal change over a 26-y period in the proportion of dental services provided in 10 main service provision areas by Australian dentists. A random sample of Australian dentists was surveyed approximately every 5 y, commencing 1983 to 1984. The mean proportion of dental services provided was calculated from practitioner activity logs. Mixed effects regression models estimated the longitudinal change in the proportion of services provided, by dentists' age and birth-year cohort. Response rates across data collection waves ranged from 67% to 76%. Between 1983 to 1984 and 2009 to 2010, the mean proportion of diagnostic, preventive, and crown/bridge services provided tended to increase, and the mean proportion of restorative, oral surgery, and prosthodontic services tended to decrease. Mean proportions of endodontic and orthodontic services fluctuated. Relative to the youngest cohort (born after 1984), across cohorts of older to younger dentists, the proportions of diagnostic and preventive services increased, and restorative and prosthodontic decreased. Older cohorts provided the lowest proportions of diagnostic and preventive services (oldest cohort born before 1918: β = -32.1 ± 4.8; cohort born 1934 to 1938: β = -11.6 ± 3.2, respectively). Older cohorts provided the highest proportions of restorative and prosthodontic services (born before 1918: β = 27.3 ± 5.6; born 1919 to 1923: β = 10.5 ± 2.4, respectively). Some service area trends varied across birth-year cohorts. Endodontic service provision was declining for younger cohorts but increasing for older cohorts. Preventive service provision was increasing for younger cohorts but declining for older cohorts. This study identified trends not evident in previous time-series analysis. First, provision of restorative and oral surgery services, as a proportion of all services provided, was declining. Second, there were competing intercohort trends. These may indicate that new norms in dental education are influencing clinical decision making and that new trends in dental service provision may emerge as older dentists retire. Knowledge Transfer Statement: This study identified several trends in dental service provision and indicated that not all trends were consistent across all birth-year cohorts. Findings inform dental health care policy and priorities for dental education. In addition, the identified trends have implications for the future composition of the oral health workforce.

A portable and reconfigurable multi-organ platform for drug development with onboard microfluidic flow control

The drug development pipeline is severely limited by a lack of reliable tools for prediction of human clinical safety and efficacy profiles for compounds at the pre-clinical stage. Here we present the design and implementation of a platform technology comprising multiple human cell-based tissue models in a portable and reconfigurable format that supports individual organ function and crosstalk for periods of up to several weeks. Organ perfusion and crosstalk are enabled by a precision flow control technology based on electromagnetic actuators embedded in an arrayed format on a microfluidic platform. We demonstrate two parallel circuits of connected airway and liver modules on a platform containing 62 electromagnetic microactuators, with precise and controlled flow rates as well as functional biological metrics over a two week time course. Technical advancements enabled by this platform include the use of non-sorptive construction materials, enhanced scalability, portability, flow control, and usability relative to conventional flow control modes (such as capillary action, pressure heads, or pneumatic air lines), and a reconfigurable and modular organ model format with common fluidic port architecture. We demonstrate stable biological function for multiple pairs of airway-liver models for periods of 2 weeks in the platform, with precise control over fluid levels, temperature, flow rate and oxygenation in order to support relevant use cases involving drug toxicity, efficacy testing, and organ-organ interaction.

The importance of workforce surveillance, research evidence and political advocacy in the context of international migration of dentists

The international migration of dentists is an issue of pressing significance that poses several complex policy challenges. Policy-making is mainly constrained by the lack of workforce surveillance, research evidence and political advocacy - all three are required to work together, yet with different purposes. We first discuss the inconsistencies in migrant dentist surveillance in major country-level governmental systems (immigration departments, dentist registration authorities and workforce agencies). We argue that the limitations in surveillance collections affect independent research and in turn scholarly contributions to dental workforce policy. Differences in country-level surveillance collections also hinder valid cross-country comparisons on migrant dentist data, impeding global policy efforts. Due to these limitations, advocacy, or the political process to influence health policy, suffers, but is integral to future challenges on dentist migration. Country-level advocacy is best targeted at improving migrant dentist surveillance systems. Research interest can be invigorated through targeted funding allocations for migration research and by improving the availability of dentist surveillance data for research purposes. At the global level, the WHOs global code of practice for international recruitment of health personnel (a crucial advocacy tool) needs to be strengthened. Global organisations such as the FDI World Dental Federation have an important role to play in advocating for improved migrant dentist workforce surveillance and research evidence, especially in low- and middle-income countries.

