The association of travel distance and severity of odontogenic infections

BACKGROUND

Odontogenic infections (OI) are a preventable disease commonly managed in a tertiary hospital setting. Prevention of severe infections and hospitalisation relies on timely access to primary dental care. This study outlines the pre-hospital treatment of patients presenting to hospital with OIs and the association between travel distance from the patients' residence to a tertiary hospital oral and maxillofacial surgical (OMS) unit.

METHODS

This study analysed patients who initially presented hospital with an OI. Patient demographics, pre-hospital treatment, and clinical markers of severity were recorded. The travel distance from the patient's residence to the hospital was recorded in kilometers, along with any inter-hospital transfer via road/air ambulance.

RESULTS

Two hundred twenty-seven patients were included in this study, 17.2% required an inter-hospital transfer. Of these patients, 70.3% had prior treatment before hospitalisation, and antibiotics without source control was the most frequent treatment (83.1%). The mean travel distance for patients with more severe markers of infection significantly greater than patients with minor infections (p = < .001). Patients who required an inter-hospital transfer accounted for most cases with airway compromise requiring ICU admission.

CONCLUSION

This study found that most patients presenting to hospital with an OI had received antibiotics alone as treatment before hospitalisation. The travel distance from a tertiary hospital with OMS services had a significant correlation to more severe infections. This has important public health implications for the allocation of preventative dental services, and patient access to OMS services.

Oral complications associated with metal ion release from oral piercings: a systematic review

PURPOSE

This systematic review explored dental complications associated with metal ion release from oral piercings using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

METHODS

Item retrieval from October 2022 to December 2022 from databases, such as Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, Scopus and Web of Science, using predefined search terms was undertaken by two independent reviewers. Data were extracted and risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. From 1509 identified studies, 25 were included for analysis.

RESULTS

Of the 25 studies, 20 included both clinical examination and questionnaire-based data. The remaining five studies were deemed low quality based on the Joanna Briggs Institute criteria. The average time piercings were worn ranged between 5 and 48 months. Most studies did not investigate complications from metal ion release. Only two studies examined the direct effects of metal ion release and showed that metal ions may cause hypersensitivity reactions and mucosal changes. Other soft tissue complications were reported, with gingival recession noted in 16 out of 25 studies, especially due to lip piercings. Studies reporting other complications were as follows: swelling (9), pain (8), infection (6), bleeding (6), inflammation (5), alterations to speech, eating and/or swallowing (5), changes to taste or metallic taste (5), and mucosal changes (4). Ten studies reported tooth chipping from tongue piercings.

CONCLUSION

Oral piercings leach metal ions into surrounding tissues which may cause local mucosal changes. Furthermore, oral piercings cause damage to both soft and hard oral tissues, particularly gingival recession for lip piercings and tooth chipping for tongue piercings. Thus, to prevent such adverse injuries, dental professionals should discourage patients against oral piercings.

Tobacco retailer density and smoking behaviour: how are exposure and outcome measures classified? A systematic review

INTRODUCTION

To date only a limited number of reviews have focused on how exposure and outcome measures are defined in the existing literature on associations between tobacco retailer density ('density') and smoking behaviour ('smoking'). Therefore this systematic review classified and summarised how both density and smoking variables are operationalised in the existing literature, and provides several methodological recommendations for future density and smoking research.

METHODS

Two literature searches between March and April 2018 and April 2022 were conducted across 10 databases. Inclusion and exclusion criteria were developed and keyword database searches were undertaken. Studies were imported into Covidence. Cross-sectional studies that met the inclusion criteria were extracted and a quality assessment was undertaken. Studies were categorised according to the density measure used, and smoking was re-categorised using a modified classification tool.

RESULTS

Large heterogeneity was found in the operationalisation of both measures in the 47 studies included for analysis. Density was most commonly measured directly from geocoded locations using circular buffers at various distances (n = 14). After smoking was reclassified using a smoking classification tool, past-month smoking was the most common smoking type reported (n = 26).

CONCLUSIONS

It is recommended that density is measured through length-distance and travel time using the street network and weighted (e.g. by the size of an area), or by using Kernel Density Estimates as these methods provide a more accurate measure of geographical to tobacco and e-cigarette retailer density. The consistent application of a smoking measures classification tool, such as the one developed for this systematic review, would enable better comparisons between studies. Future research should measure exposure and outcome measures in a way that makes them comparable with other studies.

IMPLICATIONS

This systematic review provides a strong case for improving data collection and analysis methodologies in studies assessing tobacco retailer density and smoking behaviour to ensure that both exposure and outcome measures are clearly defined and captured. As large heterogeneity was found in the operationalisation of both density and smoking behaviour measures in the studies included for analysis, there is a need for future studies to capture, measure and classify exposure measures accurately, and to define outcome measures in a manner that makes them comparable with other studies.

Factors associated with access to dental care among refugees: A systematic review of quantitative studies

OBJECTIVES

To identify, appraise and synthesize the published evidence from quantitative studies on the individual and contextual-level factors determining access to dental care among refugees worldwide.

METHODS

A systematic literature search was conducted until the last week of February 2022 in four electronic databases - MEDLINE, Embase, Web of Science (all databases) and APA PsycINFO - without any restrictions. Quantitative studies published in English language and meeting the a priori eligibility criteria were reviewed and data extracted. Quality assessment was conducted using the National Institutes of Health tool. The identified factors were stratified according to the framework of the Behavioural Model of Health Services Use, and the evidence related to each of these factors was summarized in tables. Narrative synthesis of the findings was conducted.

RESULTS

The search retrieved 6776 unique records, of which 69 were deemed eligible for full-text screening and nine studies were included in the final data analysis and synthesis. The studies were rated to be of 'fair' quality at best. Self-reported previous dental visits was the most commonly used measure of access. Associations between individual-level factors and dental care access were most frequently examined (predisposing [n = 6], need [n = 2] and enabling [n = 1]), while the contextual-level factors were rarely examined (predisposing and enabling [n = 1, each]).

CONCLUSIONS

Individual-level predisposing factors, such as English language proficiency, education, health and dental literacy and acculturation and integration, were shown to be significantly associated with refugees' access. There is limited evidence to determine the effect of individual enabling and need and contextual factors.

Strategies to integrate oral health into primary care: a systematic review

OBJECTIVES

Integration of oral health into primary care has been proposed as a primary healthcare approach for efficient and sustainable delivery of oral health services, and the effective management of oral diseases. This paper aimed to synthesise evidence on the effectiveness of strategies to integrate oral health into primary care.

DESIGN

Systematic review.

DATA SOURCES

MEDLINE, CINAHL, Embase, Scopus, ProQuest, Cochrane and Google Scholar were searched without date limits until the third week of June 2022. Reference lists of eligible studies were also searched. Experts in the field and existing professional networks were consulted.

