The protective effect of CALD identity in the presence of low income on missing teeth of Australian adults over time.

BACKGROUND: 'Culturally And Linguistically Diverse (CALD)' populations have diverse languages, ethnic backgrounds, societal structures and religions. CALD populations have not experienced the same oral health benefits as non-CALD groups in Australia. However, the socio-demographic profile of Australian CALD populations is changing. This study examined how household income modifies the oral health of CALD and non-CALD adults in Australia. METHODS: Data were from two National Surveys of Adult Oral Health (NSAOH) conducted in 2004-06 (NSAOH 2004-06) and 2017-18 (NSAOH 2017-18). The outcome was self-reported number of missing teeth. CALD status was identified based on English not the primary language spoken at home and country of birth not being Australia. Social disadvantage was defined by total annual household income. Effect-measure modification was used to verify differences on effect sizes per strata of CALD status and household income. The presence of modification was indicated by Relative Excess Risk due to Interactions (RERIs). RESULTS: A total of 14,123 participants took part in NSAOH 2004-06. The proportion identifying as CALD was 11.7% and 56.7% were in the low-income group, and the mean number of missing teeth was 6.9. A total of 15,731 participants took part in NSAOH 2017-18. The proportion identifying as CALD was 18.5% and 38.0% were in the low-income group, and the mean number of missing teeth was 6.2. In multivariable modelling, the mean ratio (MR) for CALD participants with low household income in 2004-06 was 2% lower than the MR among non-CALD participants with high household income, with the RERI being - 0.23. Non-CALD participants from lower income households had a higher risk of having a higher number of missing teeth than low income CALD individuals (MR = 1.66, 95%CI 1.57-1.74 vs. MR = 1.43 95%CI 1.34-1.52, respectively). In 2017-18, the MR for CALD participants with low household income was 3% lower than the MR among non-CALD participants with high household income, with the RERI being - 0.11. Low income CALD participants had a lower risk of missing teeth compared to their non-CALD counterparts (MR = 1.43, 95% CI 1.34-1.52 vs. MR = 1.57, 95% CI 1.50-1.64). CONCLUSIONS: The negative RERI values indicate that the effect-measure modification operates in a negative direction, that is, there is a protective element to being CALD among low income groups with respect to mean number of missing teeth.

Priority setting: Development of the South Australian Aboriginal Chronic Disease Consortium RoadMap for Action.

ISSUES ADDRESSED: Aboriginal and Torres Strait Islander (Aboriginal) people in South Australia are overburdened by cardiovascular disease, diabetes and cancer. The South Australian Aboriginal Chronic Disease Consortium (Consortium) was established in June 2017 as a collaborative partnership to lead the implementation of three state-wide chronic disease plans using a strategic approach to identifying key priority areas for action. METHODS: In 2017-2018, the Consortium Coordinating Centre facilitated a priority setting process, which involved extensive consultation, including a prioritisation survey and stakeholder workshops. The Consortium's Aboriginal Community Reference Group was instrumental in leading the identification of priorities for action. RESULTS: The Consortium RoadMap for Action identified seven across-plan priorities and six condition-specific priorities. It acknowledged that: strengthening social and emotional well-being is central to improving health outcomes; prevention and early detection, acute management and ongoing management are all components of the continuum of care; and improving access to services, strengthening the workforce, and monitoring and evaluation are required across the continuum of care. CONCLUSION: Widespread implementation failure in the past across the health system and health services implementation and research translation highlights the value of the Consortium approach and its commitment to implementing the state-wide chronic disease plans in a collaborative manner. The Consortium relies on and fosters cross-sectoral alignment, with all key players including all public, private and Aboriginal Community Controlled health services, to progress its priorities and aspirations to improve health outcomes for Aboriginal people using evidence-based strategies. SO WHAT?: Rigorous and transparent priority setting processes that bring together research, clinical practice, health services operations, policy and community perspectives can foster intersectoral collaboration and partnership and support the implementation of shared priorities.