Quality of Life and Disability Weights Associated with Periodontal Disease

Burden-of-oral-disease studies have been hampered by lack of data on disability weights. It is likely that disability weights will vary between conditions such as gingivitis and periodontal pockets. The aims of this study were to assess health-related quality of life and disability weights for periodontal conditions. A random sample of 45- to 54-year-olds was surveyed during 2004-05 (n = 879, response rate = 43.8%), with oral examinations on n = 709 persons (completion rate = 80.7%). Oral disease symptoms were recorded by the EuroQol, from which disability weights were calculated. Reported pain/discomfort ranged from 6.1% of persons (gingivitis) to 25.8% of persons (6+ mm pockets). Lower disability weights were associated with gingivitis (0.001) and 6+ mm gingival recession (0.004), with higher weights for 6+ mm loss of attachment (0.012) and 6+ mm pocket depth (0.018). Variation in symptom experience indicated the need for investigators to identify periodontal conditions and apply appropriate disability weights in burden-of-disease studies.

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.

Greater inequalities in dental treatment than in disease experience

This study aimed to (1) describe social gradients in dental caries in a population-level survey and (2) examine whether inequalities are greater in disease experience or in its treatment. Using data from Australia's National Survey of Adult Oral Health 2004-2006, we examined absolute and relative income inequalities for DMFT and its separate components (DT, MT, FT) using adjusted proportions, means, and health disparity indices [Slope Index of Inequality (SII) and Relative Index of Inequality (RII)]. Approximately 90% of Australian adults had experienced caries, with prevalence ranging from 89.7% in the highest to 96.6% in the lowest income group. Social gradients in caries were evident across all components of DMFT, but particularly notable in Missing (SII = -15.5, RII = -0.3) and untreated Decay (SII = -23.7, RII = -0.9). Analysis of age- and gender-adjusted data indicated less variation in levels of disease experienced (DMFT) than in the health outcomes of its management (missing teeth). The findings indicate that social gradients for dental caries have a greater effect on how the disease was treated than on lifetime disease experience.

Oral mucosal lesions: findings from the Australian National Survey of Adult Oral Health

BACKGROUND

The prevalence of oral mucosal lesions (OMLs) and factors associated with these has not previously been reported in the Australian population. This study aimed to report on the prevalence of OMLs in Australian adults and to evaluate their association with socio-demographic factors.

METHODS

This study utilized data from the Australian National Survey of Adult Oral Health 2004-06, which employs a multi-stage, stratified random sample selection procedure. Information on socio-demographics, smoking and presence of OMLs were collected using telephone interview, self-reported questionnaires and comprehensive oral examination. A multivariate regression model was generated to estimate effect of factors on the prevalence of non-ulcerated OMLs.

RESULTS

A total of 3551 dentate adult Australians had complete data for this analysis. Over 20% of study participants presented with an OML on the day of examination. The prevalence of suspected malignancy was less than 1% and over 17% for non-ulcerated OMLs. Prevalence of non-ulcerated OMLs was associated with age, gender, residential location, household income and smoking.

CONCLUSIONS

The study reported that epidemiological survey can provide useful information on OMLs. Certain population groups had a higher risk of having the condition. Preventing smoking uptake and smoking cessation can reduce the prevalence of OMLs in the population.

Will improving access to dental care improve oral health-related quality of life?

BACKGROUND

The aim of this study was to determine if Australian Defence Force (ADF) members had better oral health-related quality of life (OHRQoL) than the general Australian population and whether the difference was due to better access to dental care.

METHODS

The OHRQoL, as measured by OHIP-14 summary indicators, of participants from the Defence Deployed Solomon Islands (SI) Health Study and the National Survey of Adult Oral Health 2004-06 (NSAOH) were compared. The SI sample was age/gender status-adjusted to match that of the NSAOH sample which was age/gender/regional location weighted to that of the Australian population.

