Preparedness and competency of New Zealand graduates for general dental practice - perceptions from the workforce.

BACKGROUND: Dental graduates need to demonstrate clinical competency. This mixed-methods study explored the perceptions of clinicians who employ or work with new graduates from the University of Otago, New Zealand, and identified themes reflecting graduates' preparedness for independent practice. METHODS: An online survey using a semantic differential scale and open-ended questions collected opinions and experiences from the workforce. Quantitative data were analysed using SPSS software, and qualitative data were analysed thematically. RESULTS: A representative sample of the workforce was obtained with a response rate of 35% (N = 83). Most clinicians engage new graduates to support the profession and/or rural communities. They perceived that graduates were well prepared in most areas, could translate theory to clinical practice and demonstrate professionalism. Graduates were reportedly stronger in basic dentistry, communication, ethics, and record keeping however were less strong in complex treatment planning, molar endodontics, fixed prosthodontics and exodontia. Clinical exposure during dental training was perceived as more limited, and mentoring and guidance in the transition to practice were deemed to be important. CONCLUSIONS: New Zealand dental graduates appear prepared for independent practice; however, maximising clinical opportunities during training, mentoring and early professional development in advanced areas of practice is essential to enhance competency and confidence.

Conceptualising a theoretical framework for planning and evaluating workplace oral health promotion programs.

ISSUED ADDRESSED: Workplaces have considerable potential for enhancing personal resources and providing a supportive working environment for staff health, including oral health and well-being. To date, assessments of workplace oral health promotion (WOHP) activities have observed benefits ranging from self-reported oral health to clinical parameters. However, previous WOHP actions were not based on a theoretical framework and did not consider the working environment as part of the planning and evaluation process. METHODS: This article used evidence-based health promotion theoretical frameworks, and associated facilitators and barriers, in constructing an integrated and theoretically robust approach to planning and evaluating oral health promotion activities in the workplace. RESULTS: The PRECEDE-PROCEED Model for planning and evaluation, the reach effectiveness adoption implementation maintenance, and the Salutogenic Model of Health were chosen to complement each other in the planning and evaluation process, based on their different features and the applicability of those features to the workplace setting. Because of the limited literature in this area, the current article also used evidence from oral health promotion in other settings (including schools and the community) and general health promotion in the workplace to construct a theoretical framework for planning and evaluating WOHP activities. CONCLUSIONS: The theoretical framework developed could assist in planning or improving existing workplace health promotion programs that focus on or incorporate oral health elements. SO WHAT?: Future research on applying and adapting the proposed framework is required.

Workplace oral health promotion activities among community-aged care workers: A qualitative exploration.

BACKGROUND: The workplace is an ideal-and priority-setting for health promotion activities. Developing and implementing workplace health promotion interventions, including oral health promotion activities, can help create health-supporting workplace environments. OBJECTIVE: To pilot workplace oral health promotion activities among staff working in the aged care sector, report their impact and explore participants' views on the factors that contribute to participation and effectiveness. METHODS: This study comprised three phases: (i) the development and face validation of the resources, (ii) a 3-h educational session and (iii) five interview sessions with participants 4-6 weeks following the education session. The recorded interviews were transcribed verbatim and analysed thematically. RESULTS: Eleven community-aged care workforce were invited to five feedback sessions. Ten participants were female and ranged in age from 18 to 64. All participants gave favourable comments about the content and delivery of the training session and accompanying resources. The participants felt that the benefits of WOHP include improved staff knowledge, awareness and oral care routine, the ability to share (and put into practice) the gained knowledge and information with their dependants, a lower risk of having poor oral health that adversely affects their well-being and work tasks, and potentially beneficial impacts on the organization's staff roster. Their attendance in the WOHP was facilitated by being paid to attend and scheduling the sessions during work time. Future WOHP suggestions include the possibility of a one-stop dental check-up at the workplace or staff dental care discounts from local dental practitioners and combining oral health with other health promotion activities. CONCLUSIONS: Planning and implementing WOHP was deemed acceptable and feasible in this study context and successfully achieved short-term impacts among community-aged care workers. Appropriate times and locations, organizational arrangements and a variety of delivery options contributed to successful programme planning and implementation.

