Abstract –  Objectives:  Efficiency is concerned with producing maximum output with the minimum input, although what constitutes inputs and outputs within an organization is not always clear. Labour substitution is one method of achieving efficiency gains, although cost savings are found to be context dependent and may not be achieved in some situations. Because dental therapists (DTs) in England are permitted to work in dental practices, we set out to investigate how efficiency with respect to the use of DTs is conceptualized by practitioners to deepen our understanding of the potential for substitution to realize efficiency gains in dental practice.

Methods:  Nine dental practices were selected using a purposive sampling methodology to give a range of practice size and DT employment arrangements. Semi-structured interviews were held with 26 dentists. Transcripts were coded and analysed thematically.

Results:  Efficiency was perceived as optimum use of surgery time to generate intermediate outputs of (i) managing patient flow to give patient satisfaction and business cash flow and (ii) volume of work (procedures and numbers of patients). DT efficiency gains were evaluated according to whether lower labour costs were offset by a slower working pace and higher rate of failed appointments. Patient need and demand, and whether the practice had health improvement goals, influenced whether DTs were deemed to improve efficiency.

Conclusions:  Findings are in accord with skill mix reviews in wider health care that substitution may be effective in improving efficiency but this may be limited to particular situations where conditions are conducive. More studies are needed to explore these issues further in other dental practice contexts and with other groups of dental auxiliary.

Abstract –  Objectives:  To assess the impact of children’s dental caries (DC) and traumatic dental injuries (TDI) on parents’ quality of life (QoL), adjusted by family income.

Methods:  Parents of 219 children aged 5 and 6 years answered the Family Impact Scale (FIS) on their perception of QoL and data about income. Three calibrated dentists examined the severity of DC according to decayed, missing and filled permanent teeth index, and children were categorized into: 0 = caries free; 1–5 = low severity; and ≥6 = high severity. TDI were classified into uncomplicated and complicated injuries. QoL was measured through FIS items and total score, and Poisson regression was used to associate the variables with the outcome.

Results:  Severity of DC showed a negative impact on the total score and subscales on parental/family activities, parental emotions and financial burden (P < 0.001). TDI showed a negative impact on total score and in some FIS items. The multivariate-adjusted model showed that only the increase in the severity of children’s DC (RR = 3.19; 95% CI = 2.36, 4.31; P < 0.001) was associated with a greater negative impact on parents’ QoL, while high family income was a protective factor (RR = 0.68; 95% CI = 0.48, 0.95; P < 0.001).

Conclusions:  The severity of children’s DC has a negative impact on parents’ QoL, whereas TDI do not. A lower family income might have a negative impact on parents’ QoL.

Abstract –   Objectives:  The aim of this study was to describe the effect of income on demand and utilization of dental services according to household income in the adult population.

Methods:  The data were collected using a questionnaire, which was sent to a random sample of Norwegians aged 20 years or older living at home, 1861 persons in total. Demand was measured according to whether the person had been to the dentist during the last year. Utilization was measured as expenditure for dental treatment for those who had been to the dentist during the last year. The independent variables were the respondents’ household income, age, gender, education, dental status and the mean fee for a dental consultation in the municipality. In the first stage, we carried out a logistic regression analysis of the log odds of having demanded dental services during the last year. In the second stage, we carried out a multiple regression analysis of expenditure for dental treatment for those who had been to the dentist during the last year.

Results:  Altogether, 80% of the respondents had been to the dentist during the last year. Demand during the last year varied most according to dental status. There was little difference between men and women. The results of the logistic regression showed that the probability of having been to the dentist was 0.82 for those with a household income of €25 000 and 0.85 for those with a household income of €100 000. Mean expenditure for dental treatment was €355. There was no statistically significant relationship between household income and expenditure for dental treatment.

Conclusions:  Differences in demand for dental services according to household income are small, and there are no differences in utilization according to income. The findings are interesting, because in a population in which people have to pay almost all the costs for dental treatment themselves, one would expect the income differences in demand and utilization to be greater.

Abstract –  Objectives:  The most effective method to prevent caries is the regular use of fluoride toothpaste. The aim of this study was to evaluate self-care routines in a population by identifying knowledge, attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits.

Methods:  A questionnaire was sent to 3200 individuals in two municipalities in Sweden. Four age groups representing different life stages were chosen: 15–16, 31–35, 61–65 and 76–80 years of age. The participants were selected from the population register by random selection of birth dates.

Results:  Totally 2023 (63%) individuals answered the questionnaire. The majority (84–94%) in all age groups brushed their teeth twice a day or more often. Good toothpaste behaviour identified as brushing at least twice a day, using at least 1 cm toothpaste, brushing 2 minutes or longer and using a small amount of water when rinsing was reported by only 10% of the respondents. The factors that increased the odds for having good caries-preventive behaviour were: (i) being female, (ii) being younger than 35 years, (iii) having knowledge about fluoride, (iv) finding use of fluoride toothpaste important and (v) rating own oral health as good.

Conclusions:  The population seems to have embraced regular toothbrushing with fluoride toothpaste to a large extent. However, regarding techniques for using fluoride toothpaste effectively, there was great potential for improvement, especially among the older respondents.

Abstract –  Objectives:  Few prospective studies have investigated the impacts of socio-behavioural position throughout adolescence on self-reported oral health in young adulthood. This study aimed to describe the development of oral health behaviours between age 15 years (1992) and age 30 years (2007) and to assess how changes in or stability of socio-behavioural characteristics during that period influences the oral impacts on daily performance (OIDP) and satisfaction with teeth assessed at age 30.

Methods:  Self-administered questionnaires were included as part of a prospective cohort study. In 1992, a representative sample of 963 15-year-old adolescents participated in the study; 627 (64%) and 532 (55.2%) remained in the study at ages 23 and 30, respectively. A total of 394 (40.9% of baseline sample) participated at ages 15, 23 and 30.