ELIGIBILITY CRITERIA

Only studies that evaluated integration strategies were included in the review. Eligibility was restricted to English language studies published in academic peer-reviewed journals.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data and performed the risk of bias assessments. A narrative synthesis approach was used to report review findings. Heterogeneity among included studies precluded a meta-analysis.

RESULTS

The search identified 8731 unique articles, of which 49 were included in the review. Majority of the studies explored provision of oral healthcare by primary care professionals in primary care settings, where integration was primarily via training/education and/or policy changes. Most studies reported results favouring the integration strategy, such as improvements in referral pathways, documentation processes, operating efficiencies, number of available health staff, number of visits to non-dental primary care professionals for oral health issues, proportion of children receiving fluoride varnish applications/other preventive treatment, proportion of visits to an oral health professional and dental caries estimates.

CONCLUSION

The findings from this review demonstrate that the majority of identified strategies were associated with improved outcomes and can be used to inform decision-making on strategy selection. However, more research and evaluation are required to identify best practice models of service integration.

PROSPERO REGISTRATION NUMBER

CRD42020203111.

Gender differences in the association between malocclusion traits and oral health-related quality of life in Finnish adults

We aimed to evaluate the gender-specific associations of malocclusion traits with oral health-related quality of life (OHRQoL) among Finnish adults. Data were obtained from the Health 2000 Survey, Finland. Included participants (n = 3993) were ≥30 years old with OHRQoL and occlusion data. OHRQoL was measured using the 14-item Oral Health Impact Profile (OHIP-14). OHIP-14 severity mean score, prevalence of impacts, and means of seven dimensions were outcomes. Explanatory variables were any malocclusion trait, increased overjet, negative overjet, open bite, deep bite, and crossbite/scissor bite. Logistic (prevalence) and cumulative (severity) regression models were adjusted for age, decayed teeth, deep periodontal pocket, occluding pairs, orthodontic treatment, and self-perceived health. Gender modified the association between any malocclusion trait and OHRQoL, with the association being stronger in females. Females without any malocclusion trait (OR = 1.62, 95% CI = 1.14-2.28) or without crossbite/scissor bite (OR = 1.68, 95% CI = 1.16-2.43) had better OHRQoL (lower prevalence) than those with malocclusions. Males without increased overjet (OR 1.50, 95% CI = 1.04-2.17) had lower mean OHIP-14 severity score than males with increased overjet, after adjustments. The association between psychological and physical disability and malocclusion traits was different between males and females. Gender differences in the impact of malocclusion traits should be considered when assessing orthodontic treatment need.

Patterns and predictors of public dental service utilisation among refugees in Victoria, Australia: a latent profile and multilevel analysis

BACKGROUND

The purpose of the study was to explore, analyse, and describe the patterns of public dental service utilisation among the refugee populations in Victoria, Australia, and determine their predictors at the individual and contextual levels.

METHODS

Data on the refugees who attended Victorian public dental services between July 2016 to June 2020 was gathered from the Dental Health Program dataset. Latent profile analysis was used to identify discrete groups among the refugee clientele with similar mean utilisation patterns across six indicator variables describing the attributes of dental services received and the site of care provision, over the study period. Multilevel multinomial logistic regression analysis was performed to examine the individual and contextual level correlates of the identified utilisation patterns.

RESULTS

Six distinct profiles of public dental service utilisation were identified among the study population (n = 25,542). The largest group comprised refugees predominantly using restorative services under general course of care (38.10%), followed by extraction services under emergency course of care (23.50%). Only a small proportion were estimated as having a higher mean utilisation of preventive services under general course of care (9.10%). Multilevel analysis revealed that the following variables had a significant association with refugee utilisation pattern: at the individual-level - demographic and ethnic attributes including age, gender, region of birth, preferred language for communication, use of language interpreter services, and type of eligibility card; at the contextual-level - characteristics of refugees' neighbourhood of residence including urbanicity, socioeconomic disadvantage, delivery of Refugee Health Program at the community health centres, and spatial accessibility to public dental services via driving and public transit modes of travel.

CONCLUSIONS

The study represents a significant step towards the development of an evidence-based knowledge around public dental service utilisation among Victorian refugees. Overall, the study findings reiterate the critical need for targeted strategies to promote the importance of routine dental visits, oral disease prevention, and timely intervention among refugee groups.

Differences in complete denture longevity and replacement in public and private dental services: A propensity score-matched analysis of subsidised dentures in adult Australians across 20 years

OBJECTIVES

To examine the differences in treatment outcomes for patients who received subsidized complete dentures in private dental clinics and in public dental clinics over 20 years in Victoria, Australia.

METHODS

Between 2000 and 2019, 187 227 complete dentures were provided to eligible public patients by the Victorian public dental system. Of these, approximately 52% were provided to public patients in private clinics through the voucher system. Of the 97 107 participants who received denture care in private clinics, 70 818 were matched 1:1 by propensity score (PS) quantiles with participants who received denture care in public clinics. The PS matching balanced the characteristics between these two groups. Subsequently, a conditional logistic regression model investigated the binary outcome of denture replacement whilst a conditional Poisson regression modelled the number of years to denture replacement. A frailty Cox regression after PS matching investigated denture survival over time.

RESULTS

Dentures provided in public clinics had a mean time to replacement of 5.5 years (SD: 34.0) and 25.9% were replaced during the observation period. In the first year of denture service, incidence rate per person year (IR) for complete denture replacement in public clinics was 0.04 (95% CI: 0.04-0.04). Dentures provided in private clinics had a mean time to replacement of 6.5 years (SD: 3.8) with 29.4% replaced during the observation period. In the first year of denture service, the IR for complete denture replacement in private clinics was 0.02 (95% CI: 0.02-0.02), which was less than half that of the public IR. Multivariate analyses found that although private dentures were more likely to be replaced during the observation period than those provided in the public sector (odds ratio [OR]: 1.31, 95% CI: 1.28-1.35, p < .001), they had greater longevity (incidence rate ratio [IRR]: 1.23, 95% CI: 1.23-1.24, p < .001). Longer longevity of private dentures was also supported by the frailty Cox regression showing that private dentures had a reduced hazard of denture replacement over time (better survival) in comparison to public dentures (hazard ratio [HR]: 0.94, 95% CI: 0.92-0.97, p < .001). Probabilistic sensitivity analysis supported the study findings.

CONCLUSIONS

Increased denture longevity, higher rates of denture replacement and lower rates of early denture replacement were associated with receiving denture care in private clinics as compared with dentures provided in the public sector.

Ion release from oral piercings from in vitro acidic challenges

OBJECTIVES

This laboratory-based study measured ion release from metallic piercings when exposed to organic acids (lactic, citric) and inorganic acids (phosphoric, hydrochloric) that could be encountered in the oral cavity.

METHODS

Barbell and ring oral piercings composed of stainless steel, titanium or gold-plated titanium were submerged in 2 mL volumes of 0.1% lactic acid, 10% citric acid, 0.2% phosphoric acid, and 0.1% hydrochloric acid for 7 and 34 days. Ion release into the liquid was measured using inductively coupled plasma optical emission spectroscopy (ICPOES) and expressed in relationship to surface area. Surface changes from baseline were assessed using light and backscatter scanning electron microscopy (SEM).

