Title: Cross-sectional associations between nutrient intake and tooth decay in older Australian men: The Concord Health and Ageing in Men Project.

Poor nutrition is a risk factor for dental decay in younger people. However, except for sugar it is unclear if this is true in older age groups. The aim of this study was to analyze the possible associations between overall dietary intake of nutrients and diet quality and presence of dental decay in community dwelling older men. A cross-sectional analysis of a longitudinal study with a standardized validated diet history assessment and comprehensive oral health examination in 520 community dwelling men (mean age: 84 years) participating in the Concord Health and Ageing in Men Project. Nutrient Reference Values (NRVs) were used to determine if individual micronutrients and macronutrients were meeting recommendations. Acceptable Macronutrient Distribution Ranges (AMDR) were attained for fat and carbohydrate intakes and were incorporated into a dichotomous variable to determine if the participants were consuming a high fat and low carbohydrate diet. Diagnosis of coronal caries was based on visual criteria and inspection and was completed on each of the five coronal surfaces. Root surface caries was textual changes across four root surfaces. This diagnosis was used to categorize participants by presence and severity of coronal and root caries. Adjusted logistic regression showed not meeting the recommended intakes for thiamin (odds ratio (OR): 2.32 95% confidence interval (CI) 1.15 - 4.67), and zinc (OR: 3.33, 95% CI 1.71 - 6.48) were associated with presence of severe root decay. Adjusted analysis also showed that participants who were outside the recommended AMDR for fat (OR: 0.61, 95% CI 0.38 - 0.98), and those who consumed a high fat and low carbohydrate diet (OR: 0.56, 95% CI 0.35 - 0.91) were less likely to have coronal tooth decay. Our study shows associations between micronutrients and macronutrients and coronal and root surface decay. Although this study cannot prescribe causality or be generalized to all older adults, diet has a possible association with dental decay in older men.

A longitudinal evaluation of the Rural Clinical Placement Program at the University of Sydney Dental School.

INTRODUCTION: Australia has a lack of dental practitioners in rural and remote regions. This study evaluates the impact of a Rural Clinical Placement Program (RCPP) offered to final year students at the University of Sydney (USYD) Dental School on the graduates working locations. MATERIALS AND METHODS: University of Sydney students who graduated between 2009 and 2013 (n = 404) were invited to complete a telephone interview. One hundred and thirty-five graduates were interviewed, 90 RCPP participants and 45 non-participants. RESULTS: The majority of graduates interviewed were from a metropolitan background (87%), 47% were female, 77% worked full time, and 70% were employed in private practice. A higher proportion (33%) of the RCPP participants were working in rural Australia compared with 18% of the non-participants. The graduates reported that the RCPP was a high-quality program with excellent rural clinical supervisors, provided broad clinical dentistry; they met appreciative patients and enjoyed the rural lifestyle. CONCLUSIONS: The RCPP was a valuable and positive experience with many considering it as a highlight of their dental education. A large proportion reported the program positively influenced their employment location choices, and a higher proportion of the RCPP participants were identified as working rurally, compared to the non-participants.

Chewing function, general health and the dentition of older Australian men: The Concord Health and Ageing in Men Project.

OBJECTIVES: To describe the associations between chewing function with oral health and certain general health characteristics, in a population of community-dwelling older Australian men. METHODS: Analysis of data obtained from a cross-sectional analysis of the 4th wave of the Concord Health and Ageing in Men Project cohort of 614 participants, 524 whom were dentate, aged 78 years and over. Their chewing capacity was assessed using three main indicators: capacity to chew eleven food items ranging from boiled eggs through to fresh carrots and nuts; discomfort when eating; and interruption of meals. Associations with chewing were tested for dentate vs edentate participants, numbers of teeth present, active dental disease and key general health conditions such as disabilities, comorbidities and cognitive status. Log binomial regression models adjusted for age, country of birth, income, education and marital status. Prevalence ratios and 95% confidence intervals were estimated. RESULTS: Twenty-one per cent of participants could not eat hard foods, while 23.1% reported discomfort when eating, and 8.8% reported interrupted meals when eating. There was a threefold difference in the capacity of dentate men to chew firm meat over that of edentulous men (95% CI, 2.0-4.9); a 2.5 times greater likelihood of edentate men reporting discomfort when eating (95% CI: 1.5-4.3); and 1.9 times greater likelihood of edentate participants reporting having meals interrupted (95% CI: 1.4-2.6). Chewing/eating difficulties were associated with both dental status (number of teeth, active dental caries) and self-rated dental health. Fewer than 20 teeth and the presence of active coronal or root decay were associated with more discomfort when eating. General health conditions associated with chewing function included disability, physical activity, comorbidities, cognitive status and depression. Older men's self-rated oral health and general health perceptions were also associated with aspects of chewing function. Poorer self-reported oral health was associated with inability to eat hard foods (95% CI: 1.3-2.7) and with discomfort when eating (95% CI: 2.6-5.1), while poorer self-reported general health was associated with discomfort when eating (95% CI: 1.2-2.2). CONCLUSIONS: Falling rates of edentulism may lead to improved chewing and eating function in older men. Maintaining 20 or more natural teeth, and preventing active coronal and root caries should enhance chewing function and promote self-reported health and oral health. Lower capacity to chew hard foods and a higher reporting of discomfort when eating is associated with co-morbidity in older Australian men.