The development and validation of a nationwide dataset of water distribution zones in Aotearoa New Zealand: A cross-sectional geospatial study.

The reliable supply of safe drinking water is vital for the health of human populations. Despite this, there is no consistent nationwide spatial dataset of water distribution zones (WDZ) for Aotearoa New Zealand (A-NZ). The purpose of this data article is to describe the development and validation of a consistent nationwide dataset of WDZ across A-NZ. We obtained spatial data from all 67 district and city councils through: 1) information requests between 2021 and 2023; 2) the Ministry of Health and; 3) the Institute of Environmental Science and Research. Data were modified to improve the spatial accuracy of the WDZ using auxiliary data on the building footprints (Land Information New Zealand) and the drinking water reticulation (WSP & councils). We estimated the population served by each WDZ through spatial linking to meshblock-level data provided by Statistics New Zealand (meshblocks are the smallest administrative geographic unit in A-NZ). The dataset will be useful to provide insights into the extent of the publicly-owned drinking water assets in A-NZ and is essential for the accurate exposure assessment in epidemiological research investigating the impact of drinking water quality on human health.

Measurement of tooth displacement.

The periodontium is a biological structure that supports the tooth in the jaw and behave as a developmental, biological, and functional unit. Teeth may be considered to be 'suspended' in their tooth sockets which provides teeth the ability to move in response to an applied load. In terms of the protection the suspension effect of the periodontal ligament may offer dental restorations, movement in an axial direction is of interest. No device or system to measure this movement is readily available, thus a novel approach had to be developed to address the questions of this research. The device developed allowed images to be taken of the participants teeth before, during and after a participant bit down on the tooth and used to measure the displacement of the tooth in image processing software. Average maximum tooth displacement from all participants of 73.8 µm (sd = 22.5 µm) were recorded. Longer application time of bite force was associated with greater cumulative tooth displacement, for a given level of force, and female participants experienced approximately 2 µm more displacement per Newton than males. The device and methods utilised in this study has shown good potential as a measurement protocol for measurement of vertical tooth movements in vivo. The response to load the teeth in this study has shown, highlighted the visco-elastic properties of the periodontal ligament and the amount of movement recorded supports the protection that controlled tooth movement offers teeth.

Using the Child Perceptions Questionnaire with young adults.

OBJECTIVES: That no study has investigated oral health-related quality of life (OHRQoL) through the transition from adolescence to young adulthood is partly due to no OHRQoL index having been validated in both adult and child populations. Having separate measures for adolescence and young adulthood has meant that the different measures cannot be compared directly. Accordingly, the study objectives were: to determine whether the CPQ11-14 is a valid and reliable OHRQoL measure in young adults and to compare its performance with the OHIP-14 in young adults. METHODS: A cross-sectional study was undertaken of a convenience sample of 968 young New Zealand adults aged 18-30 years (83.1% female) using RedCap. Two separate measures of OHRQoL were used (the CPQ11-14 and OHIP-14), along with Locker's global oral health item. RESULTS: Internal consistency reliability was high for the CPQ11-14 and the OHIP-14, with Cronbach's alpha scores of .87 and .92, respectively. Mean scale scores were 15.8 (SD = 9.7) for the CPQ11-14 and 24.1 (SD = 10.1) for the OHIP-14. The scale scores were strongly and positively correlated (Pearson's r = .8). Both demonstrated acceptable construct validity, represented by ascending gradients in mean scores across the ordinal response categories of Locker's global oral health item. Ordinal logistic regression modelling of Locker's item showed the CPQ11-14 to have a slightly better fit and explain more variance than the OHIP-14. CONCLUSION: The CPQ11-14 was valid and reliable in this young adult population. Further epidemiological validation studies should confirm the findings in representative samples.