Results:  Cochrane’s Q revealed that the proportions of individuals who were frequent performers regarding flossing, intake of nonsugared mineral water and use of snuff increased whereas the proportions who were frequent performers regarding consumption of sugared mineral water decreased in subjects with low and high parental education and in both sexes across the survey period. Smokers increased in males and decreased in females and in subjects with low parental education. Spearman’s rank-order correlation ranged from 0.19 (nonsugared mineral water) to 0.36 (smoking). Multiple logistic regression analysis showed that participants with a stable advantaged socio-behavioural position were less likely to report OIDP at age 30. Participants with a stable disadvantaged socio-behavioural position were more likely to report OIDP at age 30. Participants who were stable satisfied with their health and who changed educational status were more likely to be satisfied with their teeth at age 30.

Conclusions:  Oral health behaviours tracked moderately from age 15 to 30. Continuity of an advantaged or disadvantaged socio-behavioural position across the survey years contributed to differing levels of oral health. Early and contemporary public health policies that target disadvantaged socio-behavioural groups may help prevent poor oral health perceptions in young adults in Norway.

Abstract – Objectives: To determine the efficacy of 5% sodium fluoride (NaF) varnish application in reducing caries increments in the permanent dentition of rural Brazilian school children over the course of 12 months.

Methods:  A double-blind, randomized, placebo-controlled trial was conducted with 379 children aged 7–14 years who attended three schools in Brazil between January 2006 and December 2007. During this period, each school was visited four times at 6-month interval for recruitment, dental examinations, and fluoride varnish applications. Recruited children were randomly assigned to either a treatment (5% NaF varnish, n = 198) or a control group (placebo, n = 181). Trained interviewers collected data on oral health habits and sociodemographic characteristics from the children. Information on the child’s diet was collected through a 7-day food frequency diary. Caries examinations were conducted using the International Caries Detection and Assessment System (ICDAS). The efficacy of fluoride varnish application on caries prevention was reported as a preventive fraction (PF). Crude caries increments of decayed and filled surfaces (DFS) were compared between fluoride varnish and placebo groups. A generalized linear model (GLM) was constructed to test the differences in DFS increments between the groups after accounting for confounding factors.

Results:  Of the total sample (N = 379), 210 (55.4%) children had completed 12 months of follow-up including one or two applications of fluoride varnish or placebo. At the baseline examination, the children in the treatment and control groups presented on average 6.2 and 5.6 DFS, respectively (P < 0.001). After 12 months of follow-up, the children in the varnish group showed significantly lower DFS increments than did children in the control group (10.8 versus 13.3; P < 0.007), with PF of 40% (95% CI: 34.3–45.7%; P < 0.0001).

Conclusions:  The results of this study suggest that applications of 5% NaF varnish can be recommended as a public health measure for reducing caries incidence in this high-caries-risk population.

Abstract –  Objectives:  In clinical practice, a visual–tactile caries examination is frequently supplemented by bitewing radiography. This study evaluated strategies for combining visual–tactile and radiographic caries detection methods and determined their implications for clinical management decisions in a low-caries population.

Methods:  Each of four examiners independently examined preselected contacting interproximal surfaces in 53 dental students aged 20–37 years using a visual–tactile examination and bitewing radiography. The visual–tactile examination distinguished between noncavitated and cavitated lesions while the radiographic examination determined lesion depth. Direct inspection of the surfaces following tooth separation for the presence of cavitated or noncavitated lesions was the validation method. The true-positive rate (i.e. the sensitivity) and the false-positive rate (i.e. 1-specificity) were calculated for each diagnostic strategy.

Results:  Visual–tactile examination provided a true-positive rate of 34.2% and a false-positive rate of 1.5% for the detection of a cavity. The combination of a visual–tactile and a radiographic examination using the lesion in dentin threshold for assuming cavitation had a true-positive rate of 76.3% and a false-positive rate of 8.2%. When diagnostic observations were translated into clinical management decisions using the rule that a noncavitated lesion should be treated nonoperatively and a cavitated lesion operatively, our results showed that the visual–tactile method alone was the superior strategy, resulting in most correct clinical management decisions and most correct decisions regarding the choice of treatment.

Abstract –  The most common way of presenting data from studies using quality of life or patient-based outcome (PBO) measures is in terms of mean scores along with testing the statistical significance of differences in means. We argue that this is insufficient in and of itself and call for a more comprehensive and thoughtful approach to the reporting and interpretation of data. PBO scores (and their means for that matter) are intrinsically meaningless, and differences in means between groups mask important and potentially different patterns in response within groups. More importantly, they are difficult to interpret because of the absence of a meaningful benchmark. The minimally important difference (MID) provides that benchmark to assist interpretability. This commentary discusses different approaches (distribution-based and anchor-based) and specific methods for assessing the MID in both longitudinal and cross-sectional studies, and suggests minimum standards for reporting and interpreting PBO measures in an oral health context.

Abstract – Objectives:  Elderly people with disabilities have an increased risk of developing oral diseases as compared with the healthy elderly. The aim of this study was to investigate oral hygiene habits, clinical variables related to oral self-care and caries risk in elderly individuals living at home with moderate and substantial needs of home care.

Methods:  A random sample of 151 elderly people with moderate needs and 151 with substantial needs of home care were examined. Data concerning general health, social conditions and oral hygiene habits were collected using a questionnaire. Data showing the prevalence of caries, plaque scores and gingival bleeding were obtained through clinical examinations.

Results:  Elderly subjects with substantial needs of home nursing had more active caries (P < 0.01) and more often gingival bleeding (P < 0.05), as compared with elderly people with moderate needs. Forty-nine per cent of the elderly with moderate needs performed acceptable self-care, as compared with 25% of the individuals with substantial needs. Good self-care was associated with women, low plaque scores, less bleeding and less caries. Factors increasing the risk of having caries were low saliva secretion, high plaque scores and a large number of fillings, while having a dentist and good oral hygiene habits increased the chance of not developing caries.

Conclusions:  Good oral hygiene habits were associated with less prevalence of plaque and oral disease in the elderly irrespective of extent of needs of home nursing. However, the elderly with moderate needs more often performed good self-care, indicating that the possibilities of strengthening self-care and learning new routines are better when functions are less affected.

Abstract –  Objectives:  Oral condition could be associated with cognitive impairment, but this is not yet well documented. We therefore hypothesized that people with poor oral condition would be more at risk to develop dementia. The objective of this study thus was to describe the oral condition of French community-dwelling elderly persons and to assess its relationship with the occurrence of dementia.