RESULTS

NSAOH respondents with good access to dental care had lower OHIP-14 summary measures [frequency of impacts 8.5% (95% CI = 5.4, 11.6), extent mean = 0.16 (0.11, 0.22), severity mean = 5.0 (4.4, 5.6)] than the total NSAOH sample [frequency 18.6 (16.6, 20.7); extent 0.52 (0.44, 0.59); severity 7.6 (7.1, 8.1)]. The NSAOH respondents with both good access to dental care and self-reported good general health did not have as low OHIP-14 summary scores as in the SI sample [frequency 2.6 (1.2, 5.4), extent 0.05 (0.01, 0.10); severity 2.6 (1.9, 3.4)].

CONCLUSIONS

ADF members had better OHRQoL than the general Australian population, even those with good access to dental care and self-reported good general health.

Effects of fluoridated drinking water on dental caries in Australian adults

Systematic reviews produce conflicting conclusions regarding dental caries-preventive effects of water fluoridation in adults. The authors investigated the relationship using data from the nationally representative 2004-2006 Australian National Survey of Adult Oral Health. Effects were compared between the pre-fluoridation cohort born before 1960 (n = 2,270) and the cohort born between 1960 and 1990 (n = 1,509), when widespread implementation of fluoridation increased population coverage from < 1% to 67%. Residential history questionnaires determined the percentage of each person's lifetime exposed to fluoridated water. Examiners recorded decayed, missing, and filled teeth (DMF-Teeth) and decayed and filled tooth surfaces (DF-Surfaces). Socio-demographic and preventive dental behaviors were included in multivariable least-squares regression models adjusted for potential confounding. In fully adjusted models, > 75% of lifetime exposure to fluoridation relative to < 25% of lifetime exposure was associated with 11% and 10% fewer DMF-Teeth in the pre-1960 (p < .0001) and 1960-1990 cohorts (p = .018), respectively. Corresponding reductions in DF-Surfaces were 30% (p < .001) and 21% (p < .001). Findings for intermediate fluoridation exposure suggested a dose-response relationship. Results were consistent in sensitivity analyses accounting for missing data. In this nationally representative sample of Australian adults, caries-preventive effects of water fluoridation were at least as great in adults born before widespread implementation of fluoridation as after widespread implementation of fluoridation.

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.

How first-time mothers perceive and deal with teething symptoms: a randomized controlled trial

BACKGROUND

Teething, especially in their first child, continues to be a daunting problem for parents.

OBJECTIVE

The objective of this paper was to assess the effects of providing first-time mothers with information about symptoms commonly associated with teething and ways to manage these.

METHODS

In a randomized controlled trial to decrease the incidence of early childhood caries, we included information on teething as another issue in a child's oral health. Mothers in the intervention group received three rounds of printed information: at enrolment during pregnancy and when the child was 6 and 12 months old. Information on teething arrived when a child reached 6 months of age. Outcome assessment was at 20 ± 2.5 months of age. Data were complemented with a systematic search for evidence on teething symptoms and how to alleviate them in other populations.

RESULTS

Of 649 expectant mothers enrolled in the study, 441 completed the 'Child's oral health' questionnaire. There were no significant differences in teething symptoms reported by mothers in the intervention (n = 232) and control (n = 209) groups. However, mothers in the intervention group were less likely to use topical and oral medications to manage teething problems (P < 0.03) and relied more on rubbing the gums to ease discomfort (P < 0.005) than mothers in the control group.

CONCLUSIONS

Providing mothers with information on how to address teething symptoms markedly reduced the use of medications for symptom relief. There is still need for better evidence, first, on what symptoms can or cannot be attributed to teething and, second, on what is effective in alleviating them.

Dental self-care and visiting behaviour in relation to social inequality in caries experience

OBJECTIVES

To investigate associations of dental behaviour with social inequality in oral health.

METHODS

A random sample of 45-54 year-olds from Adelaide, South Australia was surveyed by self-complete questionnaire in 2004-05 (n = 879, response rate 43.8%). Oral examinations were performed by calibrated dentists on 709 persons (80.7% of participants).

RESULTS

The mean (SE) number of decayed teeth (D) was 0.4 (0.04), with 5.3 (0.2) missing teeth (M), 11.0 (0.2) filled teeth (F) and 16.6 (0.2) DMFT. The majority brushed their teeth 8 or more times per week (78.8%) and had made a dental visit within the last 12 months (63.7%). Nearly a quarter had a household income of under $30,000 (24.0%). Multivariate analysis showed a three-way interaction (p < 0.05, GLM) between income and brushing and visiting for decayed teeth, showing that the relationship between decayed teeth and dental behaviour varied across levels of income. Among those who had not made a dental visit in the last 12 months, those who brushed their teeth 8 or more times per week in the low income group had D = 0.7 (0.2) while those who brushed less often had D = 2.2 (0.5) compared to D = 0.3 (0.08) and D = 0.3 (0.2) respectively in the high income group.

