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Praganta J, De Silva H, De Silva R, Tong DC, Thomson WM. Effect of Advanced Platelet-Rich Fibrin (A-PRF) on Postoperative Level of Pain and Swelling Following Third Molar Surgery. J Oral Maxillofac Surg 2024; 82:581-589. [PMID: 38412975 DOI: 10.1016/j.joms.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Postoperative pain and swelling following third molar (M3) removal can be debilitating, and there is interest in using advanced platelet-rich fibrin (A-PRF) to reduce their severity. PURPOSE This study compared postoperative pain and swelling between A-PRF and gelatin dressing in extraction sockets following mandibular M3 removal. METHODS, SETTING, SAMPLE This split-mouth, single-blinded, randomized controlled trial was completed at the Oral Surgery clinic of University of Otago between November 2020 and July 2021. Patients aged between 16 and 40 years with bilaterally impacted mandibular M3 of similar Pederson index difficulty and deemed to be American Society of Anesthesiologists (ASA) I or II comprised the study sample. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The exposure variable was M3 socket management. One socket received A-PRF and 1 gelatin dressing, while the other received 2 gelatin dressings. MAIN OUTCOME VARIABLE(S) The outcome variables were postoperative pain and swelling over 7 days. Pain was measured using the visual analog scale (VAS), and swelling using stereophotogrammetry. COVARIATES Demographic characteristics (gender, ethnicity, and age), dental anxiety, smoking status, Pederson index, and intraoperative surgical time were the covariates. ANALYSES The two sides were compared using cross-tabulations and the McNemar test for categorical and paired t-tests for continuous variables. Statistical analysis used IBM SPSS Statistics for Windows (version 28).The Alpha level was 0.05. RESULTS 76 (87.3%) of 87 patients who met the eligibility criteria participated in the study, and 70 patients (65.7% female; age range 16-30 years) were included in the analysis. Mean visual analog scale scores showed no statistically significant difference between the A-PRF and control sides, being 29.6 (95% CI 23.9, 35.3) and 29.5 (95% CI 23.5, 35.5) on day 2, and falling to 12.6 (95% CI 8.7, 16.5) and 14.2 (95% CI 10.0, 18.4) by day 7. Likewise, mean peak facial swelling on day 2 was recorded as 6.3 cm3 (95% CI 4.9, 7.7) and 6.6 cm3 (95% CI 5.5, 7.7), and by day 7 they were 1.1 cm3 (95% CI 0.5, 1.7) and 1.0 cm3 (95% CI 0.3, 0.7) on the A-PRF and control sides, respectively. CONCLUSIONS A-PRF placement in M3 sockets did not reduce postoperative pain and swelling over gelatin dressing alone.
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Affiliation(s)
- Jesslyn Praganta
- Specialist Oral Surgeon, Senior Professional Practice Fellow - Department of Oral Diagnostics and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
| | - Harsha De Silva
- Associate Professor, Consultant Oral and Maxillofacial Surgeon, Department of Oral Diagnostics and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Rohana De Silva
- Associate Professor, Consultant Oral and Maxillofacial Surgeon, Department of Oral Diagnostics and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Darryl C Tong
- Professor, Consultant Oral and Maxillofacial Surgeon, Head of Department of Oral Diagnostics and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Emeritus Professor of Dental Epidemiology and Public Health, Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Guiney H, Caspi A, Ambler A, Belsky J, Kokaua J, Broadbent J, Cheyne K, Dickson N, Hancox RJ, Harrington H, Hogan S, Ramrakha S, Righarts A, Thomson WM, Moffitt TE, Poulton R. Childhood sexual abuse and pervasive problems across multiple life domains: Findings from a five-decade study. Dev Psychopathol 2024; 36:219-235. [PMID: 36562290 PMCID: PMC10287838 DOI: 10.1017/s0954579422001146] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of this study was to use longitudinal population-based data to examine the associations between childhood sexual abuse (CSA) and risk for adverse outcomes in multiple life domains across adulthood. In 937 individuals followed from birth to age 45y, we assessed associations between CSA (retrospectively reported at age 26y) and the experience of 22 adverse outcomes in seven domains (physical, mental, sexual, interpersonal, economic, antisocial, multi-domain) from young adulthood to midlife (26 to 45y). Analyses controlled for sex, socioeconomic status, prospectively reported child harm and household dysfunction adverse childhood experiences, and adult sexual assault, and considered different definitions of CSA. After adjusting for confounders, CSA survivors were more likely than their peers to experience internalizing, externalizing, and thought disorders, suicide attempts, health risk behaviors, systemic inflammation, poor oral health, sexually transmitted diseases, high-conflict relationships, benefit use, financial difficulties, antisocial behavior, and cumulative problems across multiple domains in adulthood. In sum, CSA was associated with multiple persistent problems across adulthood, even after adjusting for confounding life stressors, and the risk for particular problems incremented with CSA severity. The higher risk for most specific problems was small to moderate, but the cumulative long-term effects across multiple domains reflect considerable individual and societal burden.
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Affiliation(s)
- Hayley Guiney
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- King’s College London, Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & Neuroscience, London, UK
| | - Antony Ambler
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
- King’s College London, Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & Neuroscience, London, UK
| | - Jay Belsky
- Robert M. and Natalie Reid Dorn Professor, Department of Human Ecology, University of California, Davis, CA, USA
| | - Jesse Kokaua
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
- Centre for Pacific Health, Va’a O Tautai, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | | | - Kirsten Cheyne
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Nigel Dickson
- Department of Preventive and Social Medicine, Otago Medical School, University of Otago, New Zealand
| | - Robert J. Hancox
- Department of Preventive and Social Medicine, Otago Medical School, University of Otago, New Zealand
| | - HonaLee Harrington
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Sean Hogan
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Antoinette Righarts
- Department of Preventive and Social Medicine, Otago Medical School, University of Otago, New Zealand
| | | | - Terrie E. Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- King’s College London, Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & Neuroscience, London, UK
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
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Chapman RA, Thomson WM, Broadbent JM. Using the Child Perceptions Questionnaire with young adults. Community Dent Oral Epidemiol 2023; 51:1225-1231. [PMID: 37291732 DOI: 10.1111/cdoe.12887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES That no study has investigated oral health-related quality of life (OHRQoL) through the transition from adolescence to young adulthood is partly due to no OHRQoL index having been validated in both adult and child populations. Having separate measures for adolescence and young adulthood has meant that the different measures cannot be compared directly. Accordingly, the study objectives were: to determine whether the CPQ11-14 is a valid and reliable OHRQoL measure in young adults and to compare its performance with the OHIP-14 in young adults. METHODS A cross-sectional study was undertaken of a convenience sample of 968 young New Zealand adults aged 18-30 years (83.1% female) using RedCap. Two separate measures of OHRQoL were used (the CPQ11-14 and OHIP-14), along with Locker's global oral health item. RESULTS Internal consistency reliability was high for the CPQ11-14 and the OHIP-14, with Cronbach's alpha scores of .87 and .92, respectively. Mean scale scores were 15.8 (SD = 9.7) for the CPQ11-14 and 24.1 (SD = 10.1) for the OHIP-14. The scale scores were strongly and positively correlated (Pearson's r = .8). Both demonstrated acceptable construct validity, represented by ascending gradients in mean scores across the ordinal response categories of Locker's global oral health item. Ordinal logistic regression modelling of Locker's item showed the CPQ11-14 to have a slightly better fit and explain more variance than the OHIP-14. CONCLUSION The CPQ11-14 was valid and reliable in this young adult population. Further epidemiological validation studies should confirm the findings in representative samples.
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Thomson WM. Editorial - The Robin Heath Citation Award 2023. Gerodontology 2023; 40:409. [PMID: 37971284 DOI: 10.1111/ger.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
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Horncastle AJ, Gauld TD, Smith MB, Thomson WM. Comparing approaches to determining poor oral health among older adults in a national survey. Gerodontology 2023. [PMID: 38009567 DOI: 10.1111/ger.12729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To compare the clinical validity of the three approaches in residential care facility residents. BACKGROUND In NZ residential care facilities, the interRAI assessment tool is used by trained registered nurses for assessing oral status when new residents are admitted, but its validity has been questioned. Although Locker's global oral health item has been used to measure oral health in surveys and health services research, it is not routinely used in care facilities, yet its clinical validity has been demonstrated in population-based samples. Self-perceived oral health need may also be useful. MATERIALS AND METHODS Using a secondary analysis of clinical and self-reported data from a national survey of nursing home residents (the 2012 New Zealand Older People's Oral Health Survey, or OPOHS), we compared the validity of Locker's item, the interRAI tool and self-reported treatment need for identifying three key clinical indicators of poor oral health among dentate older adults; those were coronal caries (3+ teeth affected), root caries (1+ teeth affected) and xerostomia. Analyses were conducted using STATA, and survey weighting was used to obtain estimates for a source population of 25-843 individuals. RESULTS The prevalence of 3+ teeth with coronal caries was 28.7% (23.9, 34.0), the prevalence of 1+ teeth with root caries was 33.7% (28.7, 39.0), the prevalence of xerostomia was 23.1% (18.4, 28.3). Marked gradients in prevalence risk ratio were seen across different categories of Locker's global oral health item and the interRAI assessment tooth for coronal caries and xerostomia. Locker's global oral health item gave a better fitting model and was more discriminative in detecting coronal caries than the interRAI assessment tool (Lockers AIC = 0.76, interRAI AIC = 0.81). None of the approaches was particularly discriminative for root surface caries experience. CONCLUSION Self-reported approaches are discriminative for poor oral health. Standardised assessment tools used in residential care facilities should consider including a self-assessment component such as Locker's global oral health item.
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Affiliation(s)
- Alice J Horncastle
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - Taylor D Gauld
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - Moira B Smith
- Department of Public Health, Faculty of Medicine, Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - W Murray Thomson
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
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Bakri NN, Ferguson CA, Majeed S, Thomson WM, Oda K, Bartlett S, Broadbent JM, Smith MB. Workplace oral health promotion activities among community-aged care workers: A qualitative exploration. Community Dent Oral Epidemiol 2023. [PMID: 37950336 DOI: 10.1111/cdoe.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The workplace is an ideal-and priority-setting for health promotion activities. Developing and implementing workplace health promotion interventions, including oral health promotion activities, can help create health-supporting workplace environments. OBJECTIVE To pilot workplace oral health promotion activities among staff working in the aged care sector, report their impact and explore participants' views on the factors that contribute to participation and effectiveness. METHODS This study comprised three phases: (i) the development and face validation of the resources, (ii) a 3-h educational session and (iii) five interview sessions with participants 4-6 weeks following the education session. The recorded interviews were transcribed verbatim and analysed thematically. RESULTS Eleven community-aged care workforce were invited to five feedback sessions. Ten participants were female and ranged in age from 18 to 64. All participants gave favourable comments about the content and delivery of the training session and accompanying resources. The participants felt that the benefits of WOHP include improved staff knowledge, awareness and oral care routine, the ability to share (and put into practice) the gained knowledge and information with their dependants, a lower risk of having poor oral health that adversely affects their well-being and work tasks, and potentially beneficial impacts on the organization's staff roster. Their attendance in the WOHP was facilitated by being paid to attend and scheduling the sessions during work time. Future WOHP suggestions include the possibility of a one-stop dental check-up at the workplace or staff dental care discounts from local dental practitioners and combining oral health with other health promotion activities. CONCLUSIONS Planning and implementing WOHP was deemed acceptable and feasible in this study context and successfully achieved short-term impacts among community-aged care workers. Appropriate times and locations, organizational arrangements and a variety of delivery options contributed to successful programme planning and implementation.