Methods:  Oral examination was conducted on a sample of individuals aged 66–80 years followed-up prospectively for screening of dementia over 15 years in Gironde, France. Univariate and multivariate analyses of the risk of dementia were performed using a Cox proportional hazard model with delayed entry.

Results:  Data from 405 individuals were analyzed; 45.4% men; median age at baseline: 70 years [interquartile range (IQR): 68–75]. The median number of decayed, missing, and filled teeth was 18 (IQR: 13–24) and was higher in women (median: 20 versus 17, P = 0.004) and in persons with lower school level (median: 21 versus 17, P = 0.003). Among 348 persons with sextant eligible for periodontal assessment, 2/3 required periodontal care: 5.2% had bleeding observed, 44.8% calculus, 17.8% 4–5 mm pockets, and 2.9%≥6 mm pockets. The incidence of dementia during a median follow-up of 10 years (IQR: 6.5–13.7) was 19 per 1000 person-years. The adjusted hazard ratio for a number of missing teeth≥11 (median) on the risk of dementia was 1.13 (95% confidence interval, CI = [0.60–2.12]) in people with higher education (n = 312) and 0.30 (CI = 0.11–0.79) in persons with lower school level (n = 93) (P for modification effect = 0.0002).

Conclusions:  Having eleven or more missing teeth seemed to be associated with a lower risk of dementia in people with lower education possibly owing to the suppression of source of chronic inflammation.

Abstract –  Objectives:  The aim of the present study was to assess the psychometric properties and level of agreement between the self-administered and interviewer-administered Child Perceptions Questionnaire (CPQ) for children between 8 and 10 years of age (CPQ_8–10) and between 11 and 14 (CPQ_11–14) years of age.

Methods:  A randomized cross-over study was carried out, involving 180 children (Group 1 – 90 children between 8 and 10; Group 2 – 90 children between 11 and 14 years of age) in the state of Minas Gerais, Brazil. All children completed both administration modes of the CPQ; half of each group received interviewer-administered mode first [Subgroup A (CPQ_8–10n = 45) and Subgroup C (CPQ_11–14n = 45)], and the other half performed the self-administered mode first [Subgroup B (CPQ_8–10n = 45) and Subgroup D (CPQ_11–14n = 45)]. Test–retest reliability of each mode of administration was tested on 60 children (30 for CPQ_8–10; 30 for CPQ_11–14), who were not included in the other analyses. The level of agreement between scores on the self-administered and interviewer-administered versions of the CPQ_8–10 and CPQ_11–14 was established using the intraclass correlation coefficient (ICC). The order of presentation of both instruments was tested considering the four subgroups (A, B, C and D). The calculation of effect size proposed by Cohen (1992) was used to test the clinical significance of the findings.

Results:  Both the self-administered and interviewer-administered versions of CPQ_8–10 and CPQ_11–14 demonstrated acceptable psychometric properties. Agreement between the administration modes for the CPQ_8–10 and CPQ_11–14 was 0.90 and 0.88 (ICC), respectively. With the exception of the functional limitation subscale, the scores of the subscales and overall score on the CPQ_8–10 were significantly higher in the group of children who responded to the interviewer-administered measure first. With the CPQ_11–14, statistically significant differences were found only for the emotional well-being subscale.

Conclusions:  Both administration modes of the CPQ_8–10 and CPQ_11–14 demonstrated satisfactory psychometric properties and a high level of agreement. Although statistically significant differences were observed for oral symptoms, emotional well-being and social well-being, with the first administration of the interviewer-administered version, the effect of the order of administration had small to medium effects on the CPQ scores.

Abstract –  Objectives:  Previous studies have found an association between bruxism and emotional and behavioral problems in children, but reported data are inconsistent. The objective of this study was to estimate the prevalence of bruxism, and of its components clenching and grinding, and its associations with mental problems and depression.

Methods:  Data from two Brazilian birth cohorts were analyzed: one from 869 children in Ribeirão Preto – RP (São Paulo), a more developed city, and the other from 805 children in São Luís – SL (Maranhão). Current bruxism – evaluated by means of a questionnaire applied to the parents/persons responsible for the children – was defined when the habit of tooth clenching during daytime and/or tooth grinding at night still persisted until the time of the assessment. Additionally, the lifetime prevalence of clenching during daytime only and grinding at night only was also evaluated. Mental health problems were investigated using the Strength and Difficulties Questionnaire (SDQ) and depression using the Children’s Depression Inventory (CDI). Analyses were carried out for each city: with the SDQ subscales (emotional symptoms, conduct problems, peer problems, attention/hyperactivity disorder), with the total score (sum of the subscales), and with the CDI. These analyses were performed considering different response variables: bruxism, clenching only, and grinding only. The risks were estimated using a Poisson regression model. Statistical inferences were based on 95% confidence intervals (95% CI).

Results:  There was a high prevalence of current bruxism: 28.7% in RP and 30.0% in SL. The prevalence of clenching was 20.3% in RP and 18.8% in SL, and grinding was found in 35.7% of the children in RP and 39.1% in SL. Multivariable analysis showed a significant association of bruxism with emotional symptoms and total SDQ score in both cities. When analyzed separately, teeth clenching was associated with emotional symptoms, peer problems, and total SDQ score; grinding was significantly associated with emotional symptoms and total SDQ score in RP and SL. Female sex appeared as a protective factor for bruxism, and for clenching and grinding in RP. Furthermore, maternal employment outside the home and white skin color of children were associated with increased prevalence of teeth clenching in SL.

Conclusions:  Mental health problems were associated with bruxism, with teeth clenching only and grinding at night only. No association was detected between depression and bruxism, neither clenching nor grinding. But it is necessary to be cautious regarding the inferences from some of our results.

Abstract –  Objective:  To appropriately explore risk factors for tooth loss operating at the tooth-level, subject-related factors and a hierarchical data structure have to be considered. The purpose of this study was to evaluate tooth-related and subject-related risk factors affecting tooth loss.

Methods:  A 10-year longitudinal survey was carried out on 286 elderly subjects. At baseline, the prosthodontic status and abutment function of the 5574 teeth were recorded. Tooth loss was defined as the main outcome variable, and a multilevel logistic regression model considering subject and tooth levels was applied.