Oral health promotion activities in the workplace: a scoping review.

There is limited literature and no reviews on oral health promotion activities in the workplace to guide planning and practice. This review summarizes evidence about oral health promotion activities in the workplace (nature and extent), its impact and the factors that facilitate or act as barriers to implementation. Using the PRISMA-ScR guidelines, scientific articles written in English and published in peer-reviewed journals up to April 2021, from six databases (Medline, PubMed, CINAHL, Scopus, EMBASE and Emcare) were screened and selected. The full texts of 95 articles were then considered; 21 articles met the inclusion criteria of using oral health status or oral health predisposing factors as primary outcome after an intervention in the workplace. Almost all included articles took a quantitative approach (n = 18), two used a qualitative design and another used a mixed-method approach. The most common activities were personalized or group oral health education interventions and oral health screenings conducted by a dental professional. Two studies reported the cost-benefit of workplace oral health promotion (WOHP). The literature indicated that WOHP interventions can be successful in achieving improvements in oral health, measured using a range of clinical (plaque accumulation, gingival inflammation, periodontal inflammation) and self-rated oral health indicators. Based on the limited literature available, WOHP may have benefits for employee oral health and employers, and the support of managers and organizations potentially improves the success of programmes. The workplace would appear to be an ideal setting to promote oral health. However, there is limited information to guide oral health promotion planning and implementation, and policy.

Occlusal Features and TMJ Clicking: A 30-Year Evaluation from a Cohort Study.

Occlusal features that deviate from normative values have been historically considered risk factors for temporomandibular joint (TMJ) disorders. Nowadays, a putative association between dental occlusion and TMJ disorders remains controversial, with research findings on associations being inconsistent and inconclusive. We hypothesized that putative occlusal features identified during adolescence are associated with TMJ clicking later in life. The Dunedin Multidisciplinary Health and Development Study is a longitudinal birth cohort study investigation of 1,037 children (48.4% female) born in Dunedin, New Zealand, between April 1, 1972, and March 31, 1973, and assessed repeatedly since then. Associations between posterior crossbite, overbite, and overjet at age 15, as well as both self-reported and clinically assessed TMJ clicking sounds at age 45, were studied. Data were analyzed using multivariate logistic regression, after controlling for sex, emotional style, self-reports of tooth clenching and sleep bruxism, and history of orthodontic treatment. Self-reported and examiner-reported TMJ clicking at age 45 affected 18.3% and 23.8% of the study sample, respectively, and were not associated with the presence of a posterior crossbite or abnormal overjet/overbite values during adolescence. Self-reported history of tooth clenching and emotional style were associated with self-reported TMJ clicking later in life. In addition, there is a suggestion that high overbite during adolescence is negatively associated with TMJ clicking later in life. A history of orthodontic treatment was not associated with TMJ clicking. Abnormal occlusal features, such as posterior crossbite and high and low overjet/overbite in adolescence, are not associated with higher prevalence of TMJ clicking later in life. Personality also appears to influence self-reports of TMJ clicking later in life.

Development of a bite force transducer for measuring maximum voluntary bite forces between individual opposing tooth surfaces.

Bite forces are studied in order to understand a wide range of factors pertaining to the mastication system. Various strain gauge transducers have been employed to measure bite forces, with several descriptions of these available in the literature; unfortunately, many reports provide insufficient detail to enable accurate reproduction. The aim of this project was to develop a bite force transducer with the capability of measuring maximum voluntary bite forces between individual opposing tooth surfaces. Furthermore, in an attempt to address the issue of vague device descriptions in the available literature, a detailed account of the transducer development has been included. A novel strain gauge transducer was designed and built. Bite forces of forty individuals were measured to verify the capabilities and clinical application of the device.

The Dunedin Multidisciplinary Health and Development Study: Oral health findings and their implications.