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Affiliation(s)
- N N Bakri
- Centre of Population Oral Health and Clinical Prevention Studies, Faculty of Dentistry, Sungai Buloh Campus, Universiti Teknologi MARA, Selangor, Malaysia
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - C A Ferguson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - S Majeed
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - W M Thomson
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - K Oda
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Bartlett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - J M Broadbent
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - M B Smith
- Department of Public Health, University of Otago, Wellington, New Zealand
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Haag DG, Schuch HS, Nath S, Baker SR, Celeste RK, Thomson WM, Jamieson LM. Gender inequities in dental research publications: Findings from 20 years. Community Dent Oral Epidemiol 2023; 51:1045-1055. [PMID: 36546530 DOI: 10.1111/cdoe.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 05/12/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The first steps towards gender equity in science are measuring the magnitude of inequity and increasing awareness of the problem. OBJECTIVES To describe trends in gender disparities in first and last authorship in the most cited dental publications and general dental literature over a 20-year period. METHODS Articles and bibliometric data were retrieved from the Scopus database for the period 1996 to 2015. Two groups of 1000 articles each were retrieved: a random sample and another sample of top-cited articles for each year. The gender of the first and last author of each publication was manually identified. When this was not possible, we used an online software platform (https://genderize.io/). Descriptive analyses identified the proportion of women first and last authors in both samples, stratifying by dental discipline and geographic region. Trends were ascertained by frequency metrics across years. Gender disparity was observed in both first and last authorship, with a larger gap being observed in the top-cited sample. RESULTS Women led 28.4% and 20.3% of articles in the random and top-cited samples, respectively. A similar pattern was observed for the last authorship group (22.1% and 16.1%, respectively). An increasing trend in the proportion of articles led by women over time was observed in both samples. This increase was larger in the top-cited sample (from 15.0% in 1996-2000 to 25.1% in 2015) than in the random sample (from 26.3% in 1996-2000 to 33.2% in 2011). CONCLUSIONS Clear gender disparities in dental research publications in the last 20 years were identified in both general and top-cited manuscripts, across dental disciplines, across countries, across first and last authorship, and over time. It is paramount that actions are taken to attract, retain and promote women in science, as well as to monitor and ensure progress towards gender equity.
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Affiliation(s)
- Dandara Gabriela Haag
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - Helena Silveira Schuch
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Sonia Nath
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - Sarah R Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Farroupilha, Brazil
| | - W Murray Thomson
- Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
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Ruiz B, Broadbent JM, Thomson WM, Ramrakha S, Moffitt TE, Caspi A, Poulton R. Childhood caries is associated with poor health and a faster pace of aging by midlife. J Public Health Dent 2023; 83:381-388. [PMID: 37920118 PMCID: PMC10919959 DOI: 10.1111/jphd.12591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/29/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Childhood caries is associated with poorer self-rated general health in adulthood, but it remains unclear whether that holds for physical health and aging. The aim of this study was to identify whether age-5 caries is associated with (a) biomarkers for poor physical health, and (b) the pace of aging (PoA) by age 45 years. METHODS Participants are members of the Dunedin Multidisciplinary Health and Development Study birth cohort. At age 45, 94.1% (n = 938) of those still alive took part. Data on age-5 caries experience and age-45 health biomarkers were collected. The PoA captures age-related decline across the cardiovascular, metabolic, renal, immune, dental and pulmonary systems from age 26 to 45 years. We used (a) generalized estimating equations to examine associations between age-5 caries and poor physical health by age 45 years, and (b) ordinary least squares regression to examine whether age-5 caries was associated with the PoA. Analyses adjusted for sex, perinatal health, childhood SES and childhood IQ. RESULTS High caries experience at age-5 was associated with higher risk for some metabolic abnormalities, including BMI ≥30, high waist circumference, and high serum leptin. Those with high caries experience at age-5 were aging at a faster rate by age 45 years than those who had been caries-free. CONCLUSIONS Oral health is essential for wellbeing. Poor oral health can be an early signal of a trajectory towards poor health in adulthood. Management for both conditions should be better-integrated; and integrated population-level prevention strategies should be foundational to any health system.
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Affiliation(s)
- Begoña Ruiz
- Sir John Walsh Research Institute, Department of Oral Sciences, Faculty of DentistryUniversity of OtagoDunedinNew Zealand
| | - Jonathan M. Broadbent
- Sir John Walsh Research Institute, Department of Oral Sciences, Faculty of DentistryUniversity of OtagoDunedinNew Zealand
| | - W. Murray Thomson
- Sir John Walsh Research Institute, Department of Oral Sciences, Faculty of DentistryUniversity of OtagoDunedinNew Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, Division of SciencesUniversity of OtagoDunedinNew Zealand
| | - Terrie E. Moffitt
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
- Center for Genomic and Computational BiologyDuke UniversityDurhamNorth CarolinaUSA
- Social, Genetic, and Developmental Psychiatry Centre, Institute of PsychiatryKings College LondonLondonUSA
| | - Avshalom Caspi
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
- Center for Genomic and Computational BiologyDuke UniversityDurhamNorth CarolinaUSA
- Social, Genetic, and Developmental Psychiatry Centre, Institute of PsychiatryKings College LondonLondonUSA
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, Division of SciencesUniversity of OtagoDunedinNew Zealand
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Boyd DH, Foster Page LA, Moffat SM, Thomson WM. Time to complain about pain: Children's self-reported procedural pain in a randomised control trial of Hall and conventional stainless steel crown techniques. Int J Paediatr Dent 2023; 33:382-393. [PMID: 36841968 DOI: 10.1111/ipd.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/21/2022] [Accepted: 02/18/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Children's pain in dentistry has undesirable short- and long-term consequences; therefore, less invasive treatments merit consideration. AIM To investigate procedural pain scores for two treatments for carious primary molars in New Zealand primary care. DESIGN This study was a split-mouth randomised control trial, with secondary outcome analysis. Children (4-8 years) with proximal carious lesions on matched primary molars had one tooth treated with the Hall technique (HT) and one treated with a conventional stainless steel crown (CT); treatment type and order of treatment were randomly allocated (allocation concealment). The Wong-Baker self-report pain scale measured pretreatment dental pain, procedural pain at each treatment and post-operative pain. RESULTS Data were analysed for 103 children: 49 children had the HT first and 54 children had the CT first. Procedural pain scores did not differ by treatment type, with 71.8% and 76.7% of children reporting low pain for the HT and the CT, respectively. Fewer children reported low procedural pain for the second treatment than the first (p = .047). Most children reported low procedural pain for both treatments (58.3%), although 41.7% experienced moderate-high procedural pain with at least one treatment. CONCLUSIONS The HT caused pain for as many children as the CT. There is an opportunity for better dental pain management in this setting.
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Affiliation(s)
- Dorothy H Boyd
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Lyndie A Foster Page
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Susan M Moffat
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Foster Page L, Thomson WM, Baker S, Bekes K. Chapter 10: Oral Health-Related Quality of Life and Coronal Caries. Monogr Oral Sci 2023; 31:205-220. [PMID: 37364563 DOI: 10.1159/000530614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/18/2022] [Indexed: 06/28/2023]
Abstract
Dental caries is the most prevalent oral health disease and affects the health of individual and populations. The conventional disease metrics do not represent the impact of caries on people's lives. Oral-health-related quality of life measures were developed to help understand which aspects of dental caries have the greatest impact on well-being. How these measures were developed follows a standardized process of development and testing, with the ultimate aim of the entire process being that they be used in clinical dentistry, dental epidemiology, and health services research. There has been ongoing debate about whether these measures have adequate discriminative ability for the wide range of caries experience, and whether they are responsive to changes in disease experience. Whether these measures are "perfect" or not, what we do know after two decades is that numerous studies have found them to be sufficiently discriminative for caries in adults and children alike. There is also evidence for their responsiveness, chiefly from studies of children undergoing dental treatment under general anesthetic for early childhood caries. The influence of environmental, social, and psychological characteristics is another consideration in how people self-rate their oral health. Is there a need to improve the quality of these measures by refining existing ones or developing new ones which may represent those broader concepts? Regardless of the future, the most pressing challenge is the need for health systems work to ensure the routine use of these measures in clinical and public health practice.
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Affiliation(s)
- Lyndie Foster Page
- Division of Dental Public Health, School of Dentistry, Oregon Health and Science University, Portland, Oregon, USA
| | - W Murray Thomson
- Department of Dental Epidemiology and Public Health, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Sarah Baker
- Unit of Oral Health, Dentistry and Society, School of Dentistry, University of Sheffield, Sheffield, UK
| | - Katrin Bekes
- Department of Paediatric Dentistry, Medical University of Vienna, Vienna, Austria
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Thomson WM. Editorial for Gerodontology 40:2. Gerodontology 2023; 40:147. [PMID: 37198103 DOI: 10.1111/ger.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- W M Thomson
- Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
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Ha DH, Nguyen HV, Bell LK, Devenish-Coleman G, Golley RK, Thomson WM, Manton DJ, Leary SD, Scott JA, Spencer J, Do LG. Trajectories of child free sugars intake and dental caries - a population-based birth cohort study. J Dent 2023:104559. [PMID: 37230240 DOI: 10.1016/j.jdent.2023.104559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES To investigate the association between trajectories of free sugars intake during the first five years of life and dental caries experience at five years. METHODS Data from the SMILE population-based prospective birth cohort study, collected at one, two and five years old, were used. A 3-days dietary diary and food frequency questionnaire were used to estimate free sugars intake (FSI) in grams. The primary outcomes were dental caries prevalence and experience (dmfs). The Group-Based Trajectory Modelling method was used to characterize three FSI trajectories ('Low and increasing'; 'Moderate and increasing'; and 'High and increasing'), which were the main exposures. Multivariable regression models were generated to compute adjusted prevalence ratios (APR) and rate ratios (ARR) for the exposure, controlling for socioeconomic factors. RESULTS The prevalence of caries was 23.3%, with a mean dmfs of 1.4, and a median of 3.0 among those who had caries. There were clear gradients of caries prevalence and experience by the FSI trajectories. The 'High and increasing' had an APR of 2.13 (95%CI 1.23-3.70) and ARR of 2.77 (95%CI 1.45-5.32) against the 'Low and increasing'. The 'Moderate and increasing' group had intermediate estimates. A quarter of the caries cases could have been prevented if the whole study sample had been in the 'Low and increasing' FSI trajectory. CONCLUSION A sustained, high trajectory of FSI from a young age was positively associated with child dental caries. Measures to minimise consumption of free sugars must commence early in life. CLINICAL SIGNIFICANCE The study has provided high level evidence to inform clinicians' decisions in promoting a healthy dietary pattern for young children.