CONCLUSION

Dental behaviour in terms of brushing and visiting was associated with social gradients in oral health for decayed teeth across income groups, with less favourable dental behaviour having a stronger negative association with oral health among lower income groups.

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.

The Second National Oral Health Survey of Vietnam--1999: variation in the prevalence of dental diseases

The 1999 National Oral Health Survey of Vietnam, a population-based survey from a developing country, provides a contrast to the findings of recent surveys in Australia and New Zealand.

OBJECTIVES

This paper aims to describe oral health status and its socio-economic distribution and to evaluate change over time in the oral health of the population of Vietnam.

METHODS

A multi-staged stratified sampling process was employed. Data on children aged 6 to 17 years were collected by an oral examination and a parental questionnaire. Adults aged 18+ years completed a questionnaire and were examined by trained and calibrated dentists.

RESULTS

Oral hygiene status of the child and adult population was poor. Caries experience was high in children but moderate in adults. Caries experience was present mostly as untreated decay. Factors related to caries were sex, hygiene practices, socio-economic status, location and dental visiting.

CONCLUSIONS

The oral health status of the younger Vietnamese generations was compromised by various factors and there are worrying trends, indicating deteriorating oral health in this population.

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.

The Strong Teeth Study; background, rationale and feasibility of fluoridating remote Indigenous communities

The caries experience of Australian Indigenous children has deteriorated at the same time as that of non-Indigenous children has greatly improved. Fluoridating the water supplies of Indigenous communities emerged as a policy direction at the beginning of the 2000s. However, remote Indigenous communities are small, highly dispersed and isolated. This paper describes the Strong Teeth Study, a series of projects for the fluoridation of remote Indigenous communities in the Northern Territory. The background and rationale for two demonstration fluoridation projects are presented and the feasibility of operating small-scale fluoridation plant and measuring the impact on caries experience described. The demonstration fluoridation projects were commenced, but not sustained. The lessons learnt about environmental enablers and essential service requirements are highlighted. Fluoridation has the potential to improve oral health so as to contribute positively to child development as part of the broader mission of closing the gap in health between Indigenous and non-Indigenous Australians.

The Second National Oral Health Survey of Vietnam, 1999: background and methodology

Few high-quality epidemiological surveys of oral health have been conducted in developing countries. A National Oral Health Survey of Vietnam was previously conducted in 1989.

OBJECTIVE

To conduct a Second National Oral Health Survey to facilitate planning of preventive and treatment programmes and the dental workforce in Vietnam.

DESIGN

The 1999 survey utilised a multistage stratified random sampling strategy to obtain a random sample of the Vietnamese population. The population was stratified by province, urban/rural location and age in order to ensure adequate representation. Participants were clustered into schools (children) or communes (adults). Data were collected through a social survey, and dental examinations were conducted by calibrated examiners.

RESULTS

High percentages of the target samples in each stratum were obtained. Inter-examiner and intra-examiner reliability were good to high (kappa: 0.48-0.98). All data were weighted to adjust for the probabilities of selection and known biases to provide unbiased estimates at provincial and national level.

CONCLUSION

The National Oral Health Survey of Vietnam was a high-quality epidemiological survey with high participation rates. This was made possible through strong support from the Vietnamese Ministry of Health and regional and local officials.

Predicting relative need for urgent dental care

OBJECTIVE

To develop prediction models of the relative need for care to differentiate between urgent and not urgent individuals presenting for emergency dental care.

DESIGN AND METHODS

Data were collected from 839 adults presenting to public dental clinics across South Australia (SA) and New South Wales (NSW) for emergency dental care. Prediction of the urgency of emergency dental care was based on the assessment of two binary logistic regression models - Model 1: urgency of care=<48 hours vs. 2+ days, Model 2: urgency of care=2-7 days vs. 8+ days. Subsequently predictive equations for urgency of emergency dental care were developed using binary logistic regression analysis. The models incorporated subjective oral health indicators (i.e., experience of pain or other oral symptoms) and measures of psychosocial impact of oral disorders (i.e., difficulty sleeping and being worried about the appearance/health of one's teeth or mouth).