Longitudinal research is needed to better understand the natural history of oral conditions and long-term health and social outcomes. Oral health data has been collected periodically in the Dunedin Multidisciplinary Health and Development Study for over 40 years. To date, 70+ peer-review articles on the Study's oral health-related findings have been published, providing insight into the natural history of oral conditions, risk factors, impacts on quality of life, and disparities in oral health. Some of these report new findings, while others build upon the existing body of evidence. This paper provides an overview of these findings and reflects on their public health implications and policy utility in New Zealand.

The Dental Amalgam Phasedown in New Zealand: A 20-year Trend.

BACKGROUND AND OBJECTIVES: Information on the choice of material and performance of restorations placed in a dental practice annually is limited. The Minamata Convention on Mercury is likely to affect the use of amalgam worldwide. The objective of this research was to investigate the use of restorative materials at the University of Otago Faculty of Dentistry in New Zealand from 1998 to 2017. METHODS: Data from the Faculty of Dentistry's database from the years of interest were compiled. These data included information on the characteristics of restorations, including information on the material used and number of surfaces involved for each restoration. The tooth in which each restoration was placed was categorized by arch, tooth type, and deciduous or permanent dentition. RESULTS: Records identified 227,514 permanent restorations placed from January 1998 to December 2017, of which 91.7% were direct restorations. Among direct restorations, composite resin was the most commonly used material, followed by amalgam, glass ionomer, and compomer. The use of amalgam for direct restorations decreased from 52.3% of direct restorations in 1998 to 7.1% in 2017. A corresponding increase was observed in the use of tooth-colored direct restorations, particularly composites. Among indirect restorations, porcelain fused to metal, gold, and stainless steel (in pediatric applications) were the materials most frequently used. CONCLUSIONS: Despite having no official policy on reducing the use of dental amalgam, the Faculty of Dentistry is following the global trend in reducing its use, with composite resin now well established as the predominant restorative material used. If the current rate of decline persists unchecked, the Faculty of Dentistry could transition to being amalgam free by 2020, although it seems likely that the characteristics and principles of use of the material (and its removal) will be taught for some time to come. This knowledge is important to planning curriculum changes needed to prepare graduates for clinical practice.

Pregnancy, parity and periodontal disease.

Many women believe that their dental condition deteriorated during pregnancy or as a result of having children. Epidemiological studies have reported an association between higher parity and tooth loss, and higher parity and periodontal attachment loss. Several possible explanations for this association exist. First, hormonal changes during pregnancy affect the immune response to bacterial plaque and drive vascular and gingival changes that may contribute to heightened gingival inflammation. These changes are transient, without irreversible loss of periodontal attachment, and post-partum resolution can be expected for most women. For women with destructive periodontal disease, the effects of pregnancy and parity are unclear. Second, it is also plausible that parity and socioeconomic position (SEP) have shared risk factors, increasing the incidence of disease or influencing its management. Education, one aspect of SEP, is an important determining factor for women's fertility rate, with a gradient of fewer children with higher educational attainment. Higher levels of education are also favourably associated with behaviours conducive to oral health, and a lower incidence of damaging health behaviours. Thus, the potential for confounding is considerable. This review examines the literature on the association between pregnancy, parity and periodontal health, and explores sociobehavioural mechanisms for the observed association.

Studying the human oral microbiome: challenges and the evolution of solutions.

Since the pioneering work of van Leeuwenhoek in 1684, subsequently built upon by other renowned microbiologists Robert Koch, Willoughby Miller and GV Black, oral microbiology has developed innovative techniques to study the oral microflora (now termed the 'oral microbiome'). The advent of molecular techniques such as DNA-DNA hybridization, polymerase chain reaction and DNA sequencing has created an array of opportunities to construct a comprehensive picture of the diversity and composition of the oral microbiome. Approximately 700 oral bacterial species have been identified, of which 50% have yet to be cultivated, and some of these are known only by their signature DNA sequences. The synergism of ever-evolving culture-based and state-of-the-art culture-independent molecular techniques has facilitated in-depth understanding of the dynamics, acquisition and transfer of oral bacteria, along with their role in oral and general health and disease. Further research is needed to not only analyse but also to make sense of the ever-increasing volumes of data which these molecular techniques (especially high-throughput DNA sequencing) are generating, as well as why particular bacteria are present and what they are 'actually doing' there. This review presents a comprehensive literature search of oral microbiology-related methods currently used to study the oral microbiome.