RESULTS

ICPOES results showed that hydrochloric and phosphoric acid caused the greatest release of material per surface area. Released elements included (ranked highest to lowest): Fe, P, Ti, Na, Cr, S, Ni, Ca, Mg, K, Si, Al, V, Mn, Ba, and Co. SEM imaging identified qualitative surface changes consistent with corrosion, for most piercing types examined.

CONCLUSIONS

Under the exposure conditions used, inorganic acids cause greater metal dissolution than organic acids. Inorganic acids could therefore pose a risk of corrosion and leaching of ions from metallic oral piercings.

Curriculum mapping of health promotion competencies in dental and oral health training programmes in Australia

ISSUE ADDRESSED

Dental diseases are chronic conditions that place a significant burden on the population's health; however, they are mostly preventable using a range of health promotion strategies Health promotion is a core competency for all dental and oral health graduates, but little is known about what health promotion content is taught in undergraduate degrees. The aim of this study was to explore the dental and oral health content in Australian undergraduate dental and oral health degrees and map against the last two versions of the Australian Dental Council (ADC) health promotion competencies.

METHODS

All ADC-accredited dental and oral health courses delivered at Australian universities in 2019 were eligible to be included. Key words were used to locate subjects within the courses that contained health promotion content. This was analysed and ranked against the last two versions (2011 and 2016) of the ADC health promotion competencies. The competencies were then ranked using Blooms updated "six levels of thinking."

RESULTS

Seven oral health and eight dental courses were mapped. The number of health promotion subjects in courses varied substantially; the percentage of subjects that contained health promotion in oral health courses ranged from 30% to 75% and 16% to 60% for dental courses. All oral health courses were explicitly meeting the current ADC health promotion competencies, however, only half of the dental courses met the competency standards.

CONCLUSION

Curriculum mapping provided a snapshot of the health promotion content within dental and oral health degrees in Australia. Evaluations of the extent to which these courses meet the ADC competencies provide useful information for students, clinicians and policy makers. SO WHAT?: This study provides evidence that health promotion training is occurring at varying levels. However, in dentistry, not all the ADC health promotion competencies are being met. A change is needed in the ADC health promotion competencies and ethos of academics involved in the development of curriculum to include and give appropriate attention to health promotion theory, especially advocacy. This will enable future dental professionals to advocate for a range of oral health promotion activities such as water fluoridation, universal dental care and sugar-sweetened beverage taxes.

Identifying tobacco retailers in the absence of a licensing system: lessons from Australia

OBJECTIVES

To estimate the proportion of retailers that sell tobacco in the absence of appropriate local government oversight, and to describe the characteristics by which they differ from those that can expect to receive such oversight.

METHODS

A database of listed tobacco retailers was obtained from a regional Victorian local government. Potential unlisted tobacco retailers were added using online searches, and attempts to visit all retailers were undertaken. GPS coordinates and sales type information of retailers that sold tobacco were recorded and attached to neighbourhood-level data on socioeconomic disadvantage and smoking prevalence using ArcMap. Logistic regression analyses, χ2 tests and t-tests were undertaken to explore differences in numbers of listed and unlisted retailers by business and neighbourhood-level characteristics.

RESULTS

Of 125 confirmed tobacco retailers, 43.2% were trading potentially without government oversight. Significant differences were found between listed and unlisted retailers by primary business type (p<0.001), and sales type (p<0.001) but not by the other characteristics.

CONCLUSIONS

The database of tobacco retailers was inaccurate in two ways: (1) a number of listed retailers no longer operated or sold tobacco, and (2) 43.2% of businesses confirmed as selling tobacco were missing. As no form of licensing system exists in Victoria, it is difficult to identify the number of retailers operating, or to determine how many receive formal regulatory oversight. A positive licensing system is recommended to regulate the sale of tobacco and to generate a comprehensive database of retailers, similar to that which exists for food registration, gaming and liquor-licensed premises.

An overview of methodological approaches in systematic reviews

AIM

The aim of this overview is to identify and collate evidence from existing published systematic review (SR) articles evaluating various methodological approaches used at each stage of an SR.

METHODS

The search was conducted in five electronic databases from inception to November 2020 and updated in February 2022: MEDLINE, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and APA PsycINFO. Title and abstract screening were performed in two stages by one reviewer, supported by a second reviewer. Full-text screening, data extraction, and quality appraisal were performed by two reviewers independently. The quality of the included SRs was assessed using the AMSTAR 2 checklist.

RESULTS

The search retrieved 41,556 unique citations, of which 9 SRs were deemed eligible for inclusion in final synthesis. Included SRs evaluated 24 unique methodological approaches used for defining the review scope and eligibility, literature search, screening, data extraction, and quality appraisal in the SR process. Limited evidence supports the following (a) searching multiple resources (electronic databases, handsearching, and reference lists) to identify relevant literature; (b) excluding non-English, gray, and unpublished literature, and (c) use of text-mining approaches during title and abstract screening.

CONCLUSION

The overview identified limited SR-level evidence on various methodological approaches currently employed during five of the seven fundamental steps in the SR process, as well as some methodological modifications currently used in expedited SRs. Overall, findings of this overview highlight the dearth of published SRs focused on SR methodologies and this warrants future work in this area.

Oral health surveillance in Australia: the need for ongoing data to inform public health decision-making

Surveillance of people's health takes on an important meaning in the practice of public health because it allows monitoring of diseases and prompt response to change in proportions and rates at which diseases occur in populations. Improving health of populations requires establishment of an effective public health system. Population level data and analysis is critically important in government policy and program development and monitoring. Lack of or inadequate information about the health of populations leads to ineffective policies that may often attenuate health problems instead of solving them. Australia's current oral health surveillance is mostly through ad hoc sentinel surveys, which lack recency in time. This position paper is to present the need for real-time oral health surveillance in Australia, which can be used to inform health decision-making in a timely manner.

Complete denture replacement: a 20-year retrospective study of adults receiving publicly funded dental care

PURPOSE

There is little evidence as to what is the appropriate replacement interval for complete dentures. The aim of this study was to determine the longevity of complete dentures in a population of publicly insured adults across a 20 year observation period.

METHODS

The records of 187,227 Australian adults who accessed complete denture treatment through public clinics between 2000-2019 were assessed. Time to denture replacement was modelled using a Weibull regression and a competing risk regression to adjust for the competing risk of mortality.

RESULTS

Over a 20-year period, 27.7% of dentures were replaced, with a mean longevity of 6.06 (SD: 3.93) years. Pairs of complete dentures had greater mean longevity than single dentures (p<0.001). Approximately 4.6% of dentures provided were replaced within 2 years; 18.4% were replaced between 2 and 10 years and 4.6% of replacements occurred after 10 years.Over 70% of adults who received a complete denture did not replace it during the observation period. Dentures provided by denturists had higher levels of replacement than those made by dentists. Participants over 80 years of age had lower rates of denture replacement. Low socio-economic status and living outside a major city were associated with reduced rates of replacement for dentures under 10 years of age.