RESULTS

The cut-off point for the prediction of urgency was defined as a probability value > or =0.40 and > or =0.50 for Model 1 and Model 2 respectively. These cut-off values were chosen as they produced test results that were consistent with the proportions of patients falling into various urgency categories derived from dentist's assessment of urgency. Model 1's sensitivity was 58%, specificity 77% and positive predictive value (PPV) 59%. Model 2's sensitivity was 75%, specificity 65% and PPV 71%.

CONCLUSIONS

These models of relative need may be useful tools for the screening of urgent dental care and for allocating priority among patients presenting for emergency dental care.

Association of urgent dental care with subjective oral health indicators and psychosocial impact

Pressures on public dental services require new approaches to managing demand.

OBJECTIVE

To identify possible predictors of urgency of clinically assessed emergency dental care using self-reported oral health indicators.

DESIGN AND METHODS

This study was a prospective study examining associations between patient reports of oral health indicators and psychosocial impact of oral disorders and a clinical determination of a hierarchy of urgency of emergency dental care. The data set comprised a random sample of 839 eligible adults presenting to nine public dental clinics across South Australia and New South Wales for emergency dental care. All participants held a government health concession card and were aged 18+ years and had a minimum of six natural teeth. Significant associations between self-reported oral health indicators and psychosocial impacts and a normative clinical assessment of urgency of emergency dental care were examined by means of binary logistic regression analysis in order to develop prediction models. Prediction of the urgency of emergency dental care was based on the assessment of two models--Model 1: urgency of care = <48 hours vs. 2+ days, Model 2: urgency of care = 2-7 days vs. 8+ days.

RESULTS

Some 35.8%, 34.8% and 29.4% of respondents were classified by the assessing dentist as requiring dental care within 48 hours, 2-7 days and 8+ days respectively. For Model 1, difficulty sleeping all the time (OR = 4.8, CI = 3.0-8.0), pain in the jaw when opening wide (OR=2.4, CI=1.6-3.7), having a broken filling (OR = 1.7, C1 = 1.1-2.4), having a loose tooth (OR = 2.4, CI = 1.5-3.8), bleeding gums (OR = 0.7, CI = 0.5-1.0) and being dentally anxious (OR = 1.5, CI = 1.0-2.3) had a statistically significant association with needing to be seen within 48 hours. For Model 2, factors significantly associated with an urgency of care in the period 2-7 days included experience of toothache (OR = 2.6, CI = 1.6-4.3), pain in teeth with hot food or fluids (1.9, CI = 1.2-2.9), bleeding gums (OR = 2.0, CI = 1.3-3.2), having a broken filling (OR = 2.1, CI = 1.2-3.5), difficulty sleeping all the time (OR = 2.9, CI=1.4-6.4), and being concerned about the appearance of teeth or mouth very often (OR=0.3, CI = 0.1-0.7).

CONCLUSION

This study has identified a pertinent set of self-reported oral health indicators that can be used to predict the urgency of emergency dental care.

Evaluation of oral health-related quality of life questionnaires in a general child population

BACKGROUND

The evaluation of instruments measuring oral health-related quality of life (OHRQoL) of children has been largely among convenience samples of patients with specific diseases or disorders such as cleft lip/cleft palate or malocclusion.

AIM

This study aimed to evaluate the consistency and validity of the recently developed Child Perception Questionnaires (CPQ(8-10) and CPQ(11-14)) and the corresponding Parental Perception Questionnaire (PPQ) in a general child population sample in South Australia.

METHODS

The study was nested in the Child Oral Health Study. Some 1401 children aged 8 to 13 in 2002/03 were approached. Children were asked to complete the CPQ(8-10) and CPQ(11-14) according to their age while parents completed the PPQ. The questionnaires included global ratings of oral health and overall well-being. Scores for four domains (oral symptoms, functional limitations, emotional well-being and social well-being) were calculated. Data on caries experience (number of decayed, missing and filled tooth surfaces) and occlusal traits (using Dental Aesthetic Index) were collected for each child.