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Affiliation(s)
- Diep H Ha
- School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Australia.
| | - Huy V Nguyen
- Health Innovation and Transformation Centre, Federation University, Australia
| | - Lucinda K Bell
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | | | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - W Murray Thomson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | | | - Sam D Leary
- Centrum voor Tandheelkunde en Mondzorgkunde, UMCG, University of Groningen, the Netherlands
| | - Jane A Scott
- Nutrition and Dietetics, School of Population Health, Curtin University, Australia
| | - John Spencer
- Bristol Biomedical Research Centre Nutrition Theme, Bristol Dental School, University of Bristol, United Kingdom
| | - Loc G Do
- School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Australia; Nutrition and Dietetics, School of Population Health., Curtin University, Australia; Australian Research Centre for Population Oral Health, University of Adelaide, Australia
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Ruiz B, Broadbent JM, Thomson WM, Ramrakha S, Hong CL, Poulton R. Differential Unmet Needs and Experience of Restorative Dental Care in Trajectories of Dental Caries Experience: A Birth Cohort Study. Caries Res 2023; 57:524-535. [PMID: 37231938 DOI: 10.1159/000530378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/13/2023] [Indexed: 05/27/2023] Open
Abstract
Dental caries is a chronic and cumulative disease but little has been reported on the continuity of the disease and its treatment through life. Group-based multi-trajectory modeling was used to identify developmental trajectories of untreated carious tooth surfaces (DS), restored tooth surfaces (FS), and teeth extracted due to caries (MT) from ages 9 to 45 years in a New Zealand longitudinal birth cohort, the Dunedin Multidisciplinary Health and Development Study (n = 975). Associations between early-life risk factors and trajectory group membership were examined by specifying the probability of group membership according to a multinomial logit model. Six trajectory groups were identified and labeled: "low caries rate"; "moderate caries rate, maintained"; "moderate caries rate, unmaintained"; "high caries rate, restored"; "high caries rate, tooth loss"; and "high caries rate, untreated caries". The two moderate-caries-rate groups differed in count of FS. The three high-caries-rate groups differed in the relative proportion of accumulated DS, FS, and MT. Early childhood risk factors associated with less favorable trajectories included higher dmfs scores at age 5, lack of exposure to community water fluoridation during the first 5 years of life, lower childhood IQ, and low childhood socioeconomic status. Parent self-ratings of their own or their child's oral health as "poor" were associated with less favorable caries experience trajectories. Children who had clinical signs of dental caries together with a parent rating of child's oral health as poor were more likely to follow a less favorable caries trajectory. Higher deciduous dentition caries experience at age 5 years was associated with less favorable caries trajectories, as were children whose parents gave "poor" ratings of their own or their child's oral health. These findings highlight the considerable intergenerational continuity in dental caries experience from early childhood to midlife. Subjective measures of child oral health are informative and might aid as predictors of adult caries experience in cases where childhood dental clinical data were not available.
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Affiliation(s)
- Begoña Ruiz
- Sir John Walsh Research Institute, Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Jonathan M Broadbent
- Sir John Walsh Research Institute, Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Sir John Walsh Research Institute, Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, Division of Sciences, University of Otago, Dunedin, New Zealand
| | - Chuen Lin Hong
- Sir John Walsh Research Institute, Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, Division of Sciences, University of Otago, Dunedin, New Zealand
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Naysmith KE, Foster Page LA, Tong DC, Thomson WM. Oral Health Status of New Zealand Defence Force Recruits. Mil Med 2023; 188:e804-e810. [PMID: 34559238 DOI: 10.1093/milmed/usab385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/19/2021] [Accepted: 09/10/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The demands of operational deployment mean that defense force personnel must be dentally fit. Although medical evacuation for dental causes should be avoided, dental emergencies are a major non-combat-related contributor to withdrawal from deployment. Information on the oral health status of recruits and officer cadets entering the New Zealand Defence Force (NZDF) is scarce, yet it is useful for service and workforce planning. We investigated oral health status and its associations in new recruits and officer cadets entering the NZDF over a 13-month period. MATERIALS AND METHODS This study used data from recruits' initial dental examination (including baseline forensic charting), posterior bitewing radiographs, orthopantomograph radiograph, and a socio-dental questionnaire. The impaction status of third molar teeth was evaluated. Ethical approval was obtained from the University of Otago Ethics Committee (reference number D18/200) and the NZDF Organisational Research Committee. RESULTS Of the 874 (83%) of the 1,053 recruits (age range 17-59 years) who participated, one in five were Māori. Nearly two-thirds were Army recruits. Caries prevalence was almost 70%. Mean Decayed, Missing, and Filled Teeth (DMFT) (3.0 overall) was higher among females and Māori. Few teeth were missing due to caries. Third molars were common, seen in 745 (88.3%). One in four maxillary third molars (but only one in six mandibular ones) had fully erupted. The most common type of impaction among mandibular third molars was the mesioangular type, followed by vertical, horizontal, and distoangular. Almost 60% of recruits had one or more potentially problematic third molars. The prevalence was highest in the youngest age groups, those of medium or low socioeconomic status and in Army or Navy recruits. CONCLUSIONS Recruits' oral health was acceptable, but potentially problematic third molars were common, indicating a need for careful assessment (and their possible removal) before operational deployment.
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Affiliation(s)
- K E Naysmith
- Dental Department, Hutt Hospital, Hutt Valley District Health Board, Lower Hutt 5010, New Zealand
| | - L A Foster Page
- New Zealand Defence Force Health Directorate, Defence House, Wellington 6011, New Zealand
| | - D C Tong
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand
| | - W M Thomson
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand
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15
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Hong CL, Thomson WM, Broadbent JM. Oral Health-Related Quality of Life from Young Adulthood to Mid-Life. Healthcare (Basel) 2023; 11:515. [PMID: 36833050 PMCID: PMC9957151 DOI: 10.3390/healthcare11040515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
Quality of life varies with time, often worsening, and is affected by circumstances, events, and exposures at different stages of life. Little is known about how oral health-related quality of life (OHRQoL) changes during middle age. We investigated OHRQoL changes from age 32 to 45 years among participants in a population-based birth cohort, along with clinical and socio-behavioural associations. Generalised estimating equation models were used to investigate the association between OHRQoL (assessed at ages 32, 38, and 45 years; n = 844), and the socioeconomic position in childhood (up to age 15 years) and adulthood (ages 26 through to 45 years), dental self-care (dental services utilisation and tooth brushing), oral conditions (such as tooth loss), and experiencing a dry mouth. The multivariable analyses were controlled for sex and personality traits. At each stage of life, those of a lower socioeconomic status were at greater risk of experiencing OHRQoL impacts. Those who engaged in favourable dental self-care habits (the regular use of dental services and at least twice daily tooth brushing) experienced fewer impacts. A social disadvantage at any stage of life has enduring deleterious effects on one's quality of life in middle age. Ensuring access to timely and appropriate dental health services in adulthood may reduce the impacts of oral conditions on one's quality of life.
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Affiliation(s)
| | | | - Jonathan M. Broadbent
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin 9016, New Zealand
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16
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Benn AML, Heng NCK, Thomson WM, Broadbent JM. Plaque and Dental Caries Risk in Midlife. Caries Res 2023; 56:464-476. [PMID: 36273463 DOI: 10.1159/000527255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 09/25/2022] [Indexed: 11/19/2022] Open
Abstract
Dental caries is an endogenous microbial community-based disease resulting from an ecological shift from dynamic stability to metabolic imbalance in a consortium of acidogenic and aciduric bacteria comprising the dental plaque biofilm. Participants were members of the Dunedin Multidisciplinary Health and Development Study, a longitudinal investigation of health and behaviour in a cohort born in Dunedin, New Zealand. Oral biofilm samples (collected at age 32 years) from anterior labial supragingival, posterior lingual supragingival, posterior subgingival, and the dorsum of the tongue habitats for 841 participants were analysed using checkerboard DNA-DNA hybridisation (CKB), focussing on 30 ecologically significant bacteria. Associations of CKB data with dental caries at ages 32 and 45 years were assessed using regression modelling, adjusting for potential confounders including sex, xerostomia, and oral hygiene. The putative periodontitis pathobiont Tannerella forsythia (in the anterior supragingival biofilm) was associated with untreated caries at age 32 years. The percentage of total summed cell number counts for two putative periodontitis-associated species (T. forsythia and Micromonas micros) was associated with greater caries experience at age 32 years and the development of new caries between age 32 and 45 years. Additionally, severe caries (3 + cavities) was associated with putative caries pathobionts (Lactobacillus fermentum, Lactobacillus plantarum), periodontitis-associated species, and commensals (M. micros, Campylobacter rectus, Streptococcus mitis biovar I, Streptococcus mitis biovar II) in the subgingival biofilm. Participants with sustained poor oral hygiene through age 32 years not only had greater experience of caries by that age than those with good oral hygiene (fully adjusted incidence risk ratio = 5.10, 95% CI: 3.30, 7.89) but also experienced greater incidence of new caries from age 32 to 45 years (incidence risk ratio = 3.69, 95% CI: 2.62, 5.20). These findings provide evidence in support of the extended caries ecological plaque hypotheses, the polymicrobial aetiology of caries, and the integrated aetiology of dental caries and periodontal diseases. They also underscore the roles of poor oral self-care (particularly over the life course) and xerostomia in the occurrence and progression of caries.
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Affiliation(s)
- Angela M L Benn
- Sir John Walsh Research Institute, University of Otago, Faculty of Dentistry, Dunedin, New Zealand
| | - Nicholas C K Heng
- Sir John Walsh Research Institute, University of Otago, Faculty of Dentistry, Dunedin, New Zealand
| | - W Murray Thomson
- Sir John Walsh Research Institute, University of Otago, Faculty of Dentistry, Dunedin, New Zealand
| | - Jonathan M Broadbent
- Sir John Walsh Research Institute, University of Otago, Faculty of Dentistry, Dunedin, New Zealand
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17
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Dwipa L, Wardhani R, Setiani T, Sufiawati I, Susanti Pratiwi Y, Susandi E, Huang I, Natasya Moenardi V, Thomson WM. Summated Xerostomia Inventory to detect both xerostomia and salivary gland hypofunction. Eur Rev Med Pharmacol Sci 2023; 27:517-523. [PMID: 36734710 DOI: 10.26355/eurrev_202301_31052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aims to evaluate the diagnostic performance of the Summated Xerostomia Inventory (SXI-ID) questionnaire in detecting xerostomia and salivary gland hypofunction (SGH). SUBJECTS AND METHODS This diagnostic study first underwent a validity and reliability test. Participants were randomly sampled from the Geriatric Clinics of Dr. Hasan Sadikin Hospital, Bandung, Indonesia. The SXI-ID was generated through a forward-backward translation, after which its validity (item-total item correlations), internal consistency (Cronbach's alpha), and test-retest reliability (kappa statistic) were all assessed. The diagnostic performance of the SXI-ID in detecting SGH was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS A total of 60 participants (aged ≥60 years) were involved in this study, most of whom were female (75%). The internal consistency of the SXI-ID was acceptable (α = 0.823), and its test-retest reliability was perfect (K= 1.00). ROC analysis showed that an SXI-ID cut-off value > 11 could detect SGH with a sensitivity of 96.0%, a specificity of 100.0%, and an area under the curve of 0.985 (p < 0.001). CONCLUSIONS The SXI-ID questionnaire is a valid and reliable tool to detect xerostomia and SGH in older Indonesians, and a score of 11 or above is useful to identify those with a low salivary flow.