CONCLUSION

Complete dentures were commonly replaced after 6 years of service. Pairs of dentures lasted longer than single dentures.

Tobacco retailer density and smoking behavior in a rural Australian jurisdiction without a tobacco retailer licensing system

INTRODUCTION

An emerging body of research has developed around tobacco retailer density and its contribution to smoking behavior. This cross-sectional study aimed to determine the association between tobacco retailer density and smoking behavior in a rural Australian jurisdiction without a tobacco retailer licensing system in place.

METHODS

A local government database (updated 2018) of listed tobacco retailers (n=93) was accessed and potential unlisted tobacco retailers (n=230) were added using online searches. All retailers (n=323) were visited in 2019 and GPS coordinates of retailers that sold tobacco (n=125) were assigned to suburbs in ArcMap. A community survey conducted in the Local Government Area provided smoking and sociodemographic data amongst adult respondents (n=8981). Associations between tobacco retailer density (calculated as the number of retailers per km² based on respondents’ suburb of residence) and daily, occasional and experimental smoking were assessed using multilevel logistic regression analysis. Separate models with and without covariates were undertaken.

RESULTS

Without adjusting for possible confounders, living in suburbs with greater retailer density did not increase the odds of daily smoking (OR=1.01; 95% CI: 0.92–1.12), occasional smoking (OR=1.05; 95% CI: 0.94–1.18), or experimental smoking (OR=0.98; 95% 0.92– 1.05). However, after adjustment, living in suburbs with greater retailer density increased the odds of occasional smoking behavior (AOR=1.37; 95% CI: 1.10–1.71) but not daily or experimental smoking.

CONCLUSIONS

This study found a significant positive association between tobacco retailer density and the likelihood of occasional smoking in a rural Australian jurisdiction without a tobacco retailer licensing system in place. The findings strengthen calls for the introduction of a comprehensive, positive tobacco retailer licensing system to provide a framework for improving compliance with legislation and to reduce the overall availability of tobacco products in the community.

Oral health interventions for older people in residential aged care facilities: a protocol for a realist systematic review

INTRODUCTION

Poor oral health among older people is a global problem impacting on health and well-being. The economic cost to the health system is significant. An ageing population is intensifying the urgency for action. However, poor oral health, particularly for those in residential aged care facilities, continues to be highly resistant to resolution. The overall aims of this realist review are to: (A) explore and synthesise evidence on oral health interventions for older people in residential aged care facilities, (B) produce a causal theory on how contextual factors and mechanisms interact to produce outcomes, and (C) produce guidelines/policies to inform high-quality oral health interventions to improve older people's oral health in residential aged care facilities.

METHODS AND ANALYSIS

The review is guided by the RAMESES publication standards for realist synthesis. Participants include older people in residential aged care facilities, the aged care workforce, carers and families. Interventions include oral healthcare, oral health education, policy interventions and oral health promotion. The five-step realist review process of Pawson et al will guide the review: clarification of scope and development of initial framework, systematic searches, study appraisal and data extraction, synthesising evidence, drawing conclusions, and dissemination, implementation and evaluation. Expert input with key stakeholders will occur through a blog. Stakeholders will examine consistencies across studies and an explanatory causal theory will be developed to guide policy and practice.

ETHICS AND DISSEMINATION

Formal ethical approval was granted by the La Trobe University Ethics Committee HREC 20144. The developed theory will guide education, practice and policy decisions about interventions and the factors that impact on implementation. Using an integrated knowledge translation approach, traditional research outputs such as international conference presentations and publications will be supplemented with stakeholder forums, infographics, blogs, social media postings, webinars, podcasts and writing for web-based independent outlets.

PROSPERO REGISTRATION NUMBER

CRD42021155658.

Oral health academics' conceptualisation of health promotion and perceived barriers and opportunities in dental practice: a qualitative study

BACKGROUND

Oral diseases place a significant burden on individual and population health. These diseases are largely preventable; health promotion initiatives have been shown to decrease the disease rates. However, there is limited implementation of health promotion in dentistry, this could be due to a number of factors; the ethos and philosophy of dentistry is focused on a curative, individualised approach to oral diseases, confusion around health promotion as a concept. Oral health academics are well placed to implement health promotion, training of these professionals needs to include prevention, as training influences dental practice. However, there is a little understanding about how oral health academics (dental professionals who educate dental and oral health students) view health promotion. The aim of this exploratory study is to understand how oral health academics conceptualise health promotion and perceive the barriers and possible opportunities for health promotion implementation in dental practice.

METHODS

Nominal group technique (NGT), a highly structured face-to-face meeting, was conducted with 24 oral health academics to explore how they conceptualize health promotion and the barriers and opportunities for health promotion in practice. An additional 4 questions were emailed to oral health educators after the NGT meeting to gather additional data, 6 oral health academics were involved. The data was analyzed using thematic analysis.

RESULTS

Three board themes were identified: "Knowledge, ideas and concepts of health promotion", "Challenges to health promotion", "Opportunities for health promotion practice". The oral health academics in this study discussed health promotion in a holistic way, however, health education and behaviour change were mentioned more than other aspects of health promotion. The structure of dental practice specifically the curative approach that underpins dentistry and the lack of funding, and value placed on health promotion could act as a challenge to health promotion being implemented in practice. There has been a shift towards prevention in dentistry, however the participants acknowledge there needs to be a change in the curative culture of the profession. Collaboration with other health professionals and using a common risk factor approach were the identified opportunities for health promotion practice.

CONCLUSIONS

Oral health academics have a holistic understanding of health promotion, but still focus more on behavioural approaches which is common within dentistry. For a change to occur in health promotion practice a change in the structure, curative approach and funding model of dentistry is required. Collaboration with other health professionals is an opportunity to be capitalised on. Training of future dental professionals is the perfect place to start to implement the changes and opportunities for health promotion presented in this paper.

Prognostic utility of cardiopulmonary exercise testing indices in arrhythmogenic right ventricular cardiomyopathy

Introduction

Cardiopulmonary exercise testing (CPET) has an established role in the clinical evaluation of exercise intolerance and in the risk stratification of patients with heart failure. There is limited data assessing its prognostic utility in the evaluation of patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). The predisposition of patients with ARVC for ventricular arrhythmias and sudden cardiac death has led to recommendations for exercise restrictions and limits our understanding of how the impairment in oxygen extraction and cardiac output impact disease progression and outcomes in these patients.

Purpose

We examined the association between CPET indices and event free survival (time to mortality or cardiac transplantation) in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC).