Results:  Tooth loss was found in 75% of subjects and most frequently in molars. A multivariable, multilevel logistic regression revealed that the following tooth-related variables were significantly related to tooth loss over 10 years: maxillary teeth, multirooted teeth, single crowns, abutment teeth for a fixed/removable partial denture (FPD/RPD), and periodontally involved teeth. Among them, single crowns, abutment teeth for an FPD, and teeth with severe periodontal disease at baseline had the highest odds of 5.1, 6.0, and 7.1, respectively.

Conclusions:  The findings of this study suggest that tooth loss is the result of complex interactions of tooth-related factors. Several tooth-related variables including multirooted teeth, abutments, and single crowns were found to be possible risk factors for tooth loss. Thus, these findings confirm and underline the potential benefit of minimizing prosthetic treatment of molars.

Abstract –  Objective:  To study the cost-effectiveness of four alternative treatments for burning mouth syndrome (BMS).

Methods:  A cost-effectiveness analysis was conducted from a healthcare payer perspective of four therapy strategies (amisulpride, paroxetine, sertraline and topical clonazepam), using a decision-tree model that incorporated direct healthcare costs and probabilities associated with the possible events and outcomes. Average cost-effectiveness and incremental cost-effectiveness ratios were calculated. Sensitivity analyses included the costs of brand name and generic drugs in five European countries (France, Italy, the Netherlands, Spain and UK), as well as two scenarios with different treatment length.

Results:  Of the drugs analysed, topical clonazepam proved to be the most cost-effective therapy. Although generic proved more efficient than brand name drugs, they displayed no advantage over brand name topical clonazepam. The Netherlands was the country with the highest overall drug efficiency. Sensitivity analyses highlighted the robustness of the model, because topical clonazepam proved to be the most efficient therapy under all the different scenarios.

Conclusions:  Topical clonazepam, which previous analyses of clinical evidence have shown to be the drug of choice for BMS, also proved to be the most cost-effective of the drugs analysed for this condition.

Abstract –  Objective:  To analyse the relationship between caries determinants in early childhood and caries prevalence in proximal surfaces in adolescents at the age of 15 years.

Methods:  The present longitudinal study is part of a series of surveys of oral health in 671 children followed from 1 to 15 years of age. Data were selected from examinations, interviews and questionnaires at 1, 3 and 6 years and bitewing radiographs at 15 years of age. Uni- and multivariable logistic regression analyses were performed to identify caries-related determinants. The outcome variable was carious lesions and fillings (DFa) in approximal tooth surfaces at 15 years of age. Statistical comparisons were made between caries-free teenagers, DFa = 0 and teenagers with DFa > 0, DFa ≥ 4 and DFa ≥ 8, respectively.

Results:  In the final logistic regression analyses, caries experience at 6 years and mother’s self-estimation of her oral health care as being less good to poor remained statistically significant and were related to caries in all three caries groups (i.e. DF > 0, ≥4 and ≥8) at 15 years of age. The consumption of sweets at 1 year remained statistically significant, with a caries experience of DF ≥ 4 and ≥ 8. The variables ‘parents born abroad’ and female gender were statistically significantly associated with DFa ≥ 4 and DFa ≥ 8, respectively. Furthermore, infrequent toothbrushing habits at 3 years of age and failure to attend the examination at 1 year were statistically significantly associated with caries at 15 years in the univariable analyses.

Conclusion:  Early caries experience, consumption of sweets at an early age and mother’s self-estimation of her oral health care as being less good to poor are associated with approximal caries in adolescents. The study indicates that caries determinants identified during early childhood have a strong impact on approximal caries in adolescence.

Abstract –  Objectives:  To assess whether the effect of providing mothers with guidance during pregnancy and when the child was 6 and 12 months old, which had drastically reduced the prevalence of early childhood caries at 20 months of age, would be sustained at 6–7 years of age.

Methods:  Children, whose mothers had been enrolled in a randomized controlled trial during pregnancy and a comparison group of similar school children, were examined for the presence of caries by the South Australian School Dental Services (SA SDS) at 6–7 years of age.

Results:  Of 625 eligible trial participants, 277 (44%) participated in the follow-up and dental records were available for 187 of them (30%). Loss to follow-up and reasons for it were similar in the intervention and control groups. At 6–7 years of age, 33% of children in the trial had caries compared with 42% in the SA SDS comparison group (n = 263). All measures of caries severity (d₃mft, d₃mfs and SiC₃₀) were lower, but not significantly so, in the intervention than in the control group. Children in the comparison group of school children had more severe caries than those in the trial (P < 0.01) and in the intervention group especially (P < 0.005). Children in both randomized groups suffered significantly less toothache than those in the comparison group (P < 0.001).

Conclusions:  Providing new mothers with guidance on caries prevention helps to reduce early childhood caries and has a sustainable effect up to school age.

Abstract –  Context:  The effects of the oral health status of one generation on that of the next within families are unclear.

Objectives:  To determine whether parental oral health history is a risk factor for oral disease.

Methods:  Oral examination and interview data were collected during the age-32 assessments in the Dunedin Study. Parental data were also collected on this occasion. The sample was divided into two familial-risk groups for caries/tooth loss (high risk and low risk) based on parents’ self-reported history of tooth loss at the age-32 assessment interview.

Main outcome measures:  Probands’ dental caries and tooth loss status at age 32, together with lifelong dental caries trajectory (age 5–32).

Results:  Caries/tooth loss risk analysis was conducted for 640 proband-parent groups. Reference groups were the low-familial-risk groups. After controlling for confounding factors (sex, episodic use of dental services, socio-economic status and plaque trajectory), the prevalence ratio (PR) for having lost 1+ teeth by age 32 for the high-familial-risk group was 1.41 [95% confidence interval (CI) 1.05, 1.88] and the rate ratio for DMFS at age 32 was 1.41 (95% CI 1.24, 1.60). In the high-familial-risk group, the PR of following a high caries trajectory was 2.05 (95% CI 1.37, 3.06). Associations were strongest when information was available about both parents’ oral health. Nonetheless, when information was available for one parent only, associations were significant for some outcomes.

Conclusions:  People with poor oral health tend to have parents with poor oral health. Family/parental history of oral health is a valid representation of the intricacies of the shared genetic and environmental factors that contribute to an individual’s oral health status. Associations are strongest when data from both parents can be obtained.