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Affiliation(s)
- L Dwipa
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
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18
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Thomson WM, Foster Page LA, Levy SM, Keels MA, Hara AT, Fontana M. Concurrent validity of the short-form Family Impact Scale (FIS-8) in 4-year-old US children. BMC Pediatr 2022; 22:391. [PMID: 35787268 PMCID: PMC9252051 DOI: 10.1186/s12887-022-03437-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background US data on the validity and reliability of the short-form Family Impact Scale (FIS-8; a scale for measuring the impact of a child’s oral condition on his/her family) are lacking. Methods Cross-sectional analysis of data on four-year-old US children taking part in a multi-center cohort study. For child-caregiver dyads recruited at child age 12 months, the impact of the child’s oral condition on the family was assessed at age 48 months using the FIS-8, with a subsample of 422 caregivers (from 686 who were approached). Internal consistency reliability was assessed using Cronbach’s α, with concurrent validity assessed against a global family impact item (“How much are your family’s daily lives affected by your child’s teeth, lips, jaws or mouth?”) and a global oral health item (“How would you describe the health of your child’s teeth and mouth?”). Results Cronbach’s alpha was 0.83. Although gradients in mean scores across ordinal response categories of the global family impact item were inconsistent, there were marked, consistent gradients across the ordinal categories of the global item on the child’s oral health, with scores highest for those rating their child’s oral health as ‘Poor’. Conclusions While the findings provide some evidence for the utility of the FIS in a US child sample, the study’s replication in samples of preschoolers with greater disease experience would be useful.
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Affiliation(s)
- W M Thomson
- Department of Oral Sciences, Sir John Walsh Research Institute, School of Dentistry, The University of Otago, Dunedin, New Zealand.
| | - L A Foster Page
- Oregon Health & Science University School of Dentistry, Portland, CA, USA
| | - S M Levy
- University of Iowa, Iowa City, IA, USA
| | | | - A T Hara
- Indiana University, Indianapolis, IN, USA
| | - M Fontana
- University of Michigan, Ann Arbor, MI, USA
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Boyd DH, Moffat SM, Foster Page LA, Lacey (Te Arawa iwi, Ngāti Whakaue hapū and Ngāruahine iwi, JK, Fuge KN, Natarajan AK, Misa (Tule fanakava Misa of Te'ekiu, Kanokupolu, Tonga Islan TF, Thomson WM. Oral health of children in Aotearoa New Zealand–time for change. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2069826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dorothy H. Boyd
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Susan M. Moffat
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Lyndie A. Foster Page
- Defence Health Directorate, Te Ope Kātua o Aotearoa–New Zealand Defence Force, Wellington, New Zealand
| | | | - Kathryn N. Fuge
- Bee Healthy Regional Dental Service, Hutt Valley District Health Board, Wellington, New Zealand
| | - Arun K. Natarajan
- Specialist Paediatric Dentist, Canterbury District Health Board, Christchurch, New Zealand
| | | | - W. Murray Thomson
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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20
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Ruiz B, Broadbent JM, Thomson WM, Ramrakha S, Boden J, John Horwood L, Poulton R. Childhood caries experience in two Aotearoa New Zealand birth cohorts: implications for research, policy and practice. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2061018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Begoña Ruiz
- Sir John Walsh Research Institute, Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Jonathan M. Broadbent
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - W. Murray Thomson
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, Division of Sciences, University of Otago, Dunedin, New Zealand
| | - Joe Boden
- Christchurch Health and Development Study, Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - L. John Horwood
- Christchurch Health and Development Study, Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, Division of Sciences, University of Otago, Dunedin, New Zealand
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21
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Ha DH, Nguyen H, Dao A, Golley RK, Thomson WM, Manton DJ, Leary S, Scott J, Spencer AJ, Do LG. Group-based trajectories of maternal intake of sugar-sweetened beverage and offspring oral health from a prospective birth cohort study. J Dent 2022; 122:104113. [DOI: 10.1016/j.jdent.2022.104113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
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Benn AML, Heng NCK, Thomson WM, Sissons CH, Gellen LS, Gray AR, Broadbent JM. Associations of sex, oral hygiene and smoking with oral species in distinct habitats at age 32 years. Eur J Oral Sci 2021; 130:e12829. [PMID: 34874583 DOI: 10.1111/eos.12829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 08/20/2021] [Indexed: 12/13/2022]
Abstract
The oral microbiome is ecologically diverse, complex, dynamic, and little understood. We describe the microbiota of four oral habitats in a birth cohort at age 32 and examine differences by sex, oral hygiene, and current smoking status, dental caries, and periodontal health. Oral biofilm samples collected from anterior labial supragingival, posterior lingual supragingival, subgingival, and tongue sites of 841 Dunedin Multidisciplinary Health and Development Study members were analysed using checkerboard DNA-DNA hybridization; focusing on 30 ecologically important bacterial species. The four habitats exhibited distinct microbial profiles that differed by sex. Streptococcus gordonii was more dominant in supragingival and tongue biofilms of males; Porphyromonas gingivalis exhibited higher relative abundance in subgingival biofilm of females. Males had higher scores than females for periodontal pathogens at supragingival sites. The relative abundance of several putative caries and periodontal pathogens differed in smokers and non-smokers. With poor oral hygiene significantly higher proportions of Gram-negative facultative anaerobes were present in subgingival biofilm and there were higher scores for the principal components characterised by putative cariogenic and periodontal pathogens at each site. Distinctive microenvironments shape oral biofilms and systematic differences exist by sex, oral hygiene, and smoking status.
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Affiliation(s)
- Angela M L Benn
- Faculty of Dentistry, University of Otago, Sir John Walsh Research Institute, Dunedin, New Zealand.,Oral Health Services, Southern District Health Board, Dunedin, New Zealand
| | - Nicholas C K Heng
- Faculty of Dentistry, University of Otago, Sir John Walsh Research Institute, Dunedin, New Zealand
| | - W Murray Thomson
- Faculty of Dentistry, University of Otago, Sir John Walsh Research Institute, Dunedin, New Zealand
| | - Chris H Sissons
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Lisa S Gellen
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Andrew R Gray
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Jonathan M Broadbent
- Faculty of Dentistry, University of Otago, Sir John Walsh Research Institute, Dunedin, New Zealand
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23
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Thomson WM. Editorial. Gerodontology 2021; 39:223. [PMID: 34825403 DOI: 10.1111/ger.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ha DH, Spencer AJ, Moynihan P, Thomson WM, Do LG. Excess Risk of Dental Caries from Higher Free Sugars Intake Combined with Low Exposure to Water Fluoridation. J Dent Res 2021; 100:1243-1250. [PMID: 33899569 DOI: 10.1177/00220345211007747] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- D H Ha
- School of Dentistry, Faculty of Health Sciences, University of Queensland, Herston, Queensland, Australia.,Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia
| | - A J Spencer
- School of Dentistry, Faculty of Health Sciences, University of Queensland, Herston, Queensland, Australia
| | - P Moynihan
- Adelaide Dental School, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | | | - L G Do
- School of Dentistry, Faculty of Health Sciences, University of Queensland, Herston, Queensland, Australia.,Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia
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Smith L, Smith M, Thomson WM. Recommendations for improving dental care for dentate home-based older people: A qualitative New Zealand study. Gerodontology 2021; 39:187-196. [PMID: 33817899 DOI: 10.1111/ger.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE A small number of national studies have explored the barriers to older people accessing dental care; however, to date none have investigated older people's recommendations for overcoming these barriers. METHODS Semi-structured interviews were conducted with 40 dentate older people (65 years and over) who resided in New Zealand's Otago region and received home-support. A joint inductive thematic analysis was undertaken, based on the constant comparative method. RESULTS Recommendations for boosting community-dwelling older people's access to dental care included publicly funding or subsiding the cost of dental care for older people, aligning the pension with the real cost of living, and making the environment at Work and Income less hostile and the emergency dental grant more readily available, making dental clinics more accessible, initiating domiciliary dental care, having mobile dental clinics visit neighbourhoods with high proportions of older people, as well as subsidised transport to the dental clinic. Other suggestions were having GPs, pharmacists and social workers emphasise oral health during appointments, along with dental education campaigns. CONCLUSION In order to boost the rates of dental care access among older New Zealanders who receive home support, multiple structural changes are necessary, but these should primarily focus on reducing the cost and increasing accessibility.
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Affiliation(s)
- Lee Smith
- Whitireia WelTec, Lower Hutt, New Zealand
| | - Moira Smith
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - W Murray Thomson
- Department of Oral Sciences/Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand
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Elliott ML, Caspi A, Houts RM, Ambler A, Broadbent JM, Hancox RJ, Harrington H, Hogan S, Keenan R, Knodt A, Leung JH, Melzer TR, Purdy SC, Ramrakha S, Richmond-Rakerd LS, Righarts A, Sugden K, Thomson WM, Thorne PR, Williams BS, Wilson G, Hariri AR, Poulton R, Moffitt TE. Disparities in the pace of biological aging among midlife adults of the same chronological age have implications for future frailty risk and policy. Nat Aging 2021; 1:295-308. [PMID: 33796868 PMCID: PMC8009092 DOI: 10.1038/s43587-021-00044-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/10/2021] [Indexed: 02/07/2023]
Abstract
Some humans age faster than others. Variation in biological aging can be measured in midlife, but the implications of this variation are poorly understood. We tested associations between midlife biological aging and indicators of future frailty-risk in the Dunedin cohort of 1037 infants born the same year and followed to age 45. Participants' Pace of Aging was quantified by tracking declining function in 19 biomarkers indexing the cardiovascular, metabolic, renal, immune, dental, and pulmonary systems across ages 26, 32, 38, and 45 years. At age 45 in 2019, participants with faster Pace of Aging had more cognitive difficulties, signs of advanced brain aging, diminished sensory-motor functions, older appearance, and more pessimistic perceptions of aging. People who are aging more rapidly than same-age peers in midlife may prematurely need supports to sustain independence that are usually reserved for older adults. Chronological age does not adequately identify need for such supports.