Effects of Taxing Sugar-Sweetened Beverages on Caries and Treatment Costs.

Caries increment is affected by sugar-sweetened beverage (SSB) consumption. Taxing SSBs could reduce sugar consumption and caries increment. The authors aimed to estimate the impact of a 20% SSB sales tax on caries increment and associated treatment costs (as well as the resulting tax revenue) in the context of Germany. A model-based approach was taken, estimating the effects for the German population aged 14 to 79 y over a 10-y period. Taxation was assumed to affect beverage-associated sugar consumption via empirical demand elasticities. Altered consumption affected caries increments and treatment costs, with cost estimates being calculated under the perspective of the statutory health insurance. National representative consumption and price data were used to estimate tax revenue. Microsimulations were performed to estimate health outcomes, costs, and revenue impact in different age, sex, and income groups. Implementing a 20% SSB sales tax reduced sugar consumption in nearly all male groups but in fewer female groups. The reduction was larger among younger than older individuals and among those with low income. Taxation reduced caries increment and treatment costs especially in younger (rather than older) individuals and those with low income. Over 10 y, mean (SD) net caries increments at the population level were 82.27 (1.15) million and 83.02 (1.08) million teeth at 20% and 0% SSB tax, respectively. These generated treatment costs of 2.64 (0.39) billion and 2.72 (0.35) billion euro, respectively. Additional tax revenue was 37.99 (3.41) billion euro over the 10 y. In conclusion and within the limitations of this study's perspective, database, and underlying assumptions, implementing a 20% sales tax on SSBs is likely to reduce caries increment, especially in young low-income males, thereby also reducing inequalities in the distribution of caries experience. Taxation would also reduce treatment costs. However, these reductions might be limited in the total population.

Ethnic and socioeconomic inequalities in dental treatment at a school of dentistry.

BACKGROUND AND OBJECTIVES: Health services should be targeted toward those most in need of health care. Poor oral health disproportionately affects Maori, Pacific Island, and socioeconomically deprived New Zealanders of all ages, and oral health care services should be prioritised to such groups. In New Zealand, free oral health care is available for all children up to the age of 17. On the other hand, adult dental services are provided on a user-pays basis, except for a limited range of basic services for some adults, access to which varies regionally. This study investigated the extent of dental treatment inequalities among patients at New Zealand's only School of Dentistry. METHODS: Data were audited for all treatments provided at the University of Otago Faculty of Dentistry from 2006 to 2011 for patients born prior to 1990. Ethnic and socioeconomic inequalities in the provision of dental extractions, endodontic treatment, crowns, and preventive care were investigated. Differences were expressed as the odds of having received one or more treatments of that type during the six-year period 2006 to 2011. RESULTS: Data were analysed for 23,799 individuals, of whom 11,945 (50.2%) were female, 1,285 (5.4%) were Maori and 479 (2.0%) were Pacific, 4,040 (17.0%) were of low socioeconomic status (SES), and 2,681 (11.3%) were beneficiaries or unemployed. After controlling for SES, age, and sex, Maori had 1.8 times greater odds of having had a tooth extracted than NZ European patients, while Pacific Islanders had 2.1 times the odds. Furthermore, after controlling for ethnicity, age, and sex, low-SES patients had 2.4 times greater odds of having had a tooth extracted than high-SES patients, and beneficiaries had 2.9 times the odds. Conversely, these groups were less likely to have had a tooth treated with a crown or endodontics or receive preventive care. CONCLUSIONS: Existing policies call for the reduction of inequalities. There is a need for a strategy to monitor changes in treatment inequality over time which includes improving equity in service care provision. The observed treatment inequalities are likely to be an underestimate of those occurring in private dental practice in New Zealand.