Abstract –  Objectives:  A few studies have revealed the impact of neighborhood social capital on oral health among young people. We sought to examine the associations of social capital in three settings (families, neighborhoods, and schools) with self-rated oral health among a sample of college students in Japan.

Methods:  Cross-sectional survey of 967 students in Okayama University, aged 18 and 19 years, was carried out. Logistic regression was used to examine the associations of poor self-rated oral health with perceptions of social capital, adjusting for self-perceived household income category and oral health behaviors.

Results:  The prevalence of subjects with poor self-rated oral health was 22%. Adjusted for gender, self-perceived household income category, dental fear, toothbrush frequency, and dental floss use, poor self-rated oral health was significantly associated with lower level of neighborhood trust [odds ratio (OR) 2.22; 95% confidence interval (CI): 1.40–3.54] and lower level of vertical trust in school (OR 1.71; 95% CI: 1.05–2.80). Low informal social control was unexpectedly associated with better oral health (OR 0.54; 95% CI: 0.34–0.85).

Conclusions:  The association of social capital with self-rated oral health is not uniform. Higher trust is associated with better oral health, whereas higher informal control in the community is associated with worse oral health.

Abstract –  Objectives:  This study examined edentulism trends among adults aged 50 and above in five ethnic groups in the United States: Asians, African Americans, Hispanics, Native Americans, and non-Hispanic Caucasians.

Methods:  Data came from the National Health Interview Surveys between 1999 and 2008. Respondents included 616 Native Americans, 2,666 Asians, 15,295 African Americans, 13,068 Hispanics, and 86,755 Caucasians.

Results:  In 2008, Native Americans had the highest predicated rate of edentulism (23.98%), followed by African Americans (19.39%), Caucasians (16.90%), Asians (14.22%), and Hispanics (14.18%). Overall, there was a significant downward trend in edentulism rates between 1999 and 2008 (OR = 0.97, 95% CI: 0.96, 0.98). However, compared with Caucasians, Native Americans showed a significantly less decline of edentulism during this period (OR = 1.10, 95% CI: 1.02, 1.19).

Conclusions:  While there was a downward trend in edentulism between 1999 and 2008, significant variations existed across racial/ethnic groups. Innovative public health programs and services are essential to prevent oral health diseases and conditions for minority populations who lack access to adequate dental care. Additionally, given the increasing numbers of adults retaining their natural teeth, interventions designed to assist individuals in maintaining healthy teeth becomes more critical.

Listl S, Moran V, Maurer J, Faggion CM Jr. Dental service utilization by Europeans aged 50 plus. Community Dent Oral Epidemiol 2011. © 2011 John Wiley & Sons A/S

Abstract –  Objective:  The purpose of this study is to examine the associations among depression, anxiety, use of oral health services, and tooth loss.

Methods:  Data were analysed for 80 486 noninstitutionalized adults in 16 states who participated in the 2008 Behavioral Risk Factor Surveillance System. Binomial and multinomial logistic regression analyses were used to estimate predicted marginals, adjusted prevalence ratios, adjusted odds ratios (AOR) and their 95% confidence intervals (CI).

Results:  The unadjusted prevalence for use of oral health services in the past year was 73.1% [standard error (SE), 0.3%]. The unadjusted prevalence by level of tooth loss was 56.1% (SE, 0.4%) for no tooth loss, 29.6% (SE, 0.3%) for 1–5 missing teeth, 9.7% (SE, 0.2%) for 6–31 missing teeth and 4.6% (SE, 0.1%) for total tooth loss. Adults with current depression had a significantly higher prevalence of nonuse of oral health services in the past year than those without this disorder (P < 0.001), after adjustment for age, sex, race/ethnicity, education, marital status, employment status, adverse health behaviours, chronic conditions, body mass index, assistive technology use and perceived social support. In logistic regression analyses employing tooth loss as a dichotomous outcome (0 versus ≥1) and as a nominal outcome (0 versus 1–5, 6–31, or all), adults with depression and anxiety were more likely to have tooth loss. Adults with current depression, lifetime diagnosed depression and lifetime diagnosed anxiety were significantly more likely to have had at least one tooth removed than those without each of these disorders (P < 0.001 for all), after fully adjusting for evaluated confounders (including use of oral health services). The adjusted odds of being in the 1–5 teeth removed, 6–31 teeth removed, or all teeth removed categories versus 0 teeth removed category were increased for adults with current depression versus those without (AOR = 1.35; 95% CI = 1.14–1.59; AOR = 1.83; 95% CI = 1.51–2.22; and AOR = 1.44; 95% CI = 1.11–1.86, respectively). The adjusted odds of being in the 1–5 teeth removed and 6–31 teeth removed categories versus 0 teeth removed category were also increased for adults with lifetime diagnosed depression or anxiety versus those without each of these disorders.

Conclusions:  Use of oral health services and tooth loss was associated with depression and anxiety after controlling for multiple confounders.

Methods:  Data from the Third National Health and Nutritional Examination Survey (1988–1994) were used, including 2- to 5.9-year-old singletons (n = 3189). Dental caries was defined as presence of any teeth with dental caries (treated or untreated) and also as presence of at least two teeth with dental caries. Exposure variables were preterm birth (<37 gestational weeks), FGR, and SGA. Covariates included were poverty, race/ethnicity, age, sex, sucrose intake, environmental tobacco smoking, dental visits, education of head of household, breastfeeding, and use of baby bottle. Separate statistical analyses were conducted for IUGR and for preterm birth through the estimation of prevalence ratio (PR), taking complex sampling design into consideration and adjusting for confounders. Sensitivity analysis was conducted including and excluding 2-year-old children and also with the two definitions of dental caries.