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Affiliation(s)
- Maxwell L. Elliott
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Renate M. Houts
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Antony Ambler
- King’s College London, Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & Neuroscience, London, UK
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Robert J. Hancox
- Department of Preventive and Social Medicine, Otago Medical School, University of Otago, New Zealand
| | - HonaLee Harrington
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Sean Hogan
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Ross Keenan
- Brain Research New Zealand-Rangahau Roro Aotearoa, Centre of Research Excellence, Universities of Auckland and Otago, New Zealand
- Christchurch Radiology group, Christchurch, New Zealand
| | - Annchen Knodt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Joan H. Leung
- School of Psychology, University of Auckland, New Zealand
- Eisdell Moore Centre, University of Auckland, New Zealand
| | - Tracy R. Melzer
- Brain Research New Zealand-Rangahau Roro Aotearoa, Centre of Research Excellence, Universities of Auckland and Otago, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Suzanne C. Purdy
- Brain Research New Zealand-Rangahau Roro Aotearoa, Centre of Research Excellence, Universities of Auckland and Otago, New Zealand
- School of Psychology, University of Auckland, New Zealand
- Eisdell Moore Centre, University of Auckland, New Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Antoinette Righarts
- Department of Preventive and Social Medicine, Otago Medical School, University of Otago, New Zealand
| | - Karen Sugden
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | | | - Peter R. Thorne
- Brain Research New Zealand-Rangahau Roro Aotearoa, Centre of Research Excellence, Universities of Auckland and Otago, New Zealand
- Eisdell Moore Centre, University of Auckland, New Zealand
- School of Population Health, University of Auckland, New Zealand
| | | | - Graham Wilson
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Ahmad R. Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Terrie E. Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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Boyd DH, Zhang Y, Smith L, Adam L, Foster Page L, Thomson WM. Caregivers' Understanding of Informed Consent in a Randomized Control Trial. J Bioeth Inq 2021; 18:141-150. [PMID: 33449316 DOI: 10.1007/s11673-020-10085-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/29/2020] [Indexed: 06/12/2023]
Abstract
There are differences in caregivers' literacy and health literacy levels that may affect their ability to consent to children participating in clinical research trials. This study aimed to explore the effectiveness, and caregivers' understandings, of the process of informed consent that accompanied their child's participation in a dental randomized control trial (RCT). Telephone interviews were conducted with a convenience sample of ten caregivers who each had a child participating in the RCT. Pre-tested closed and open-ended questions were used, and the findings were produced from an inductive analysis of the latter and a descriptive analysis of the former. Participants had limited understanding of the purpose of the RCT and rated the readability of the consent form more highly than they rated their understanding of the research. All felt that informed consent was vital, but some caregivers had not read the consent documents. Some caregivers enrolled their child in the RCT because they trusted the researchers, and the majority wanted to improve dental care for children. The informed consent process was not always effective despite high readability of the informed consent documents. Researchers must consider the health literacy of the study group, and actively engaging with caregivers to achieve meaningful informed consent may be challenging. Future research could explore participants' perspectives of informed consent in populations with low health literacy and assess whether an underlying expectation not to comprehend health-related information may be a barrier to informed consent.
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Affiliation(s)
- Dorothy Helen Boyd
- Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand.
| | - Yinan Zhang
- Stratford Dental, 82 Miranda Street, Taranaki, Stratford District, 4332, New Zealand
| | - Lee Smith
- Wellington Institute of Technology, Private Bag 39803, Wellington Mail Centre, Lower Hutt, 5045, New Zealand
| | - Lee Adam
- Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand
| | - L Foster Page
- Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand
| | - W M Thomson
- Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand
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Jamieson L, Kearns C, Ankeny R, Hedges J, Thomson WM. Neoliberalism and Indigenous oral health inequalities: a global perspective. Community Dent Health 2021; 38:44-47. [PMID: 33507648 DOI: 10.1922/cdh_00159jamieson04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Neoliberalism is the dominant ideology underpinning the operation of many governments. Its tenets include policies of economic liberalization such as privatization, deregulation, free trade and reduced public expenditures on infrastructure and social services. Champions of neoliberalism claim that expansion of global trade has rescued millions from abject poverty and that direct foreign investment successfully transfers technology to developing economies. However, critics have urged governments to pay greater attention to how neoliberalism shapes population health. Indigenous populations experience inequalities in ways that are unique and distinct from the experiences of other marginalised groups. This is largely due to colonial influences that have resulted in sustained loss of lands, identity, languages and the control to live life in a traditional, cultural way that is meaningful. Oral health is simultaneously a reflection of material circumstances, structural inequities and access to health services. Indigenous populations carry a disproportionate burden of oral health inequalities at a global level. In this commentary, we contend that neoliberalism has overwhelmingly contributed to these inequities in three ways: (1) increased dominance of transnational corporations; (2) privatization of health and; (3) the neoliberal emphasis on personal responsibility.
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Affiliation(s)
- L Jamieson
- Adelaide Dental School, University of Adelaide, Australia
| | - C Kearns
- School of Dentistry, UCSF, United States
| | - R Ankeny
- School of Humanities, History Department, University of Adelaide, Australia
| | - J Hedges
- Adelaide Dental School, University of Adelaide, Australia
| | - W M Thomson
- School of Dentistry, University of Otago, New Zealand
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29
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Riordain RN, Glick M, Mashhadani SSAA, Aravamudhan K, Barrow J, Cole D, Crall JJ, Gallagher JE, Gibson J, Hegde S, Kaberry R, Kalenderian E, Karki A, Celeste RK, Listl S, Myers SN, Niederman R, Severin T, Smith MW, Murray Thomson W, Tsakos G, Vujicic M, Watt RG, Whittaker S, Williams DM. Developing a Standard Set of Patient-centred Outcomes for Adult Oral Health - An International, Cross-disciplinary Consensus. Int Dent J 2021; 71:40-52. [PMID: 33616051 PMCID: PMC9275363 DOI: 10.1111/idj.12604] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To develop a minimum Adult Oral Health Standard Set (AOHSS) for use in clinical practice, research, advocacy and population health. Materials and methods An international oral health working group (OHWG) was established, of patient advocates, researchers, clinicians and public health experts to develop an AOHSS. PubMed was searched for oral health clinical and patient-reported measures and case-mix variables related to caries and periodontal disease. The selected patient-reported outcome measures focused on general oral health, and oral health-related quality of life tools. A consensus was reached via Delphi with parallel consultation of subject matter content experts. Finally, comments and input were elicited from oral health stakeholders globally, including patients/consumers. Results The literature search yielded 1,453 results. After inclusion/exclusion criteria, 959 abstracts generated potential outcomes and case-mix variables. Delphi rounds resulted in a consensus-based selection of 80 individual items capturing 31 outcome and case-mix concepts. Global reviews generated 347 responses from 87 countries, and the patient/consumer validation survey elicited 129 responses. This AOHSS includes 25 items directed towards patients (including demographics, the impact of their oral health on oral function, a record of pain and oral hygiene practices, and financial implications of care) and items for clinicians to complete, including medical history, a record of caries and periodontal disease activity, and types of dental treatment delivered. Conclusion In conclusion, utilising a robust methodology, a standardised core set of oral health outcome measures for adults, with a particular emphasis on caries and periodontal disease, was developed.
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Affiliation(s)
- Richeal Ni Riordain
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; University College London, London, UK; University College Cork, Cork, Ireland.
| | - Michael Glick
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; FDI Vision 2020 Think Tank, Geneva, Switzerland; School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Krishna Aravamudhan
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; American Dental Association, Chicago, IL, USA
| | - Jane Barrow
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; Harvard School of Dental Medicine, Boston, MA, USA
| | - Deborah Cole
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; Dental Health Services Victoria, Melbourne, Vic., Australia
| | - James J Crall
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; UCLA School of Dentistry, Los Angeles, CA, USA
| | - Jennifer E Gallagher
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; King's College London, London, UK
| | - Jacqui Gibson
- ICHOM Adult Oral Health Working Group, Boston, MA, USA
| | - Shalika Hegde
- Dental Health Services Victoria, Melbourne, Vic., Australia
| | | | - Elsbeth Kalenderian
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; UCSF School of Dentistry, San Francisco, CA, USA
| | - Anup Karki
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; Public Health Wales, Cardiff, UK
| | - Roger Keller Celeste
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; Federal University of Rio Grande do Sol, Porto Alegre, Grande do Sul, Brazil
| | - Stefan Listl
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; FDI Vision 2020 Think Tank, Geneva, Switzerland; Department of Conservative Dentistry, Heidelberg University Clinics, Heidelberg, Germany; Department of Dentistry - Quality and Safety of Oral Health Care, Radboud University - Radboudumc (RIHS), Nijmegen, The Netherlands
| | - Stacie N Myers
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, MA, USA
| | - Richard Niederman
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; NYU College of Dentistry, New York, NY, USA
| | - Tania Severin
- FDI World Dental Federation (FDI), Geneva, Switzerland
| | - Mark W Smith
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; Hospitals Contribution Fund, Sydney, NSW, Australia
| | - W Murray Thomson
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; University of Otago, Dunedin, New Zealand
| | - Georgios Tsakos
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; University College London, London, UK; FDI Vision 2020 Think Tank, Geneva, Switzerland
| | - Marko Vujicic
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; American Dental Association, Chicago, IL, USA
| | - Richard G Watt
- University College London, London, UK; FDI Vision 2020 Think Tank, Geneva, Switzerland
| | - Sarah Whittaker
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, MA, USA
| | - David M Williams
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; FDI Vision 2020 Think Tank, Geneva, Switzerland; Bart's and The London, School of Medicine and Dentistry, Queen Mary, University of London, London, UK
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Abstract
BACKGROUND Dentistry is predominantly provided in a commercial context in Australia. Despite this, little is known about how dentists navigate potential tensions that may arise between commercial and professional obligations in private dental practice. This analysis uses a qualitative approach to explore dentists' perceptions and attitudes toward the commercialized nature of private dental practice and how these affect their professional role in providing care. METHODS Participants were recruited by advertising on social media, as well as through a professional association and a corporate dental group's graduate training program. Data were collected from participants through interviews and written reflections. The data were subjected to thematic analysis to reveal deeper meanings and linkages between different emergent themes. RESULTS Twenty dentists who worked in private practice environments were recruited to take part. The analysis revealed the following themes within the data: dentistry devalued, commercial influences on professional behavior, the effect of advertising and competition on dentistry, ethical selling, and the impacts of commercialism on consumers of dentistry. CONCLUSIONS Consumers of dentistry may only be superficially empowered by the commercialized context of private dental practice. Empowerment to decide which services to access and from whom does not address the inherent disparities that exist within the dentist-patient clinical relationship. Advertising and the active "selling" of oral health services are all designed to create dental consumers, not to empower them. While advertising might assist patients to understand available treatments, the primary objective of marketing is not health education. Increasing competition and consumer choice within dentistry may help to empower consumers of dental services but only if the dentist-patient relationship remains founded in altruistic intent, with the doctrine of "caveat emptor" (buyer beware) having no place within dentistry. KNOWLEDGE TRANSFER STATEMENT This research provides novel insights into how dentists experience the commercial context of private dental practice and how this is perceived to be both beneficial and detrimental to the consumers of dental services. This work will help to guide policy development to address the commercial determinants of oral health generated by the nature of commercialized dental practice environments.
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Affiliation(s)
- A C L Holden
- The University of Sydney School of Dentistry, Westmead, NSW, Australia
| | - L Adam
- The University of Otago Faculty of Dentistry, Dunedin, New Zealand
| | - W M Thomson
- The University of Otago Faculty of Dentistry, Dunedin, New Zealand
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31
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Holden ACL, Adam L, Thomson WM. Overtreatment as an ethical dilemma in Australian private dentistry: A qualitative exploration. Community Dent Oral Epidemiol 2020; 49:201-208. [PMID: 33131127 DOI: 10.1111/cdoe.12592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/08/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The phenomenon of overtreatment in dentistry is under-explored and has not been the subject of much research inquiry. Most dental care in Australia is provided by practitioners in private dental practice. This research expands understanding of how the nexus between professionalism and commercialism in dentistry is impacted by the phenomenon of overtreatment. METHODS Data were collected through recorded interviews and written reflections from private dentists working in the Australian context. The data were then examined using thematic analysis to understand common themes and reveal deeper insights. RESULTS A total of 20 participants were recruited for this study. Participants spoke of their experiences in practice where financial targets and pressure from practice owners to provide high-cost treatments presented challenges to their professionalism. The participants expressed that the way in which dentistry is remunerated based on activity was a motivation towards engaging in overtreatment. The participants also spoke of finding a balance between commercialism and professionalism within private dental practice. CONCLUSIONS Participants' reports provided insights into how the mismanagement of the commercial elements of private dental practice led to a transactional ('buyer beware') relationship between the consumers and providers of dental services, rather than a relationship founded upon professional altruism and trust. Consumer empowerment through the commercialization of dentistry has potential to be a positive influence on the patient experience in accessing dental care. However, this research has shown that the shift of power through consumerism also risks attenuating professional appreciation of the imbalanced nature of the patient-clinician relationship in dentistry.