Oral Health of New Zealand Service Personnel in WW1.

BACKGROUND AND OBJECTIVES: During the First World War, 10% of New Zealand's population served in the armed forces, and around one in five of those were killed. In commemoration of 100 years since WW1, this study uses retrospective data to report on the oral health of NZ service personnel. METHODS: 325 Pakeha, 165 Maori and 150 Samoan male recruits who served in the NZ Expeditionary Force between 1914 and 1918 were randomly selected and their personnel files accessed through Archives New Zealand. RESULTS: The oral health of recruits was described as 'good' for 44%, 'pass' for 38%, 'pass with false teeth' for 5% and 'poor' for 13%. Dental health was documented at enlistment for a decreasing proportion of soldiers as the war progressed, dropping from 96% during 1914-15, to 54% in 1916 and 22% in 1917-18 (p < 0.001). Significantly more soldiers who enlisted in 1917-18 had poor dental health (44%) than those who enlisted during 1916 (20%) and 1914-15 (8%) (p < 0.001). By ethnicity, Maori had the best dental health, followed by Samoan and Pakeha recruits (p < 0.001). On average, dental health was poorer among the lower ranks and among recruits of low socio-economic status; and soldiers from major cities had better oral health than those from rural areas; however, these differences were not statistically significant in this sample. CONCLUSIONS: Enlistment criteria appear to have been loosened as the war progressed, perhaps to accept more soldiers into service. Poor oral health was reported for approximately 1 in 7 accepted recruits. Maori appear to have had better oral health.

Oral Health-related Beliefs, Behaviors, and Outcomes through the Life Course.

Complex associations exist among socioeconomic status (SES) in early life, beliefs about oral health care (held by individuals and their parents), and oral health-related behaviors. The pathways to poor adult oral health are difficult to model and describe, especially due to a lack of longitudinal data. The study aim was to explore possible pathways of oral health from birth to adulthood (age 38 y). We hypothesized that higher socioeconomic position in childhood would predict favorable oral health beliefs in adolescence and early adulthood, which in turn would predict favorable self-care and dental attendance behaviors; those would lead to lower dental caries experience and better self-reported oral health by age 38 y. A generalized structural equation modeling approach was used to investigate the relationship among oral health-related beliefs, behaviors in early adulthood, and dental health outcomes and quality of life in adulthood (age, 38 y), based on longitudinal data from a population-based birth cohort. The current investigation utilized prospectively collected data on early (up to 15 y) and adult (26 and 32 y) SES, oral health-related beliefs (15, 26, and 32 y), self-care behaviors (15, 28, and 32 y), oral health outcomes (e.g., number of carious and missing tooth surfaces), and oral health-related quality of life (38 y). Early SES and parental oral health-related beliefs were associated with the study members' oral health-related beliefs, which in turn predicted toothbrushing and dental service use. Toothbrushing and dental service use were associated with the number of untreated carious and missing tooth surfaces in adulthood. The number of untreated carious and missing tooth surfaces were associated with oral health-related quality of life. Oral health toward the end of the fourth decade of life is associated with intergenerational factors and various aspects of people's beliefs, SES, dental attendance, and self-care operating since the childhood years.

Validity of self-reported periodontal questions in a New Zealand cohort.