Results:  In general, the inclusion of 2-year-old children and the case definition of presence of any teeth with dental caries biased the results toward the null, but with no major changes in the results. In bivariate analysis, SGA and FGR birth were both negatively but not significantly associated with dental caries while a significant positive association was found for preterm birth. Sensitivity analysis showed that the PR for preterm in bivariate analysis varied from 1.65 (95% CI 1.14–2.40) to 1.84 (95% CI 1.19–2.83). After adjusting for confounders, the PR for preterm birth varied from 1.38 (95% CI 1.00–1.89) to 1.64 (95% CI 1.22–2.20). After adjustment, the PR for SGA varied from 0.79 (95% CI 0.56–101) to 0.66 (95% CI 0.33–0.96). For children from 3 to 5.9 years old, the adjusted PR for FGR using the category ‘none’ as reference were mild (PR 1.10; 95% CI 0.76–1.58), moderate (PR 0.66; 95% CI 0.26–167), and severe (PR 0.59; 95% CI 0.36–0.99). These values for FGR were very similar for the other models using other classifications of case definition or inclusion of 2-year-old children.

Conclusions:  Preterm birth was found to be positively associated with dental caries while there is an indication that SGA and FGR are negatively associated with dental caries. Although the negative association is counterintuitive, it is possible that increased antibiotic use and delayed tooth eruption may explain the negative association between IUGR and dental caries.

Objective:  To compare sociodemographic, utilization of healthcare services and health status characteristics among Medicaid-eligible children.

Methods:  The third National Health and Nutrition Examination Survey included 2821 children 2–16 years of age eligible for Medicaid. The main outcome measures are annual physician visit, annual dentist visit, general health status, oral health status, asthma (second most common childhood disease), dental caries (most common childhood disease), asthma treatment needs, and dental treatment needs. We quantified the association of these outcome measures with Medicaid insurance status and sociodemographic status using multiple logistic regression modeling, taking into account the complex survey design and sample weights.

Results:  Among Medicaid-eligible children, 27% were uninsured. Among uninsured Medicaid-eligible children, 62% had an annual physician visit, 32% had an annual dentist visit, 10% needed asthma treatment, and 57% needed dental treatment. Among insured Medicaid-eligible children, 81% had an annual physician visit, 39% had an annual dentist visit, 13% needed asthma treatment, and 42% needed dental treatment. After simultaneously taking into account other characteristics, uninsured Medicaid-eligible children were more likely to not have an annual physician visit (OR_NoMDvisit = 2.21; 1.26–3.90), and to need dental treatment (OR_DentalNeed = 1.57; 1.13–2.18).

Conclusions:  This USA population-based study found disparities exist within Medicaid's services between utilization of dental and medical services. Medicaid insurance improved utilization of medical services, but did not improve the utilization of dental services. This suggests that Medicaid insurance does not improve access to dental services for poor children.

Methods:  A telephonic survey of 504 adult Floridians was conducted in 2004. Data collected included six measures of specific fear of dental pain, one measure of global fear of dental pain, one measure of global dental fear, and demographic information.

Results:  Women were more likely to report global dental fear, global fear of dental pain, and specific fear of dental pain than men, and both women and men were more likely to report ‘dread’ of dental pain than ‘fear’ of dental pain.

Conclusions:  Our findings suggest that: (i) there are gender differences in reports of dental fear and fear of dental pain; and (ii) both men and women are more willing to express their fearful feelings regarding dentistry using a more socially acceptable term.

Methods:  Cross-sectional data from a study of university employees in Rio de Janeiro – The Pró-Saúde Study. Self-perceived oral health and the reported pattern and frequency of visits to the dentist were obtained through a multidimensional self-administered questionnaire.

Results:  Data were obtained from 3252 participants. When compared with individuals who reported self-perceived oral health as good (‘very good’, ‘good’ or ‘fair’) individuals who reported self-perceived oral health as bad (‘bad’ or ‘very bad’) were significantly more likely to be older, male, less educated, poorer; they also reported more frequently to have lost more teeth and not visiting the dentist for routine dental ‘checkup’. Among those who reported visiting for dental checks at least annually, 3% reported bad oral health, as opposed to 15% among those who reported visiting the dentist only when in trouble. Compared with those who reported visiting the dentist at least annually, odds ratio of bad oral health was 3.9 (95% CI, 2.68–5.67) for subjects who reported visiting only when in trouble, 2.6 (95% CI, 1.51–4.62) who reported visiting for dental checks less frequently than once every 2 years, and 1.4 (95% CI, 0.77–2.52) for subjects who reported visiting for dental checks once every 2 years, after controlling for sex, age, education, income and tooth loss.

Conclusions:  Not visiting the dentist for a routine dental check increased the chance of reporting one's own oral health as bad. In any case, the habit of visiting for dental ‘checkup, once per year or once every 2 years was associated with nearly all the individuals perceiving his/her oral health positively. However, in order to gather more solid scientific data to guide public polices it is necessary to perform longitudinal studies, especially experiments in different populations focused mainly on the socioeconomic characteristics and dental clinical conditions.

Methods:  This study was implemented in 1996 and 294 ART restorations were placed in 197 children aged 12–13 years by five assistant dentists in four schools. Standard ART procedures and instruments were used combined with a high-strength glass–ionomer restorative material. One examiner evaluated the restorations annually using the ART criteria while at 5 years an independent external examiner used US Public Health Service (USPHS) criteria.

Results:  Fifty-eight per cent of the restorations were followed for 6 years. At the 6-year evaluation examination, 76% and 59% of the small and large restorations respectively were present and were without major wear or defect (P < 0.01). Similar results were obtained when using the USPHS criteria. Results of a multilevel survival analysis show that the correlation between restoration failure and operator was small but failure of restorations placed in the same child was substantial. Net wear of the small and large restorations after 6 years were 176 and 172 μm respectively (P > 0.05).

Conclusion:  The 6-year survival rate of the class I ART restorations in this study, especially the smaller ones, was satisfactory. This suggests that the ART approach can be used in the school setting to improve the oral health of large populations of underserved children.

Abstract –  Objective:  To determine how people with dental phobia rate the acceptability of behavioural therapy.

Methods:  One hundred and twenty individuals with dental phobia participated in a three-factor experimental vignette-based design. The three factors examined were dental treatment history, nature of intervention (intravenous sedation or behavioural therapy) and treatment outcome. There were eight different vignettes representing all combinations of the three experimental variables, and 15 participants completed each vignette.

Results:  Treatment outcome had a strong effect on rated acceptability (F = 115.76, P < 0.001). There was a weaker effect of treatment type (F = 5.49, P < 0.05) with behavioural therapy rated as more acceptable than intravenous sedation. Previous history of intravenous sedation was associated with a decreased perception that it is possible to overcome dental fear.