Methods

Patients with definite ARVC based on 2010 task force criteria and genetically positive were enrolled into our institutional ARVC registry. 43 patients underwent CPET and have been included in our analyses. Indications for testing included: Evaluation of exercise-induced palpitations/arrhythmias or syncope (37%), pharmacotherapy optimization (28%), heart failure evaluation (19%), and ARVC management decisions (16%). CPET data (peak oxygen consumption (pVO2), respiratory exchange ratio (RER), and ventilatory efficiency (VE/VCO2) were assessed in patients at time of initial evaluation. Median follow-up time was 4.9 years (IQR 9 years).

Results

126 patients were studied (age 43.7+ 15 yrs; 41% women; LVEF 57+ 11%; 15% with LVEF &lt;50%) and 43 underwent CPET evaluation. 41 patients (95%) performed at near maximal effort (RER &gt;1) and no fatal events were reported during testing. During the follow up period, the outcome (death or cardiac transplantation) occurred in 31 patients. On Kaplan Meier analysis, pVO2 ≤14 mL/kg/min was associated with worse outcomes (unadjusted p&lt;0.001). Peak oxygen consumption (pVO2) ≤14 mL/kg/min and ventilatory efficiency (VE/VCO2) &gt;34 were associated with shorter event free survival (HR 5.58, p=0.002 and HR 5.56 p=0.005, respectively). After adjusting for age, sex, and right ventricular function, the association between peak oxygen consumption (pVO2) and event free survival remained significant (p=0.02).

Conclusions

In patients with ARVC, peak oxygen consumption (pVO2) was a prognostic indicator of worse outcomes. Our findings suggest a potential role for pVO2 in disease surveillance and early assessment for advanced heart failure therapies.

Figure 1. KM plot pVO2 & event free survival

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Mayo Clinic

Levels of support for the licensing of tobacco retailers in Australia: findings from the National Drug Strategy Household Survey 2004-2016

Background

Assessing public opinion towards tobacco policies is important, particularly when determining the possible direction of future public health policies. The aim of this study was to describe the implementation of tobacco retailer licensing systems by state and territory governments in Australia, and to use the National Drug Strategy Household Survey (NDSHS) to assess levels of public support for a retailer licensing system in each jurisdiction over time and by a range of socio-demographic and behavioural attributes.

Methods

National and state/territory estimates of public support for a tobacco retailer licensing system were derived as proportions using NDSHS data from 2004 to 2016. The effect of one’s jurisdiction of residence on the likelihood of supporting such an initiative in 2016 was assessed using logistic regression while controlling for various socio-demographic and behavioural characteristics.

Results

Public support for a tobacco retailer licensing system ranged from a high of 67.2% (95% CI 66.5–67.9%) nationally in 2007 and declined to 59.5% (95% CI 58.9–60.2%) in 2016. In 2016, support was greatest amongst those from Tasmania, those aged 50 years and older, females, those from the least disadvantaged areas, those living in major cities, never-smokers and never-drinkers. After adjusting for the socio-demographic and behavioural attributes of respondents, those from Queensland were significantly less likely to support a licensing system (adjusted OR = 0.85, 95% CI 0.77–0.94) compared to those from other jurisdictions, while those from Tasmania were significantly more likely to support a licensing system compared to those from other jurisdictions (adjusted OR = 1.29, 95% CI 1.09–1.52).

Conclusions

A clear majority of the public support a tobacco retailer licensing system, regardless of whether or not such a system is already in place in their jurisdiction of residence. Tobacco control initiatives other than a retailer licensing system may explain some of the residual variations in support observed between jurisdictions.

Characterizing Agreement in the Level of Interarm Blood Pressure Readings of Adults in the Emergency Department (CALIBRATE Study)

Background: Increased interarm systolic blood pressure difference (IASBPD) is one of the major predictors of cardiovascular disease. An IASBPD of >10 mmHg is of clinical significance. However, studies have reported a high number of patients visiting the emergency department (ED) with high IASBPD and varying correlation of IASBPD to age, ethnic background, and comorbidities such as hypertension and diabetes. Objective: The CALIBRATE study aimed to measure the IABPDs in the multiethnic patient population presenting to the ED in Qatar and to assess the distribution of IASBPD in this population. Methods: In a sitting position, two consecutive blood pressure (BP) measurements were recorded from the right and left arms for each participant using a calibrated automated machine and appropriate cuff sizes. The data were recorded using predefined data fields, including patient demographics, past medical, and social and family history. The continuous variables were reported as mean or median based on the distribution of data. The data were analyzed using Stata MP 14.0. Results: A total of 1800 patients, with a mean age of 34 (10) years, were prospectively recruited from the ED. The median absolute systolic BP difference (ΔSBP) between the right and left arms was 6 (3-10) mmHg, and it was the same for the first (ΔSBP1) and the second readings (ΔSBP2). The absolute average of ΔSBP1 and ΔSBP2 was 7 (4-10) mmHg. The difference in systolic BP difference (SBP) of < 20 mmHg for interarm blood pressure was seen in the 95th percentile of the population. No meaningful association could be detected between the IABPD and the study variables such as age, demographics, regions of interest, and risk factors. Conclusion: In population presenting to the ED, the IASBPD of at least 20 mmHg reached at the 95th percentile, validating the known significant difference. The utility of SBP difference can be improved further by taking the average of two individual readings.

Longevity of complete dentures: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Patients and clinicians are aware of the efficacy and benefits of complete dentures, but evidence regarding their longevity is limited.

PURPOSE

The purpose of this systematic review was to examine the literature describing the longevity of complete dentures and to review variations in longevity by denture type and duration of follow-up.

MATERIAL AND METHODS

Four electronic databases were searched by using key terms: MEDLINE, CINAHL (EBSCO), Dentistry and Oral Sciences Databases, and The Cochrane Library. Studies meeting the inclusion criteria were reviewed according to an established protocol and data extracted. Reference lists of identified studies were examined. Risk of bias was assessed by using the AXIS tool. Weighted means and weighted standard deviations were calculated. Pooled complete denture failure proportions were estimated by using random effects models based on the DerSimonian and Laird method.

RESULTS

The search yielded 21 607 unique abstracts, of which 273 met the inclusion criteria. Assessment of the full-text articles reduced this number to 42. Of these, 24 studies were rated as having low risk of bias and 18 as very low. The weighted mean ±standard deviation longevity of maxillary complete dentures was 10.3 ±3.8 years, of mandibular dentures was 8.6 ±2.6 years, and of both maxillary and mandibular dentures was 10.8 ±4.7 years. The pooled failure proportion for complete dentures observed for 2 years or less was 0.05 (95% confidence interval [CI]: 0.00-0.10), 5 to 6 years was 0.12 (95% CI: 0.08-0.16), and 10 years or more was 0.41 (95% CI: 0.28-0.53).

CONCLUSIONS

Complete dentures, fabricated primarily in university settings, were found to have a weighted mean ±standard deviation longevity of 10.1 ±4.0 years. The failure rate of these prostheses increased with denture age, and the longevity of maxillary dentures was greater than that of mandibular dentures.