OBJECTIVE: This study aims to assess the validity of four self-reported questions for measuring periodontitis in a birth cohort. METHODS: Full-mouth periodontal examinations (three sites/tooth) were undertaken at age 38 in a complete birth cohort born in 1972/1973 in New Zealand. Four self-reported periodontal screening questions were included ("Do you think you have gum disease"; "Has a dental professional ever told you that you have lost bone around your teeth"; "Have you ever had scaling, root planing, surgery, or other treatment for gum disease" and "Have you ever had any teeth that have become loose by themselves without some injury"), and the sensitivity and specificity of those self-reported items were calculated for individual questions and using a multivariable binary logistic regression model. Generalised linear models were used to compare relative risks for periodontitis and smoking, using the (a) clinical measures and (b) self-reported questions. RESULTS: Among the 895 who had periodontal examinations, the prevalence of periodontitis was 43.7, 22.8 and 12.0 %, respectively, for one or more sites with ≥4, ≥5 and ≥6 mm clinical attachment loss (AL). The specificity of the four self-reported questions was high (82-94 %), but the sensitivity was low for all, except the question: "Do you think you have gum disease". The four questions' highest combined sensitivity + specificity value was 1.33 for one or more sites with ≥4 mm AL, with the area under the receiver operating characteristic (ROC) curve being greatest for one or more sites with ≥6 mm AL, at 0.84. For the smoking-periodontitis association, the estimates of relative risk for periodontitis among smokers were as follows: (a) 1.81, 2.88 and 5.79, respectively, clinically determined to have one or more sites with ≥4, ≥5 and ≥6 mm AL and (b) 2.19, 2.17, 1.23 and 1.89, respectively, for the four self-reported questions. CONCLUSION: The four self-reported periodontal screening questions performed adequately in identifying clinically determined periodontal disease, and they showed moderate validity when used together as a set. However, the strength of the association between smoking and periodontitis was underestimated when they were used instead of clinically determined periodontal disease. CLINICAL RELEVANCE: These findings suggest that clinical examinations remain to be the desired approach for periodontal surveys, but where resource constraints preclude those, self-reported methods can provide useful information; after all, some periodontal information is better than none at all.

Occurrence and impact of xerostomia among dentate adult New Zealanders: findings from a national survey.

BACKGROUND: We investigated the prevalence, associations and impact of xerostomia in a nationally representative sample of dentate adult community-dwelling New Zealanders aged 18 years and over. METHODS: The data were collected from a representative sample of 2209 adults, as part of the 2009 New Zealand Oral Health Survey (NZOHS). Data were collected using face-to-face interviews, dental examinations and the short-form Oral Health Impact Profile (OHIP-14). Data analysis used appropriate weighting for all procedures to account for the complex survey design. RESULTS: The overall prevalence estimate for xerostomia was 13.1% (95% CI 11.7, 14.7), and it was more common among females. Those in the 75+  and 25-34 age groups were more likely (odds ratios of 6.5 and 4.0, respectively) to have xerostomia. After controlling for sociodemographic characteristics and clinical oral disease, the mean OHIP-14 score among xerostomics was 50% higher than among those who did not have the condition. CONCLUSIONS: These data indicate that xerostomia is a common condition which can affect quality of life among people of all ages.

Changes in students' perceptions of their dental education environment.

OBJECTIVES: To examine the 'Expected' and 'Actual' educational environment experienced by a cohort of Bachelor of Dental Surgery (BDS) students at the University of Otago's Faculty of Dentistry using the Dundee Ready Educational Environment Measure (DREEM). METHODS: Cohort members were asked to complete five DREEM surveys over the four-year BDS programme. Student expectations at the beginning of their first year were assessed using a modified version of the DREEM questionnaire, while following (standard) DREEM questionnaires at the end of each professional year addressed students' 'Actual' perception of the educational environment. RESULTS: Sixty-six students (99%) completed at least one questionnaire. Overall, the BDS students' perceptions of their educational environment tended to be positive and students identified both perceived strengths and weaknesses in the BDS programme. However, more negative than positive shifts were reported between the 'Expected' and 'Actual' individual DREEM individual items, suggesting that BDS students initially expected more from their educational environment than they actually experienced. Individual DREEM outcomes undergoing negative and positive shifts differed over the years and varied in number. These may be explained, in part, by changes in the curriculum focus from year to year. CONCLUSION: The students' changing DREEM responses over time revealed anticipated and perceived strengths and weaknesses of the BDS curriculum, as well as shifts in students' perceptions in response to curricular changes. However, our findings highlight the potential usefulness for dental education of a measure for use that takes the unique aspects of the dental education environment into account.