Conclusions:  The perceptions of individuals with dental phobia of the acceptability of behavioural approaches to management are influenced by the perceived outcome of the treatment.

Abstract –  Objective:  To explain the association between children’s self-perceived oral health status and dental anxiety, by considering their levels of cognitive vulnerability.

Methods:  Participants were 161 children (47.8% female; mean age = 11.93 years) who filled in a questionnaire comprising self-assessed oral health-related status, dental treatment-related cognitive vulnerability and dental anxiety measures. Gender, age and number of decayed, missing and filled permanent teeth were controlled for. Bivariate correlations, hierarchical regression analyses and structural equation modelling were conducted to test the hypotheses.

Results:  Subjective oral health status, cognitive vulnerability variables and dental anxiety were strongly correlated. Regression and structural models testing the mediating effects of cognitive vulnerability variables on the relationship between perceived oral health and dental anxiety were supported.

Conclusions:  The activation of the cognitive vulnerability schema, as a mediating variable, is a mechanism by means of which children’s self-perceptions of a poor oral health might lead to dental anxiety. Both components of vulnerability analysed (threat and disgust) contribute decisively to this potential process.

Abstract – Objectives: Dental anxiety prevalence has not changed markedly in the last 30 years, in spite of more modern and less painful technology. The objective of this study was to explore the four components (dangerousness, uncontrollability, unpredictability and disgustingness) of the Cognitive Vulnerability Model (CVM) in relation to the acquisition and maintenance of dental anxiety/phobia. Methods: Three hundred and seventy-five participants were recruited through two dental anxiety online support groups. They completed an online questionnaire which included: a formal dental anxiety measure; open-ended questions regarding the perceived origins of their dental anxiety, and questions specifically assessing the CVM components in the acquisition and maintenance of their fear. Results: Perceptions of the dental context as uncontrollable and unpredictable were considered important in fear acquisition, however ‘dangerousness’ was not as fully established and ‘disgustingness’ was not considered salient by participants. Three of the key components of the CVM (controllability, dangerousness and disgustingness) predicted current dental anxiety scores explaining 54% of the variance. Unpredictability was not found to have a significant independent relationship with dental anxiety. Conclusions: These findings show general support for the CVM as an explanatory model for maintaining dental anxiety, though its role as a model for fear acquisition is still not fully established.

Abstract –  Background:  The level of Fluoride exposure needed to cause dental fluorosis is not known precisely. An awareness of total F intake from all sources, especially during the critical stages of dental development during infancy and early childhood, is important in preventing the development of dental fluorosis.

Objectives:  The aim of the study was to measure F content of ready-to-feed (RTF) infant drinks and foods in the UK.

Methods:  In total, 122 infant foods were analysed for F concentrations, in triplicate, indirectly by an acid diffusion method and 25 infant drinks analysed directly using an F-ion-selective electrode after addition of TISABIII.

Results:  The median (range) F concentration was 0.110 (0.030–0.221) μg/g for breakfast cereals, 0.112 (0.040–1.200) μg/g for savoury meals, 0.056 (0.030–0.379) μg/g for desserts, 0.044 (0.020–0.191) μg/g for fruits, 0.196 (0.040–0.397) μg/g for baked goods, 0.069 (0.050–0.148) μg/ml for juices, 0.016 (0.009–0.030) μg/ml for milks and 0.041 (0.022–0.069) μg/ml for waters. The median (range) F concentration of all RTF infant foods and drinks by recommended age of consumption was 0.029 (0.010–0.245), 0.088 (0.020–0.500), 0.108 (0.100–0.510) and 0.108 (0.060–1.200) μg/g for infants from birth, 4+ month, 6+ month and 10+ month, respectively.

Conclusion:  The results suggest that the F concentrations of UK-marketed RTF infant foods, drinks and formula milk are not sufficiently high to be a risk factor for dental fluorosis, if consumption is within the limits recommended for infants and young children.

MacRitchie HMB, Longbottom C, Robertson M, Nugent Z, Chan K, Radford JR, Pitts NB. Development of the Dundee Caries Risk Assessment Model (DCRAM) – risk model development using a novel application of CHAID analysis. Community Dent Oral Epidemiol 2012; 40: 37–45. © 2011 John Wiley & Sons A/S

Abstract –  Objective:  To explore the role of sense of coherence (SOC) as a mediator in the relationship between childhood socioeconomic position (SEP) and tooth retention in adulthood.

Methods:  Data from 5401 dentate adults aged 30 and over who participated in the nationally representative Finnish Health 2000 Survey were analysed. Participants provided information on demographic characteristics (sex and age), childhood SEP (parental education), adulthood SEP (years of education and household income), the SOC scale and oral health-related behaviours (dental attendance, toothbrushing frequency, sugar intake frequency and daily smoking). They also had a clinical oral health examination. Structural equation modelling was used to test a model including adulthood SEP, SOC and oral health-related behaviours as mediators of the relationship between childhood SEP and tooth retention. Multigroup comparison was also conducted to test the hypothesized model within each sex and age group (<45 years, 45–59 years and 60+ years).

Results:  The relationship between childhood SEP and tooth retention in adulthood was to a large extent mediated by adulthood SEP and to a much lesser extent by SOC. There was only a weak association between childhood SEP and adult SOC, but favourable oral health-related behaviours appeared to link a strong SOC with greater tooth retention. The model was invariant across sexes and age groups.

Conclusions:  SOC is associated with tooth retention through oral health-related behaviours, but contributes little to the relationship between childhood SEP and tooth retention.