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Affiliation(s)
| | - Lee Adam
- The University of Otago Faculty of Dentistry, Dunedin, New Zealand
| | - W Murray Thomson
- The University of Otago Faculty of Dentistry, Dunedin, New Zealand
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Do LG, Ha DH, Bell LK, Devenish G, Golley RK, Leary SD, Manton DJ, Thomson WM, Scott JA, Spencer AJ. Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) birth cohort study: cohort profile. BMJ Open 2020; 10:e041185. [PMID: 33099500 PMCID: PMC7590353 DOI: 10.1136/bmjopen-2020-041185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The long-term goal of the Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) birth cohort study is to identify and evaluate the relative importance and timing of critical factors that shape the oral health of young children. It will then evaluate those factors in their inter-relationship with socioeconomic influences. PARTICIPANTS SMILE is a single-centre study conducted in Adelaide, Australia. All newborns at the main three public hospitals between July 2013 and August 2014 were eligible for inclusion. The final recruited sample at birth was 2181 mother/infant dyads. Participants were followed up with questionnaires when the child was 3 and 6 months of age, and 1, 2 and 5 years of age. Oral epidemiological examinations and anthropometric assessments were conducted at age 2 and 5 years. FINDINGS TO DATE SMILE has contributed comprehensive data on dietary patterns of young children. Intakes of free sugars, core and discretionary foods and drinks have been detailed. There was a sharp increase in free sugars intake with age. Determinants of dietary patterns, oral health status and body weight during the first 5 years of life have been evaluated. Socioeconomic characteristics such as maternal education and household income and area-level socioeconomic profile influenced dietary patterns and oral health behaviours and status. FUTURE PLAN Funding has been obtained to conduct oral epidemiological examinations and anthropometric assessments at age 7-8 years. Plans are being developed to follow the cohort into adolescent years.
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Affiliation(s)
- Loc G Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Diep H Ha
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucinda K Bell
- Nutrition, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Gemma Devenish
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | - David J Manton
- Centrum voor Tandheelkunde en Mondzorgkunde, UMCG, Groningen, The Netherlands
| | | | - Jane A Scott
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - A John Spencer
- University of Adelaide, Adelaide, South Australia, Australia
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MacEntee MI, Brondani M, Avivi-Arber L, Bartlett D, Donnelly L, Duyck J, Hori K, Karve A, Persson GR, Kettratad-Pruksapong M, Schimmel M, Hon-Ching So F, Thomson WM, Yoon MN, Wyatt C. Clinical Oral Disorders in Adults Screening Protocol (CODA-SP) from the 2019 Vancouver IADR Consensus Symposium. Gerodontology 2020; 38:5-16. [PMID: 33009707 DOI: 10.1111/ger.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs. METHODS Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence. RESULTS Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP). CONCLUSIONS The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure.
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Affiliation(s)
| | | | | | | | | | | | | | - Avanti Karve
- University of Sydney, Camperdown, NSW, Australia
| | | | | | | | | | | | | | - Chris Wyatt
- University of British Columbia, Vancouver, BC, Canada
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Abstract
Dementia is a major contributor to dependence and disability in older people, with aging societies characterized by growing numbers of people living with the condition. Dementia rates are highest in those with low education early in life, midlife hypertension, midlife hearing loss, depression, obesity, loneliness, a sedentary lifestyle, or sustained exposure to smoking or diabetes. Tooth loss is a putative risk factor for dementia which has received increasing research attention, but systematic review findings are mixed. Three main mechanisms have been proposed, involving 1) tooth loss leading to compromised nutrition and then leading to poorer central nervous system (CNS) function; 2) tooth loss resulting in fewer interocclusal contacts and so less somatosensory feedback to the CNS, leading to impaired cognition; and (3) chronic periodontitis resulting in tooth loss, but not before the inflammation has affected the CNS, impairing cognition. None of these is supported by compelling empirical evidence. Here, we use the life course approach to propose a plausible, empirically supported explanation for the associations between missing teeth and poorer cognitive function in older people. Evidence from longstanding cohort studies demonstrates that the putative association arises from cognitive function much earlier in life, in childhood. People with better childhood cognitive function have better oral health and access to routine dental care as they go through life, losing fewer teeth along the life course. They are also much more likely to have better cognitive function in old age. Their less cognitively able childhood counterparts will experience higher disease rates and poorer access to care, resulting in greater incremental tooth loss. Comparison of the 2 groups at any age from the mid-20s on will show greater numbers of missing teeth in the group who were less cognitively able in childhood. Those differences will be most pronounced in old age.
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Affiliation(s)
- W M Thomson
- Department of Oral Sciences, Sir John Walsh Research Institute, School of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Y Barak
- Department of Psychological Medicine, Dunedin School of Medicine, The University of Otago, Dunedin, New Zealand
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Abstract
OBJECTIVE To describe the prevalence and impact of dental anxiety in the New Zealand adult population. METHODS Secondary analysis of data from the 2009 New Zealand national oral health survey. Dental anxiety was measured using the Dental Anxiety Scale (DAS). RESULTS The prevalence of dental anxiety was 13.3% (95% CI = 11.4, 15.6). On average, DAS scores were higher by 14% among females, lower among those in the oldest age group (55+), higher by 10% among those in the European/Other ethnic category, and higher by 10% among those residing in the most deprived neighbourhoods. Those who were dentally anxious had greater oral disease experience and were less likely to have visited a dentist within the previous 12 months. They also had poorer oral health-related quality of life, with the highest prevalence of OHIP-14 impacts observed in dentally anxious 35- to 54-year-olds. CONCLUSIONS Dental anxiety is a dental public health problem. It is an important contributor to poor oral health and care avoidance among New Zealanders. There is a need to develop both clinical and population-level interventions aimed at reducing the condition's prevalence and impact.
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Affiliation(s)
- Ishani Sukumaran
- Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Shay Taylor
- Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - W. Murray Thomson
- Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
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36
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Hariyani N, Do LG, Spencer AJ, Thomson WM, Scott JA, Ha DH. Maternal caries experience influences offspring's early childhood caries-a birth cohort study. Community Dent Oral Epidemiol 2020; 48:561-569. [PMID: 32776590 DOI: 10.1111/cdoe.12568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/04/2020] [Accepted: 07/24/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe early childhood caries (ECC) patterns and evaluate the associations with maternal caries experience and other factors. METHODS A secondary analysis was undertaken using data from the Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE), a population-based birth cohort study. It used data from 1040 mother/child dyads. Standardized oral examinations of the mothers and the children were conducted when children were 2-3 years old to determine the prevalence of ECC (main outcome) and maternal caries experience (main exposure variable). Maternal sociodemographic characteristics, time-restricting conditions (relationship status, work status and number of children in the household) and dental health behaviours (brushing frequency and sugary beverage consumption) served as covariates. Data on child dental health behaviours were collected at two years of age. Multivariable models were generated for ECC to estimate prevalence ratios (PR) for the association between ECC and maternal caries experience, controlling for the covariates. RESULTS The prevalence of ECC among 2- to 3-year-old children was 10.6% (95%CI: 8.7%-12.5%). It was higher in children whose mothers had greater caries experience. Children whose mothers had higher caries experience had 86% (PR = 1.86 [1.27-2.72]) greater risk of having ECC than those whose mothers had low caries experience. Children whose teeth had not been brushed the night before had a higher risk of ECC (PR = 1.4 [1.01-1.9]) than their counterparts. Women born in Australia, New Zealand or the UK had offspring with lower risk of ECC. CONCLUSIONS Maternal caries experience was an independent risk factor for offspring ECC. However, good oral health behaviours practised by mothers for their children may alleviate such risk. Mothers need to be supported to adopt good oral health behaviours and a healthy diet for their child.
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Affiliation(s)
- Ninuk Hariyani
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Loc G Do
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - A John Spencer
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Jane A Scott
- School of Public Health, Curtin University, Perth, Australia
| | - Diep H Ha
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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Horne PE, Foster Page LA, Leichter JW, Knight ET, Thomson WM. Psychosocial aspects of periodontal disease diagnosis and treatment: A qualitative study. J Clin Periodontol 2020; 47:941-951. [PMID: 32426880 DOI: 10.1111/jcpe.13309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/29/2022]
Abstract
AIMS Patient-reported outcomes have attracted interest as there has been a shift from clinician-centric endpoints. This qualitative study aimed to develop an understanding of the psychosocial impact of periodontitis and its treatment. MATERIALS AND METHODS Fourteen adults were asked to document their experiences of untreated periodontitis and non-surgical periodontal therapy at a university clinic, using written or audio-recorded diaries. The diary data were then used as a framework for semi-structured qualitative interviews, conducted at the completion of initial non-surgical treatment. Inductive thematic content data analysis was employed. RESULTS Three themes illustrated the detrimental impact of periodontitis: "concealment," "having a guilty conscience" and "patient comfort as paramount." These were related to a core underlying concept, "progression to a more positive outlook," which described a distinct shift in participants' attitudes and optimism after their periodontal treatment. Despite finding treatment unpleasant, the participants described profound positive influences on their social well-being, self-esteem, mood, work, relationships and outlook. CONCLUSIONS This study illustrated the broad psychosocial impact of periodontitis. The findings suggest that the benefits of periodontal treatment extend beyond improvements in traditional biomedical indicators to those which are more relevant and desirable to patients.
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Affiliation(s)
- Poppy E Horne
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand
- Auckland Periodontics and Implants, Auckland, New Zealand
| | - Lyndie A Foster Page
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand
- Defence Health Directorate, New Zealand Defence Force, Wellington, New Zealand
| | - Jonathan W Leichter
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand
| | - Ellie T Knight
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand
| | - W Murray Thomson
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand
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Peres KG, Thomson WM, Chaffee BW, Peres MA, Birungi N, Do LG, Feldens CA, Fontana M, Marshall TA, Pitiphat W, Seow WK, Wagner Y, Wong HM, Rugg-Gunn AJ. Oral Health Birth Cohort Studies: Achievements, Challenges, and Potential. J Dent Res 2020; 99:1321-1331. [PMID: 32680439 DOI: 10.1177/0022034520942208] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Birth cohorts are those among observational studies that provide understanding of the natural history and causality of diseases since early in life. Discussions during an International Association for Dental Research symposium in London, United Kingdom, in 2018, followed by a workshop in Bangkok, Thailand, in 2019, concluded that there are few birth cohort studies that consider oral health and that a broader discussion on similarities and differences among those studies would be valuable. This article aims to 1) bring together available long-term data of oral health birth cohort studies from the low, middle, and high-income countries worldwide and 2) describe similarities and differences among these studies. This work comprises 15 studies from all 5 continents. The most studied dental conditions and exposures are identified; findings are summarized; and methodological differences and similarities among studies are presented. Methodological strengths and weaknesses are also highlighted. Findings are summarized in 1) the negative impact of detrimental socioeconomic status on oral health changes over time, 2) the role of unfavorable patterns of dental visiting on oral health, 3) associations between general and oral health, 4) nutritional and dietary effects on oral health, and 5) intergenerational influences on oral health. Dental caries and dental visiting patterns have been recorded in all studies. Sources of fluoride exposure have been documented in most of the more recent studies. Despite some methodological differences in the way that the exposures and outcomes were measured, some findings are consistent. Predictive models have been used with caries risk tools, periodontitis occurrence, and permanent dentition orthodontic treatment need. The next steps of the group's work are as follows: 1) establishing a consortium of oral health birth cohort studies, 2) conducting a scoping review, 3) exploring opportunities for pooled data analyses to answer pressing research questions, and 4) promoting and enabling the development of the next generation of oral health researchers.