The relationship between seven health practices and oral health status in community-dwelling elderly Thai.

OBJECTIVE: This study aims to analyse the relationship between seven health practices, oral health behaviors, and oral health status in community dwelling elderly Thai. MATERIALS AND METHODS: The subjects were 612 elderly people (mean age = 68.8 ± 5.9 years). Questionnaires survey about sociodemographics, self-reported seven health practices and oral health behaviors were conducted by trained interviewers. Oral examinations investigated the number of teeth present, decayed teeth, periodontal status and functional tooth units (FTUs). Oral malodor was assessed by Organoleptic Test, and unstimulated saliva was collected for 5 min. RESULTS: Five health practices (smoking, drinking, physical activity, breakfast and weight maintenance) were significantly related with oral health behaviors. ancova analysis demonstrated the following significant associations: (i) smoking behavior with number of teeth present, number of FTUs, decayed teeth, periodontal disease, oral malodor and salivary flow rate, (ii) drinking alcohol behavior with number of teeth present, number of FTUs, periodontal disease, oral malodor and salivary flow rate, (iii) eating breakfast behavior with periodontal disease, oral malodor and salivary flow rate, (iv) eating between-meal snack with number of teeth present, number of FTUs, decayed teeth and periodontal disease, (v) maintaining weight with number of teeth present, number of FTUs, periodontal disease and oral malodor, (vi) sleeping with number of teeth present, number of FTUs, periodontal disease, oral malodor and salivary flow rate, (vii) physical activity with periodontal disease and salivary flow rate. CONCLUSION: Good health practices were related with good oral health behaviors. Moreover, general health practices were associated with the clinical oral health status such as number of teeth present, decayed teeth, FTUs, periodontal disease, oral malodor and salivary flow rate. The elderly with good general health practices were considered to have good oral health status. Improving general health habits are suggested to lead to better oral health for the elderly, and vice versa.

Factors associated with self-assessed oral health in the Japanese independent elderly.

OBJECTIVES: The purpose of this research was to analyse the relationship between oral health status, oral motor function, daily life situations and self-assessed oral health. MATERIALS AND METHODS: A cross-sectional survey was conducted on 190 independent elderly volunteers aged 62-99 years from senior citizen centres in Tokyo, Japan. A questionnaire survey and oral examination were conducted on each participant. For the descriptive analyses, Independent t-test and the chi-squared test were used. Following that, using four latent variables, (oral health, oral function, daily life situations and chronic health condition), a structural equation modelling analysis (SEMA) was undertaken. RESULTS: In the descriptive analyses, there were no significant differences between self-assessed oral health and oral health status. However, there were significant differences between self-assessed oral health and oral function and daily life situations. Findings from SEMA revealed that daily life situations and oral function have independent effects on self-assessed oral health and that the relationship between self-assessed oral health and oral health status was weak. CONCLUSIONS: Many factors affect self-assessed oral health status. Dental clinicians and researchers should attempt to understand these factors and incorporate them into effective personal and population-based oral health education and oral health promotion programmes.

The hierarchical cluster analysis of oral health attitudes and behaviour using the Hiroshima University--Dental Behavioural Inventory (HU-DBI) among final year dental students in 17 countries.

OBJECTIVE: To explore and describe international oral health attitudes/ behaviours among final year dental students. METHODS: Validated translated versions of the Hiroshima University-Dental Behavioural Inventory (HU-DBI) questionnaire were administered to 1,096 final-year dental students in 17 countries. Hierarchical cluster analysis was conducted within the data to detect patterns and groupings. RESULTS: The overall response rate was 72%. The cluster analysis identified two main groups among the countries. Group 1 consisted of twelve countries: one Oceanic (Australia), one Middle-Eastern (Israel), seven European (Northern Ireland, England, Finland, Greece, Germany, Italy, and France) and three Asian (Korea, Thailand and Malaysia) countries. Group 2 consisted of five countries: one South American (Brazil), one European (Belgium) and three Asian (China, Indonesia and Japan) countries. The percentages of 'agree' responses in three HU-DBI questionnaire items were significantly higher in Group 2 than in Group 1. They include: "I worry about the colour of my teeth."; "I have noticed some white sticky deposits on my teeth."; and "I am bothered by the colour of my gums." CONCLUSION: Grouping the countries into international clusters yielded useful information for dentistry and dental education.