Oral health interventions for people living with mental disorders: protocol for a realist systematic review

BACKGROUND

The increasing number of people who experience mental disorders is a global problem. People with mental disorders have high rates of co-morbidity and significantly poorer oral health outcomes than the general public. However, their oral health remains largely a hidden and neglected issue. A complex range of factors impact the oral health of this group. These include anxiety and dental phobia, dietary habits, including the heavy consumption of sugary drinks, substance misuse of tobacco, alcohol, and/or psychostimulants, the adverse orofacial side effects of anti-psychotic and anti-depression medications, and financial, geographic, and social barriers to accessing oral health care.

METHODS

The aim of this realist systematic review is to (a) identify and synthesise evidence that explores oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal, contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level. Using a five-step process, that incorporates primary data collection from key stakeholders, a beginning theoretical framework will be developed to describe contextual and mechanistic factors and how they might impact on the success or failure of oral health interventions for people with mental disorders. Key database searches will be conducted, with data extraction focused on the factors that might have impacted on intervention implementation and outcomes. Quality appraisal of studies will occur, and the theoretical framework will be populated with extracted data. Stakeholder input will support the development and refinement of a theory on oral health interventions for people with mental disorders.

DISCUSSION

This will be the first review to take a realist approach to explore the broad scope of causal factors that impact on the success or failure of oral health interventions for people with mental disorders. The approach includes extensive stakeholder engagement and will advance realist systematic review methodology. Review outcomes will be important in guiding policy and practice to ensure oral health interventions better meet the needs of people with mental disorders.Systematic review registration This review protocol is registered with PROSPERO (Number) 155969.

The Psychological Models of Health-related Behavior in Understanding Sugars Intake in Adults: A Review

Free sugars intake plays a major role in dental caries formation and other general health issues such as obesity. Therefore, interventions, which assist individuals or populations in the control of their free sugars intake, are of central importance in caries prevention strategies. There is good evidence that behavioral interventions benefit from a foundation in conceptual theories of behavior change founded on empirical data. In this review, we discuss the future application of seven theories, including six common psychological theories in predicting and developing interventions to reduce free sugars intake related to dental caries among adults. For each model, we summarize its key features and the data derived from its application in general and oral health settings and make recommendations for future research. We searched Medline, PsycINFO, Global Health, PubMed, and Embase databases to identify items dealing with dental caries, adults, sugars intake, and six psychological theories. These included the Transtheoretical Model of Change, Theory of Planned Behavior, Social Cognitive Theory, Information-Motivation-Behavioral Skills model, PRIME Theory, and Behavior Change Wheel theories. We searched literature published in the last 10 years, and priority was given to systematic reviews and randomized control trials. Although there is extensive literature on the application of the six psychological theories, there is a gap in knowledge about their effectiveness in reducing free sugars intake related to dental caries among adults. There is a need for better-designed trials of interventions based on the clear operationalization of psychological constructs to reduce sugars intake among the adult population.

Social inclusion as a tool to improve rural health

Health inequalities between metropolitan and rural areas persist despite a range of interventions over recent years. Social inclusion is often linked to health outcomes, yet few studies examine social inclusion across different geographic areas. In this study, a set of indicators of social inclusion were drawn together and sourced data were aligned to these indicators, which are readily available to primary health practitioners and population health planners. Through this process, a useful framework that provides a nuanced understanding to guide primary health policy and practice has been produced. Using Victoria as an example, 11 domains of social inclusion were explored using population data across 79 local government areas. Analysis highlighted significant differences in several indicators, with rural and regional local government areas ranking higher on measures of social participation, trust and social resources. The use of a diversity of data sources provided information on the social, economic, and education issues of an area, along with relational factors such as safety, trust, community resources and civic participation. A social inclusion lens can inform action to address the rural-urban primary health divide by determining and exploring the social inclusion characteristics of communities.

Effect of national culture on BMI: a multilevel analysis of 53 countries

Background

To investigate the association between national culture and national BMI in 53 low-middle- and high-income countries.

Methods

Data from World Health Survey conducted in 2002–2004 in low-middle- and high-income countries were used. Participants aged 18 years and over were selected using multistage, stratified cluster sampling. BMI was used as an outcome variable. Culture of the countries was measured using Hofstede’s cultural dimensions: Uncertainty avoidance, individualism, Power Distance and masculinity. The potential determinants of individual-level BMI were participants’ sex, age, marital status, education, occupation as well as household-wealth and location (rural/urban) at the individual-level. The country-level factors used were average national income (GNI-PPP), income inequality (Gini-index) and Hofstede’s cultural dimensions. A two-level random-intercepts and fixed-slopes model structure with individuals nested within countries were fitted, treating BMI as a continuous outcome variable.

Results

A sample of 156,192 people from 53 countries was included in this analysis. The design-based (weighted) mean BMI (SE) in these 53 countries was 23.95(0.08). Uncertainty avoidance (UAI) and individualism (IDV) were significantly associated with BMI, showing that people in more individualistic or high uncertainty avoidance countries had higher BMI than collectivist or low uncertainty avoidance ones. This model explained that one unit increase in UAI or IDV was associated with 0.03 unit increase in BMI. Power distance and masculinity were not associated with BMI of the people. National level Income was also significantly associated with individual-level BMI.

Conclusion

National culture has a substantial association with BMI of the individuals in the country. This association is important for understanding the pattern of obesity or overweight across different cultures and countries. It is also important to recognise the importance of the association of culture and BMI in developing public health interventions to reduce obesity or overweight.

The pristine nature of river Ganges: its qualitative deterioration and suggestive restoration strategies

The river Ganges, the National Heritage, and the lifeline of millions of Indians, unfortunately, ranked the second most polluted rivers of the world in 2017. This review reveals the current trends of the water quality of the Ganges assessed around 36 stretches during 2012-2016, to indicate an improvement around 6 (16.7%), deterioration around 14 (38.9%), and non-significant changes around 16 (44.4%) stretches. An increase in dissolved oxygen and a decrease in biochemical oxygen demand were observed at six stretches (Devprayag [S₅], Rishikesh upstream [S₇], Varanasi upstream [S₁₉], Mokama upstream [S₂₅], Mokama downstream [S₂₆], and Munger [S₂₇]). The total and fecal coliform contamination decreased at seven stretches (Rudraprayag [S₂ and S₃], Devprayag [S₅ and S₆], Rishikesh [S₇], Varanasi upstream [S₁₉], and Munger [S₂₇]) due to improved hygienic conditions, but it increased subsequently at eight stretches (Haridwar [S₈], Kanpur [S₁₅], Raibareili [S₁₆], Prayagraj [S₁₇ and S₁₈], Patna [S₂₄], Berhampore [S₃₀], and Serampore [S₃₁]) due to improper defecation and mass bathing during 2007-2016. Dissolved oxygen level declined significantly, and biochemical oxygen demand increased (> 3 ppm), alarmingly at places receiving heavy untreated sewage water. The water quality of the Ganges was good up to Rishikesh, because of an undisrupted flow of the uncontaminated water from the higher altitudes (≥ 372 m) with higher forest cover, lower temperatures (< 21 °C), and higher dissolved oxygen (≥ 8.5 ppm) and due to the dissolution of antipathogenic chemical constituents of the medicinal herbs, pollutant degrading alkaline phosphatase, and bacteriophages. The present review is a systematic collection of data on river pollution, its scientific analyses, and its relationship with 6Ps (namely population, poverty, pollution, precipitation, plantation, and periodicity). Not only that, but the river water restoration measures have also suggested through the novel interlinked water working groups for implementing integrated water management strategies.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Inequalities in dental caries in children within the UK: Have there been changes over time?