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Affiliation(s)
- K G Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore.,Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore
| | - W M Thomson
- Department of Oral Sciences, Sir John Walsh Research Institute, School of Dentistry, The University of Otago, Dunedin, New Zealand
| | - B W Chaffee
- Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA
| | - M A Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore.,Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore
| | - N Birungi
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - L G Do
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - C A Feldens
- Lutheran University of Brazil, Canoas, Brazil
| | - M Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - T A Marshall
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - W Pitiphat
- Chronic Inflammatory Diseases and Systemic Diseases Associated with Oral Health Research Group, and Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - W K Seow
- School of Dentistry, The University of Queensland, Brisbane, Australia
| | - Y Wagner
- Department of Orthodontics, Jena University Hospital, Jena, Germany
| | - H M Wong
- Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
| | - A J Rugg-Gunn
- The Borrow Foundation, Waterlooville, UK.,School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Innes NPT, Chu CH, Fontana M, Lo ECM, Thomson WM, Uribe S, Heiland M, Jepsen S, Schwendicke F. A Century of Change towards Prevention and Minimal Intervention in Cariology. J Dent Res 2020; 98:611-617. [PMID: 31107140 DOI: 10.1177/0022034519837252] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Better understanding of dental caries and other oral conditions has guided new strategies to prevent disease and manage its consequences at individual and public health levels. This article discusses advances in prevention and minimal intervention dentistry over the last century by focusing on some milestones within scientific, clinical, and public health arenas, mainly in cariology but also beyond, highlighting current understanding and evidence with future prospects. Dentistry was initially established as a surgical specialty. Dental caries (similar to periodontitis) was considered to be an infectious disease 100 years ago. Its ubiquitous presence and rampant nature-coupled with limited diagnostic tools and therapeutic treatment options-meant that these dental diseases were managed mainly by excising affected tissue. The understanding of the diseases and a change in their prevalence, extent, and severity, with evolutions in operative techniques, technologies, and materials, have enabled a shift from surgical to preventive and minimal intervention dentistry approaches. Future challenges to embrace include continuing the dental profession's move toward a more patient-centered, evidence-based, less invasive management of these diseases, focused on promoting and maintaining oral health in partnership with patients. In parallel, public health needs to continue to, for example, tackle social inequalities in dental health, develop better preventive and management options for existing disease risk groups (e.g., the growing aging population), and the development of reimbursement and health outcome models that facilitate implementation of these evolving strategies. A century ago, almost every treatment involved injections, a drill or scalpel, or a pair of forceps. Today, dentists have more options than ever before available to them. These are supported by evidence, have a minimal intervention focus, and result in better outcomes for patients. The profession's greatest challenge is moving this evidence into practice.
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Affiliation(s)
- N P T Innes
- 1 School of Dentistry, University of Dundee, Dundee, UK
| | - C H Chu
- 2 Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - M Fontana
- 3 Cariology and Restorative Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - E C M Lo
- 2 Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - W M Thomson
- 4 Department of Oral Sciences, School of Dentistry, University of Otago, Dunedin, New Zealand
| | - S Uribe
- 5 School of Dentistry, Universidad Austral de Chile, Valdivia, Chile
| | - M Heiland
- 6 Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Jepsen
- 7 Periodontology, Operative, and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - F Schwendicke
- 8 Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Boyd DH, Thomson WM, Leon de la Barra S, Fuge KN, van den Heever R, Butler BM, Leov F, Foster Page LA. A Primary Care Randomized Controlled Trial of Hall and Conventional Restorative Techniques. JDR Clin Trans Res 2020; 6:205-212. [PMID: 32559403 DOI: 10.1177/2380084420933154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate treatment outcomes of different restorative techniques undertaken by dental therapists for primary molar carious lesions in a sample of children in New Zealand primary care. METHODS This was a randomized controlled trial with children aged 3 to 8 y in New Zealand's Whanganui region. Children meeting inclusion criteria were randomly allocated to treatment with either the Hall technique (HT), in which a stainless-steel crown (SSC) is placed without any carious tissue removal or tooth preparation, or a non-Hall conventional restorative approach (NHT), including tooth preparation with selective carious tissue removal; this included SSC, amalgam, composite, or glass ionomer cement (GIC) restorations. Restorative outcomes after 12 and 24 mo were categorized as success, minor failure, or major failure. RESULTS Of the 295 eligible children, 149 and 146 were allocated to the HT and NHT groups, respectively, with a total of 570 carious primary molars treated by 13 dental therapists. The participant follow-up rates at 12 and 24 mo were 95% and 91%. SSCs were the most commonly used restoration in the NHT group (60%), followed by GIC (28%). SSCs were the most successful restorations regardless of whether they were placed with the HT or NHT, with success rates of 89% and 92% at 12 mo and 85% and 86% at 24 mo. In the NHT group, the treatment material was a predictor of minor failure at 12 and 24 mo, with significantly more failures with GICs. CONCLUSIONS SSCs placed by dental therapists are a highly successful restoration for the primary dentition, regardless of whether they are placed with the HT or conventionally. The high failure rate of glass ionomer restorations means that they cannot be recommended for widespread use in New Zealand primary care (Australian New Zealand Clinical Trials Registry, ACTRN12614000844640). KNOWLEDGE TRANSFER STATEMENT The findings of this study can be used by policy makers and clinicians when deciding on which materials and which approach to use to maximize success and to minimize retreatment rates when providing restorative treatment for carious primary molars in children's primary oral health care. Results also suggest that undertaking research in the primary care setting may enhance translation of new knowledge and techniques into clinicians' hands.
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Affiliation(s)
- D H Boyd
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - W M Thomson
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - S Leon de la Barra
- Consulting biostatistician, Waitaki Community Gardens, Oamaru, New Zealand
| | - K N Fuge
- Wellington Regional Dental Service, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | | | - B M Butler
- Dental Department, MidCentral District Health Board, Palmerston North, New Zealand
| | - F Leov
- Waikato District Health Board, Hamilton, New Zealand
| | - L A Foster Page
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
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Bahho LA, Thomson WM, Foster Page LA, Drummond BK. Dental trauma experience and oral-health-related quality of life among university students. Aust Dent J 2020; 65:220-224. [PMID: 32348559 DOI: 10.1111/adj.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to investigate the impact of self-reported dental trauma on oral-heath-related quality of life (OHRQoL) of young adults and determine whether personality characteristics influenced how it was reported. METHOD A cross-sectional study was carried out using a sample of 435 university students. A questionnaire sought data on previous dental trauma. OHRQoL was assessed using the short-form of the oral health impact profile (OHIP-14); the outcome being one or more impacts occurring 'fairly often'/'very often'. Personality was assessed using the Positive and Negative Affect Scale (PANAS). RESULTS The participation rate was 87.2%. Dental trauma experience was reported by 110 participants (25.3%), and 242 (55.6 %) indicated previous dental caries experience. Among those with dental trauma history, one or more OHIP-14 impacts was reported by 29.1% (with 21.2% among those with no history). Impact prevalence was higher among those who had previous dental caries experience (29.8%) than among those who had not (14.7%; P < 0.001). Higher PANAS negative affect scores were observed among those reporting one or more OHIP-14 impacts (P < 0.001). CONCLUSION While dental trauma does not appear to have a negative impact on OHRQoL in young adults, past dental caries experience does. Negative emotionality influences self-reported oral health.
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Affiliation(s)
- L A Bahho
- University of Otago Faculty of Dentistry, Dunedin, New Zealand
| | - W M Thomson
- Department of Oral Sciences, University of Otago, Faculty of Dentistry, Dunedin, New Zealand
| | - L A Foster Page
- Dental Public Health, Department of Oral Sciences, University of Otago Faculty of Dentistry, Dunedin, New Zealand.,Defence Health Directorate, New Zealand Defence Force, Wellington, New Zealand
| | - B K Drummond
- Paediatric Dentistry, Department of Oral Sciences, University of Otago Faculty of Dentistry, Dunedin, New Zealand.,Department of Paediatric Dentistry, University of Leeds School of Dentistry, Leeds, UK
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Bridgman JB, Fulton G, Lou SMY, Thomson WM, Goss AN. The New Zealand oral and maxillofacial surgeon workforce in 2017-18: characteristics, practice and prospects. N Z Med J 2020; 133:11-22. [PMID: 32325464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM To describe and consider the findings of a workforce survey of New Zealand Oral and Maxillofacial Surgeons (OMS) which was conducted in 2017-18, and to compare those to findings from a similar survey undertaken in 2001. METHODS A questionnaire was used to obtain information on the qualifications, sociodemographic characteristics and and practising circumstances of all practising OMS in New Zealand. Data were analysed using SPSS (version 24). After the computation of descriptive statistics, cross-tabulations were used to identify differences in proportions (with those tested for statistical significance using Chi-squared tests), and analysis of variance was used to examine differences in means. RESULTS All 39 OMS took part. There were 17 medically qualified surgeons who also held a surgical fellowship, comprising just under half of the workforce. Overall, one in eight surgeons worked solely in the public sector, while just under one-quarter worked solely in private; the remainder worked in both sectors. Dentoalveolar procedures were by far the most common undertaken (with considerably more done by older surgeons than younger ones), followed by implants, the treatment of facial trauma, skin lesions and surgery for malignancy. Orthognathic surgery and dentoalveolar trauma procedures were the least commonly reported. Only two-thirds of surgeons participated in public on-call work. While 95% of surgeons were indeed satisfied with their work, the lowest rate was observed among those working solely in the public sector, where it was 80%; among those working exclusively in private, it was 100%. Between 2001 and 2017-18, the proportion of medically qualified surgeons rose from just over one-quarter to more than two-thirds. The proportion of surgeons working solely in private practice rose from one in seven to almost one-quarter. There were marked increases in the mean number of malignancies dealt with and implants provided. CONCLUSION The findings highlight a number of problems-some long-standing, others emerging-in New Zealand's OMS system. Fewer surgeons are participating in public sector provision and there is stress on those who remain. Workforce planners should be aware that more resources need to be put into training surgeons who will take up hospital appointments and provide essential after-hours emergency services.