RESULTS

The CPQs and PPQ showed acceptable internal consistency and construct validity against global ratings of oral health and overall well-being. Children who had more caries or less acceptable occlusal traits reported poorer OHRQoL establishing the discriminant validity of the instruments. Parents of the children reported similar child OHRQoL.

CONCLUSION

These results suggest that the instruments have consistency and validity in measuring OHRQoL of children in a general population.

Oral health of Indigenous adult public dental patients in Australia

BACKGROUND

Indigenous Australians have been reported in a range of studies to have worse health than non-Indigenous Australians. Among health care card holders, a financially disadvantaged group eligible for public-funded dental care, oral health may also be worse among Indigenous persons. The aims of this study were to examine the oral health of Indigenous compared to non-Indigenous adult public dental patients in terms of caries experience and periodontal status, controlling for age and gender of patient, type of care and geographic location.

METHODS

Patients were sampled randomly by state/territory dental services in 2001-2002. Dentists recorded oral health status at the initial visit of a course of care using written instructions. The samples were weighted in proportion to the numbers of public-funded dental patients for each state/territory.

RESULTS

Multivariate logistic regression showed that the presence of periodontal pockets of 6+ mm was higher (P < 0.05) among Indigenous compared to non-Indigenous patients (OR = 2.24, 1.34-3.76), after controlling for age and gender of patients, type of care and geographic location. Multivariate negative binomial regression analysis (RR: rate ratio) controlling for age and gender of patients, type of care and geographic location indicated that Indigenous patients had higher numbers of decayed teeth (RR = 1.42) and missing teeth (RR = 1.44) but lower numbers of filled teeth (RR = 0.51) compared to non-Indigenous patients (P < 0.05). There was no significant difference in the DMFT index, indicating similar cumulative past and present experience of dental caries for Indigenous and non-Indigenous patients.

CONCLUSIONS

Indigenous adult public dental patients had worse oral health status than non-Indigenous patients, with a higher percentage of Indigenous patients having periodontal pockets 6+ mm, and Indigenous patients having more decayed and missing teeth. Indigenous patients lack both timely and appropriate preventive and treatment services.

Exposure to water fluoridation and caries increment

OBJECTIVE

The objective of this cohort study was to examine the association between exposure to water fluoridation and the increment of dental caries in two Australian states: Queensland (Qld)--5 per cent fluoridation coverage; and South Australia (SA)--70 per cent fluoridation coverage.

METHOD

Stratified random samples were drawn from fluoridated Adelaide and the largely non-fluoridated rest-of-state in SA, and fluoridated Townsville and non-fluoridated Brisbane in Qld.

PARTICIPANTS

Children were enrolled between 1991 and 1992 (SA: 5-15 yrs old, n = 9,980; Qld: 5-12 yrs old, n = 10,695). Follow-up caries status data for 3 years (+/- 1/2 year) were available on 8,183 children in SA and 6,711 children in Qld.

MAIN OUTCOME MEASURES

Baseline data on lifetime exposure to fluoridated water, use of other fluorides and socio-economic status (SES) were collected by questionnaire, and tooth surface caries status by dental examinations in school dental service clinics.

RESULTS

Higher per cent lifetime exposure to fluoridated water (6 categories: 0;1-24; 25-49; 50-74; 75-99; 100 per cent) was a significant predictor (ANOVA, p < 0.01) of lower annualised Net Caries Increment (NCI) for the deciduous dentition in SA and Qld, but only for Qld in the permanent dentition. These associations persisted in multiple linear regression analyses controlling for age, gender, exposure to other fluorides and SES (p < 0.05).

CONCLUSIONS

Water fluoridation was effective in reducing caries increment, even in the presence of a dilution effect from other fluorides. The effect of fluoridated water consumption was strongest in the deciduous dentition and where diffusion of food and beverages from fluoridated to non-fluoridated areas was less likely.

Intramural haematoma of the thoracic aorta: rupture and endoluminal exclusion

Intramural haematoma is an increasingly recognized condition, characterized by an acute haemorrhage into the aortic wall without the creation of a pseudolumen. We present a case that was diagnosed by non-contrast CT scanning, which showed a hitherto undescribed contained rupture into the mediastinum, but no haemothorax. This complicated intramural haematoma was then successfully treated with endoluminal exclusion, which was performed during frank rupture of the thoracic aorta into the left hemithorax which occurred just before the commencement of the endoluminal exclusion.

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

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