OBJECTIVES

To examine any change over time in the association between deprivation and caries experience between 2003 and 2013 in a nationally representative sample of UK children.

METHODS

Data from UK Children's Dental Health Surveys, 2003 and 2013, were used. The target population was 5-, 8-, 12- and 15-year-olds. A total of 9604 children in 2003 and 9866 in 2013 were included in the surveys. Outcome variables were any active caries, caries experience and total number of carious teeth. Family socio-economic position (SEP) or deprivation level was measured at school level using eligibility for free school meals (FSM) to identify children from low-income families. Incidence rate ratios (IRR) and pooled standardized incidence rates ratios were calculated to measure dichotomous outcome variables by year, age group and status of deprivation. The study continuous outcome was modelled using a zero-inflated Poisson regression while the dichotomous outcomes were modelled using logistic regressions. The multivariable analyses were run by age groups accounting for year, sex and deprivation status.

RESULTS

The percentage of those identified as deprived was significantly higher in 2013 (35.8% in 2013 vs 26.0% in 2003, P < 0.001). Among both deprived and non-deprived children, the prevalence of any active caries significantly dropped over the years, observed in all age groups. Comparing 2013 with 2003 and accounting for sex, deprivation level, "any active caries," "any caries experience" and "total number of carious teeth" significantly dropped were observed in all age groups. Comparing the years, the association of deprivation with caries outcomes mostly remained the same or decreased. This decrease was predominantly seen in "any caries experience." Only among the 5-year-olds, did the association between deprivation and total number of carious teeth over the years significantly increase. For all age groups, the likelihood of "any active caries" and "total number of carious teeth" by deprivation remained the same comparing the two points in time: 2003 and 2013. However, irrespective of year, deprivation was significantly associated with caries observed in all age groups.

CONCLUSION

In the UK, the prevalence of active dental caries and caries experience has decreased in the period between 2003 and 2013. Similarly, the likelihood of having dental caries by deprivation in 2013 was predominantly lower than that observed in 2003.

Effect of national wealth on BMI: An analysis of 206,266 individuals in 70 low-, middle- and high-income countries

BACKGROUND

This study explores the relationship between BMI and national-wealth and the cross-level interaction effect of national-wealth and individual household-wealth using multilevel analysis.

METHODS

Data from the World Health Survey conducted in 2002-2004, across 70 low-, middle- and high-income countries was used. Participants aged 18 years and over were selected using multistage, stratified cluster sampling. BMI was used as outcome variable. The potential determinants of individual-level BMI were participants' sex, age, marital-status, education, occupation, household-wealth and location(rural/urban) at the individual-level. The country-level factors used were average national income (GNI-PPP) and income inequality (Gini-index). A two-level random-intercepts and fixed-slopes model structure with individuals nested within countries was fitted, treating BMI as a continuous outcome.

RESULTS

The weighted mean BMI and standard-error of the 206,266 people from 70-countries was 23.90 (4.84). All the low-income countries were below the 25.0 mean BMI level and most of the high-income countries were above. All wealthier quintiles of household-wealth had higher scores in BMI than lowest quintile. Each USD10000 increase in GNI-PPP was associated with a 0.4 unit increase in BMI. The Gini-index was not associated with BMI. All these variables explained 28.1% of country-level, 4.9% of individual-level and 7.7% of total variance in BMI. The cross-level interaction effect between GNI-PPP and household-wealth was significant. BMI increased as the GNI-PPP increased in first four quintiles of household-wealth. However, the BMI of the wealthiest people decreased as the GNI-PPP increased.

CONCLUSION

Both individual-level and country-level factors made an independent contribution to the BMI of the people. Household-wealth and national-income had significant interaction effects.

Building Oral Health Research Capacity in India: Identifying Barriers and Enablers Using Mixed Methods

Knowledge Transfer Statement: This article will provide a brief overview of the methods in finding barriers and enablers in doing oral health research in India. This mixed-methods approach can be used by researchers in finding barriers and enablers in doing oral health research in other developing countries and building oral health research capacities.

Association between occlusal force distribution in implant overdenture prostheses and residual ridge resorption

This study aimed to investigate residual ridge resorption (RRR) of anterior and posterior maxillary and mandibular edentulous ridges, in patients treated with mandibular implant overdentures (IOD) and compare with conventional complete denture (CD) wearers, and to determine at each location, the association of RRR with the occlusal forces distribution and other patients' variables. The anterior and posterior RRR of IOD (six males, 17 females) and CD (12 males, 11 females) groups were determined using baseline and follow-up dental panaromic radiographs (DPT) (mean intervals 4 ± 1·8 years). The bone ratios were calculated using proportional area: anatomic to fixed reference areas and mean difference of ratios between the intervals determined RRR. The ridge locations included anterior and posterior maxillary and posterior mandibular arches. The T-Scan III digital occlusal system was used to record anterior and posterior percentage occlusal force (%OF) distributions. There were significant differences in anterior and posterior %OF between treatment groups. Two-way anova showed RRR was significant for arch locations (P = 0·005), treatment group (IOD versus CD) (P = 0·001), however, no significant interaction (P = 0·799). Multivariate regression analyses showed significant association between RRR and %OF at anterior maxilla (P = 0·000) and posterior mandible (P = 0·023) and for treatment groups at posterior maxilla (P = 0·033) and mandibular areas (P = 0·021). Resorption was observed in IOD compared to CD groups, with 8·5% chance of less resorption in former and 7·8% in the latter location. Depending on arch location, ridge resorption at various locations was associated with occlusal force distribution and/or treatment groups (implant prostheses or conventional complete dentures).

The impact of out-of-pocket payments for dental care on household finances in low and middle income countries

BACKGROUND

Dental care is extremely costly and beyond most people means in developing countries. The primary aim of this study was to determine the impact of out-of-pocket payments for dental care on household finances in 40 low and middle income countries. A second aim was to compare the burden of payments for dental care with that for other health services.

METHODS

We used data from 174,257 adults, aged 18 years and above, who reported their total and itemized household expenditure in the past four weeks as part of the World Health Surveys. The financial burden on households was measured using the catastrophic health expenditure (CHE) and impoverishment approaches. A household was classified as facing CHE if it spent 40% or more of its capacity to pay, and as facing impoverishment if it fell below the country-specific poverty line after spending on health care was subtracted from household expenditure. The odds of experiencing CHE and impoverishment due to expenditure on dental care were estimated from two-level logistic regression models, controlling for various individual- and country-level covariates.