Abstract – Background: Few longitudinal studies have investigated the association between dental attendance and oral health–related quality of life (OHRQoL). These studies were limited to older adults, or to study participants with an oral disadvantage and did not assess if dental attendance had a different effect on OHRQoL for different people. Objective: This project was designed to test whether routine dental attendance improved the OHRQoL of survey participants and whether any patient factors influenced the effect of dental attendance on change in OHRQoL. Methods: Collection instruments of a service use log book and a 12 month follow-up mail self-complete questionnaire were added to the Tasmanian component of the National Survey of Adult Oral Health 2004/06. The dependent variable was change in OHIP-14 severity and the independent variable was dental attendance. Many putative confounders/effect modifiers were analysed in bivariate, stratified and three-model multivariate analyses. These included indicators of treatment need, sociodemographic characteristics, socioeconomic status, pattern of dental attendance and access to dental care. Results: None of the putative confounders were associated with both dental attendance and the change in mean OHIP-14 severity. The only statistically significant interaction for change in OHIP-14 severity was observed for dental attendance by residential location (P < 0.01). In multivariate analysis, there was a statistically significant association of dental attendance with change in mean OHIP-14 severity. It also showed that the difference in association of attendance between Hobart, the capital city of Tasmania, and other places was statistically significant based on the interaction between residential location and attendance (P < 0.05). Conclusion: The effect of dental attendance on OHRQoL was influenced by a patient's residential location.

Abstract – Objectives: To investigate the influence of clinical status and salivary conditions on the presence of xerostomia on adolescents with and without type 1 diabetes mellitus (DM1), and further to investigate the influence of clinical status, salivary conditions and xerostomia on oral health-related quality of life (OHQoL) of those with DM1. Methods: A cross-sectional study was performed on 102 adolescents, 51 with DM1 and 51 nondiabetics. Xerostomia was detected by asking a question about the sensation of having ‘dry mouth’, and Oral Health Impact Profile-14 was used to measure the impact of xerostomia on OHQoL. The clinical status was assessed by using decayed, missing or filled and Community Periodontal indices, and by evaluating oral manifestations; and the following salivary conditions were evaluated: stimulated salivary flow, pH, buffer capacity, total protein, amylase, urea, calcium, and glucose salivary concentrations. Multiple logistic regression analysis was used to evaluate the influence of clinical status and salivary conditions on xerostomia and the impact of xerostomia on the OHQoL of adolescents with DM1. Results: Clinical status and salivary conditions was shown to have no influence on the presence of xerostomia. Bivariate (P = 0.00) and logistic regression (P = 0.01) analysis showed a significant association between DM1 and xerostomia. Logistic regression analysis showed association between xerostomia (P = 0.00) and OHQoL, and caries experience (P = 0.03) and OHQoL. Conclusions: DM1 showed to be predictive of a high prevalence of xerostomia in adolescents. Caries experience and xerostomia showed to have a negative impact on the OHQoL of adolescents with DM1.

Abstract – Objectives: To examine socio-economic variations in the use of publicly funded general dental practitioner care by adolescents under a fee for service arrangement. Method: Publicly funded general practitioner reimbursement data were linked to census and vital statistics data within the Northern Ireland Longitudinal Study. Data relate to 12 846 adolescents aged 11 or 12 in April 2003 included within the Northern Ireland Longitudinal Study (28% of the population). The main outcome measure was consumption of dental care between 2003/2004 and 2007/2008 by socio-economic status (as measured by National Statistics Socio-economic Classification of occupation and highest educational attainment of household reference person). Results: In multivariate analysis, socio-economic status was a significant determinant of dental care consumed. Those of the lowest socio-economic status, according to both occupation and highest educational attainment of household reference person, were less likely to have consumed orthodontics OR 0.76 (0.62, 0.95) and OR 0.79 (0.69, 0.91), respectively. Those of lower socio-economic status were, however, more likely to have undergone an extraction and restorative treatment and also consumed on average more treatment than those of higher socio-economic status. Conclusion: A demand-led service, in which practitioners are reimbursed in part on a fee for service basis, may create incentives that contribute to different patterns of utilization between social groups. Such a system may not be providing equal access for equal need and may widen existing socio-economic disparities in oral health among adolescents.

Abstract –  Objectives:  To investigate the impact of race on the likelihood of patients being recommended for surgery after a diagnosis of oral and oropharyngeal cancer.

Methods:  A total of 68 445 cases of oral and oropharyngeal cancer were extracted from the 1988 to 2005 Surveillance, Epidemiology, and End Results (SEER) database. County-level rurality data and income data were merged using the US Department of Agriculture Rural-Urban Continuum Codes dataset and US Census Bureau Small Area Income & Poverty Estimates dataset. We used logistic regression analyses to investigate the impact of race on being recommended to surgery for oral and oropharyngeal cancer, adjusting for demographic, socioeconomic, and clinical factors. Stratified analyses were further conducted by tumor site and rural/urban status.

Results:  Recommendation to surgery varied significantly by race, with black patients less likely than white patients to be recommended to surgery for their oral and oropharyngeal cancer. The racial difference in recommendation to surgery varied significantly by age, geography, and tumor subsite. Racial disparities are most evident in lip and buccal cancer from rural areas (OR, 4.4; 95% CI, 2.6–7.5); and least evident in oropharyngeal cancer from urban areas (OR, 1.2; 95% CI, 1.1–1.3). The magnitude of the racial disparity is attenuated with increasing age.

Conclusions:  We observed substantial racial disparities in surgery recommendation for oral and oropharyngeal cancer in the United States. Our results suggest the need to improve accessibility to better health care in racial minority groups, particularly in rural areas, and call for individual and institutional efforts to avoid physician bias related to the patient’s sociodemographic characteristics in healthcare service.

Abstract –  Objectives:  To investigate factors associated with older people’s preference for a dentist’s home visit. Methods: This is a report on 321 home-dwelling participants (mean age 81.6) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study, conducted in 2004–2005 in the city of Kuopio in eastern Finland. The information about sociodemographic and general health-related factors and the use of social and health services was collected by two study nurses using a structured interview. Each study subject was given a clinical oral examination and an interview about oral health and the use of dental health care services by one of two dentists. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Of the study subjects, 25.9% preferred a dentist’s home visit. The preference for choosing a dentist’s home visit was associated with a low score (≤24) in the Mini-Mental State Examination, OR 6.1 (CI: 2.9–13.6), and a low score (<8) on the scale of Instrumental Activities of Daily Living, OR 8.0 (CI: 3.6–18.6). It was also associated with living alone, OR 5.9 (CI: 2.7–13.0), and high use of home care services, OR 9.3 (CI: 4.6–19.0). Conclusions: The findings of this study emphasize the need to organize dentists’ home visits in order to increase equality in the use of dental health care services among the older people with disabilities.