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Affiliation(s)
| | | | | | - W Murray Thomson
- Professor of Dental Epidemiology and Public Health, Faculty of Dentistry, The University of Otago, Dunedin
| | - Alastair N Goss
- Emeritus Professor of Oral and Maxillofacial Surgery, The University of Adelaide, Adelaide, Australia
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Wang MT, Thomson WM, Craig JP. Association between symptoms of xerostomia and dry eye in older people. Cont Lens Anterior Eye 2020; 43:99-102. [DOI: 10.1016/j.clae.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 08/21/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022]
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Devenish G, Mukhtar A, Begley A, Spencer AJ, Thomson WM, Ha D, Do L, Scott JA. Early childhood feeding practices and dental caries among Australian preschoolers. Am J Clin Nutr 2020; 111:821-828. [PMID: 32047898 DOI: 10.1093/ajcn/nqaa012] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/21/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Recent reviews have proposed a causal relationship between prolonged breastfeeding and early childhood caries (ECC), but the evidence to date is inconsistent, with few cohort studies and limited investigation of key confounders. OBJECTIVE This study aimed to investigate the relationship between dietary practices and early childhood caries in a birth cohort of Australian preschoolers. METHODS Participants underwent a standardized dental examination at 2-3 y of age to determine the prevalence of ECC (based on the presence of decayed, missing, or filled tooth surfaces). Breastfeeding practices were reported at 3, 6, 12, and 24 mo of age. Intakes of free sugars were assessed at 1 and 2 y of age. Multivariable regression models generated prevalence ratios (PR) for the association between ECC and breastfeeding duration, and between ECC and sleep feeding practices at 1 y, controlling for sociodemographic factors and free sugars intake. RESULTS There was no independent association between breastfeeding beyond 1 y of age and ECC (PR 1.42, 95% CI: 0.85, 2.38), or between breastfeeding to sleep and ECC (PR 1.12, 95% CI: 0.67, 1.88), although the direction of effect was suggestive of an association. The only factors independently associated with ECC were high free sugars intakes (PR 1.97, 95% CI: 1.13, 3.44), and greater socioeconomic disadvantage (PR 2.15, 95% CI: 1.08, 4.28). Most participants who were breastfed at 1 y of age had ceased by 18 mo or 2 y. CONCLUSIONS Breastfeeding practices were not associated with ECC. Given the wide-ranging benefits of breastfeeding, and the low prevalence of sustained breastfeeding in this study and Australia in general, recommendations to limit breastfeeding are unwarranted, and breastfeeding should be promoted in line with global and national recommendations. To reduce the prevalence of early childhood caries, improved efforts are needed to limit foods high in free sugars.
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Affiliation(s)
- Gemma Devenish
- School of Public Health, Curtin University, Perth, Australia
| | - Aqif Mukhtar
- School of Public Health, Curtin University, Perth, Australia
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, Australia
| | - A John Spencer
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - W Murray Thomson
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - Diep Ha
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - Loc Do
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - Jane A Scott
- School of Public Health, Curtin University, Perth, Australia
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Broadbent JM, Murray CM, Schwass DR, Brosnan M, Brunton PA, Lyons KS, Thomson WM. The Dental Amalgam Phasedown in New Zealand: A 20-year Trend. Oper Dent 2020; 45:255-264. [PMID: 31995425 DOI: 10.2341/19-024-c] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Information on the choice of material and performance of restorations placed in a dental practice annually is limited. The Minamata Convention on Mercury is likely to affect the use of amalgam worldwide. The objective of this research was to investigate the use of restorative materials at the University of Otago Faculty of Dentistry in New Zealand from 1998 to 2017. METHODS Data from the Faculty of Dentistry's database from the years of interest were compiled. These data included information on the characteristics of restorations, including information on the material used and number of surfaces involved for each restoration. The tooth in which each restoration was placed was categorized by arch, tooth type, and deciduous or permanent dentition. RESULTS Records identified 227,514 permanent restorations placed from January 1998 to December 2017, of which 91.7% were direct restorations. Among direct restorations, composite resin was the most commonly used material, followed by amalgam, glass ionomer, and compomer. The use of amalgam for direct restorations decreased from 52.3% of direct restorations in 1998 to 7.1% in 2017. A corresponding increase was observed in the use of tooth-colored direct restorations, particularly composites. Among indirect restorations, porcelain fused to metal, gold, and stainless steel (in pediatric applications) were the materials most frequently used. CONCLUSIONS Despite having no official policy on reducing the use of dental amalgam, the Faculty of Dentistry is following the global trend in reducing its use, with composite resin now well established as the predominant restorative material used. If the current rate of decline persists unchecked, the Faculty of Dentistry could transition to being amalgam free by 2020, although it seems likely that the characteristics and principles of use of the material (and its removal) will be taught for some time to come. This knowledge is important to planning curriculum changes needed to prepare graduates for clinical practice.
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Rasmussen LJH, Caspi A, Ambler A, Broadbent JM, Cohen HJ, d’Arbeloff T, Elliott M, Hancox RJ, Harrington H, Hogan S, Houts R, Ireland D, Knodt AR, Meredith-Jones K, Morey MC, Morrison L, Poulton R, Ramrakha S, Richmond-Rakerd L, Sison ML, Sneddon K, Thomson WM, Hariri AR, Moffitt TE. Association of Neurocognitive and Physical Function With Gait Speed in Midlife. JAMA Netw Open 2019; 2:e1913123. [PMID: 31603488 PMCID: PMC6804027 DOI: 10.1001/jamanetworkopen.2019.13123] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Gait speed is a well-known indicator of risk of functional decline and mortality in older adults, but little is known about the factors associated with gait speed earlier in life. OBJECTIVES To test the hypothesis that slow gait speed reflects accelerated biological aging at midlife, as well as poor neurocognitive functioning in childhood and cognitive decline from childhood to midlife. DESIGN, SETTING, AND PARTICIPANTS This cohort study uses data from the Dunedin Multidisciplinary Health and Development Study, a population-based study of a representative 1972 to 1973 birth cohort in New Zealand that observed participants to age 45 years (until April 2019). Data analysis was performed from April to June 2019. EXPOSURES Childhood neurocognitive functions and accelerated aging, brain structure, and concurrent physical and cognitive functions in adulthood. MAIN OUTCOMES AND MEASURES Gait speed at age 45 years, measured under 3 walking conditions: usual, dual task, and maximum gait speeds. RESULTS Of the 1037 original participants (91% of eligible births; 535 [51.6%] male), 997 were alive at age 45 years, of whom 904 (90.7%) had gait speed measured (455 [50.3%] male; 93% white). The mean (SD) gait speeds were 1.30 (0.17) m/s for usual gait, 1.16 (0.23) m/s for dual task gait, and 1.99 (0.29) m/s for maximum gait. Adults with more physical limitations (standardized regression coefficient [β], -0.27; 95% CI, -0.34 to -0.21; P < .001), poorer physical functions (ie, weak grip strength [β, 0.36; 95% CI, 0.25 to 0.46], poor balance [β, 0.28; 95% CI, 0.21 to 0.34], poor visual-motor coordination [β, 0.24; 95% CI, 0.17 to 0.30], and poor performance on the chair-stand [β, 0.34; 95% CI, 0.27 to 0.40] or 2-minute step tests [β, 0.33; 95% CI, 0.27 to 0.39]; all P < .001), accelerated biological aging across multiple organ systems (β, -0.33; 95% CI, -0.40 to -0.27; P < .001), older facial appearance (β, -0.25; 95% CI, -0.31 to -0.18; P < .001), smaller brain volume (β, 0.15; 95% CI, 0.06 to 0.23; P < .001), more cortical thinning (β, 0.09; 95% CI, 0.02 to 0.16; P = .01), smaller cortical surface area (β, 0.13; 95% CI, 0.04 to 0.21; P = .003), and more white matter hyperintensities (β, -0.09; 95% CI, -0.15 to -0.02; P = .01) had slower gait speed. Participants with lower IQ in midlife (β, 0.38; 95% CI, 0.32 to 0.44; P < .001) and participants who exhibited cognitive decline from childhood to adulthood (β, 0.10; 95% CI, 0.04 to 0.17; P < .001) had slower gait at age 45 years. Those with poor neurocognitive functioning as early as age 3 years had slower gait in midlife (β, 0.26; 95% CI, 0.20 to 0.32; P < .001). CONCLUSIONS AND RELEVANCE Adults' gait speed is associated with more than geriatric functional status; it is also associated with midlife aging and lifelong brain health.
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Affiliation(s)
- Line Jee Hartmann Rasmussen
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
- Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Antony Ambler
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Harvey J. Cohen
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Tracy d’Arbeloff
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Maxwell Elliott
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Robert J. Hancox
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - HonaLee Harrington
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Sean Hogan
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Renate Houts
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - David Ireland
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Annchen R. Knodt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Kim Meredith-Jones
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Miriam C. Morey
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, North Carolina
| | - Lynda Morrison
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Leah Richmond-Rakerd
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill
| | - Maria L. Sison
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Kate Sneddon
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - W. Murray Thomson
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - Ahmad R. Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Terrie E. Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
- Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
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Affiliation(s)
- Syahirah Abd Aziz
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand
| | - Syazirah Kuan
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand
| | - Emily Jin
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand
| | - Carolina Loch
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand
| | - W. Murray Thomson
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand
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Thomson WM. Themed issue on child oral health. Community Dent Oral Epidemiol 2019; 46:425. [PMID: 30240047 DOI: 10.1111/cdoe.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Polonowita AD, Thomson WM, Thorburn DN. Clinical efficacy of a simplified approach to managing chronic temporomandibular disorders: evidence from a 1-year case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:227-234. [PMID: 31285165 DOI: 10.1016/j.oooo.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 05/26/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Chronic temporomandibular disorder (cTMD) produces orofacial pain and limited jaw function and impacts on quality of life. A clinical case series of patients referred to a hospital specialist service is described here. STUDY DESIGN In a 1-year consecutive case series of 162 patients with cTMDs, each patient had been managed with self-awareness and jaw exercises, as well as oral appliances. Pain severity and chewing function were scored by using a visual analogue scale (VAS), and quality of life was assessed by using the Oral Health Impact Profile-Temporomandibular Dysfunction (OHIP-TMD). RESULTS Females comprised 87% (average age 49 years). Treatment time averaged 20.8 months, and the average pain duration was 2.8 years. The mean VAS pain score fell from 6.9 (standard deviation [SD] 1.6) to 2.0 (SD 1.9) after treatment, giving a "large" effect size of 3.1. Chewing difficulty improvement also showed a "large" effect size (2.5). For the 33 patients for whom longitudinal OHIP-TMD data were available, the mean pretreatment and posttreatment scores of 51.2 (SD 20.9) and 26.2 (SD 17.7) showed a "large" effect size of 1.2. CONCLUSIONS A simple noninvasive protocol for managing cTMD with self-help, exercises, and oral devices resulted in clinically and statistically meaningful improvements in pain, function, and quality of life.
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Affiliation(s)
- Ajith D Polonowita
- Oral Medicine Specialist, Christchurch Hospital, NZ; Head of Discipline in Oral Medicine, The University of Otago, Dunedin, New Zealand.
| | - W Murray Thomson
- Professor of Dental Epidemiology and Public Health, The University of Otago, Dunedin, New Zealand
| | - Dennis N Thorburn
- Formerly Oral Medicine specialist, Christchurch Hospital, New Zealand
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Abstract
In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk-assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio-economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach.
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Affiliation(s)
- Ellie T Knight
- Sir John Walsh Research Institute, Department of Oral Sciences, School of Dentistry, The University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Sir John Walsh Research Institute, Department of Oral Sciences, School of Dentistry, The University of Otago, Dunedin, New Zealand
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