RESULTS

Households that paid for dental care had 1.88 (95% Confidence Interval: 1.78-1.99) greater odds of incurring CHE and 1.65 (95% CI: 1.52-1.80) greater odds of facing impoverishment, after adjustment for covariates. Furthermore, the impact of paying for dental care was lower than that for medications or drugs, inpatient care, outpatient care and laboratory tests but similar to that of health care products, traditional medicine and other health services.

CONCLUSION

Households with recent dental care spending were more likely to use a large portion of their disposable income and fall below the poverty line. Policy makers ought to consider including dental care as part of universal health care and advocate for the inclusion of dental care coverage in health insurance packages.

An Assessment of Oral Health Related Quality of Life in Orthodontics Patients with Micro-Implant: A Pilot Study

<p class="AbstractContent"><strong>Objective</strong>: The purpose of this study was to assess Oral Health-Related Quality of Life (OHQoL) among orthodontic patients who had micro-implants.</p><p class="AbstractContent"><strong>Methods</strong>: This pilot study involved a total of sixteen orthodontics patients. The samples were selected from the postgraduate orthodontic clinic, Faculty of Dentistry Universiti Teknologi MARA. The study consisted of five (31.3%) males and eleven females (68.8%), aged between 18-30 years. The patients were divided equally into two groups (control and titanium alloy micro-implant). The micro-implants had diameter of 1.6mm and length of 8mm. Eight patients were treated without using micro-implant for the control group. The micro-implants were inserted by single operator. Cases with higher anchorage requirement were selected for micro-implant placements. The oral health quality of life was assessed by using S-OHIP14 (M) Malay version at two times which is before micro-implant insertion (T₀) and after four weeks’ micro-implant insertion (T₁).</p><p class="AbstractContent"><strong>Results</strong>: There were no significant different found on functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap domains of OHIP-14 between the study group and control group (P&gt;0.05).</p><p class="AbstractContent"><strong>Conclusion</strong>: This pilot study showed that orthodontic treatment with micro-implants will not worsen the OHQoL of orthodontic patients and orthodontic patients without micro-implant perceived as having a similar level of OHQoL.</p>

The relationship between oral health and oral health related quality of life among elderly people in United Kingdom

OBJECTIVES

To identify the determinants of OHRQoL among older people in the United Kingdom.

METHODS

A subset of elderly (≥65year) participants from the UK Adult Dental Health Survey 2009 data was used. OHRQoL was assessed by means of the OHIP-14 additive score. The number of missing teeth; presence of active caries, dental pain, root caries, tooth wear, periodontal pockets>4mm, loss of attachment>9mm; having PUFA>0 (presence of severely decayed teeth with visible pulpal involvement, ulceration caused by dislocated tooth fragments, fistula and abscess); and wearing a denture were used as predictor variables. Age, gender, marital status, education level, occupation and presence of any long standing illness were used as control variables. Multivariate zero-inflated Poisson regression analysis was performed using R-project statistical software.

RESULTS

A total of 1277 elderly participants were included. The weighted mean(SE) OHIP-14 score of these participants was 2.95 (0.17). Having active caries (IRR=1.37, CI=1.25;1.50), PUFA>0 (IRR=1.17, CI=1.05;1.31), dental pain (IRR=1.34, CI=1.20;1.50), and wearing dentures (IRR=1.30, CI=1.17;1.44), were significantly positively associated with OHIP-14 score. Having periodontal pockets>4mm, at least one bleeding site, and anterior tooth wear were not significantly associated with the OHIP-14 score.

CONCLUSION

Whereas previous research has suggested a moderate relationship between oral disease and quality of life in this large scale survey of older adults, the presence of active caries and the presence of one or more of the PUFA indicators are associated with impaired oral health related quality of life in older adults, but not indicators of periodontal status. The implication of this is that whilst focussing on prevention of disease, there is an ongoing need for oral health screening and treatment in this group.

Intraclass correlation and design effect in BMI, physical activity and diet: a cross-sectional study of 56 countries

OBJECTIVES

Measuring the intraclass correlation coefficient (ICC) and design effect (DE) may help to modify the public health interventions for body mass index (BMI), physical activity and diet according to geographic targeting of interventions in different countries. The purpose of this study was to quantify the level of clustering and DE in BMI, physical activity and diet in 56 low-income, middle-income and high-income countries.

DESIGN

Cross-sectional study design.

SETTING

Multicountry national survey data.

METHODS

The World Health Survey (WHS), 2003, data were used to examine clustering in BMI, physical activity in metabolic equivalent of task (MET) and diet in fruits and vegetables intake (FVI) from low-income, middle-income and high-income countries. Multistage sampling in the WHS used geographical clusters as primary sampling units (PSU). These PSUs were used as a clustering or grouping variable in this analysis. Multilevel intercept only regression models were used to calculate the ICC and DE for each country.

RESULTS

The median ICC (0.039) and median DE (1.82) for BMI were low; however, FVI had a higher median ICC (0.189) and median DE (4.16). For MET, the median ICC was 0.141 and median DE was 4.59. In some countries, however, the ICC and DE for BMI were large. For instance, South Africa had the highest ICC (0.39) and DE (11.9) for BMI, whereas Uruguay had the highest ICC (0.434) for MET and Ethiopia had the highest ICC (0.471) for FVI.

CONCLUSIONS

This study shows that across a wide range of countries, there was low area level clustering for BMI, whereas MET and FVI showed high area level clustering. These results suggested that the country level clustering effect should be considered in developing preventive approaches for BMI, as well as improving physical activity and healthy diets for each country.

Household expenditure for dental care in low and middle income countries

This study assessed the extent of household catastrophic expenditure in dental health care and its possible determinants in 41 low and middle income countries. Data from 182,007 respondents aged 18 years and over (69,315 in 18 low income countries, 59,645 in 15 lower middle income countries and 53,047 in 8 upper middle income countries) who participated in the WHO World Health Survey (WHS) were analyzed. Expenditure in dental health care was defined as catastrophic if it was equal to or higher than 40% of the household capacity to pay. A number of individual and country-level factors were assessed as potential determinants of catastrophic dental health expenditure (CDHE) in multilevel logistic regression with individuals nested within countries. Up to 7% of households in low and middle income countries faced CDHE in the last 4 weeks. This proportion rose up to 35% among households that incurred some dental health expenditure within the same period. The multilevel model showed that wealthier, urban and larger households and more economically developed countries had higher odds of facing CDHE. The results of this study show that payments for dental health care can be a considerable burden on households, to the extent of preventing expenditure on basic necessities. They also help characterize households more likely to incur catastrophic expenditure on dental health care. Alternative health care financing strategies and policies targeted to improve fairness in financial contribution are urgently required in low and middle income countries.