A longitudinal assessment of chronic periodontitis in Australian adults.

AIM: The study aimed to estimate the incidence/progression and reversal of chronic periodontitis and to identify factors associated with chronic periodontitis in Australian adults over a 12-year period. MATERIALS AND METHODS: Data were obtained from the longitudinal component of the National Study of Adult Oral Health (NSAOH) in 2004-2006, and repeated data, among the same adults, in 2017-2018. NSAOH 2004-2006 was a population-based study of Australian adults aged 15+ years. The American Academy of Periodontology/European Federation of Periodontology case definitions were used, and then compared with two other case definitions. Multivariable Poisson regression models were used to estimate incidence rate ratios (IRRs) and reversal rate ratio (RRRs) of periodontitis. RESULTS: A total of 775 dentate Australian adults had dental examinations at both times. The proportion of incidence/progression and reversal among Australian adults was 56.4% and 11.0%, respectively. Tobacco smokers presented with more than three times higher incidence (IRR: 3.32, 95% CI: 1.50-7.60) and lower reversals (RRR: 0.94, 95% CI: 0.39-0.98) than those who had never smoked. Cessation of smoking was positively associated with periodontitis reversal. The total incidence/progression was 471.7/10,000 person-years, with reversal being 107.5/10,000 person-years. The average number of teeth lost due to periodontal disease was 1.9 in 2017-2018. Being male and not having periodontal treatment were significant risk markers for the incidence/progression of periodontitis. CONCLUSION: Smoking is a risk factor for periodontitis. Cessation of smoking is an effective means of reducing the incidence and progression of chronic periodontitis, to reduce the risk of tooth loss, and to improve overall periodontal health.

The Global Prevalence and Severity of Dental Caries among Racially Minoritized Children: A Systematic Review and Meta-Analysis.

Racially minoritized children often bear a greater burden of dental caries, but the overall magnitude of racial gaps in oral health and their underlying factors are unknown. A systematic review and meta-analysis were conducted to fill these knowledge gaps. We compared racially minoritized (E) children aged 5-11 years (P) with same-age privileged groups (C) to determine the magnitude and correlates of racial inequities in dental caries (O) in observational studies (S). Using the PICOS selection criteria, a targeted search was performed from inception to December 1, 2021, in nine major electronic databases and an online web search for additional grey literature. The primary outcome measures were caries severity, as assessed by mean decayed, missing, and filled teeth (dmft) among children and untreated dental caries prevalence (d > 0%). The meta-analysis used the random-effects model to calculate standardized mean differences (SMD) and 95% confidence intervals (95% CI). Subgroup analysis, tests for heterogeneity (I2, Galbraith plot), leave-one-out sensitivity analysis, cumulative analysis, and publication bias (Egger's test and funnel plots) tests were carried out. The New Castle Ottawa scale was used to assess risk of bias. This review was registered with PROSPERO, CRD42021282771. A total of 75 publications were included in the descriptive analysis. The SMD of dmft score was higher by 2.30 (95% CI: 0.45, 4.15), and the prevalence of untreated dental caries was 23% (95% CI: 16, 31) higher among racially minoritized children, compared to privileged groups. Cumulative analysis showed worsening caries outcomes for racially marginalized children over time and larger inequities in dmft among high-income countries. Our study highlights the high caries burden among minoritized children globally by estimating overall trends and comparing against factors including time, country, and world income. The large magnitude of these inequities, combined with empirical evidence on the oral health impacts of racism and other forms of oppression, reinforce that oral health equity can only be achieved with social and political changes at a global level.

An Aboriginal-led consortium approach to chronic disease action for health equity and holistic wellbeing.

ISSUE ADDRESSED: The Wellbeing Economy, which places human and ecological wellbeing at the centre of policy making, aligns with holistic Aboriginal and Torres Strait Islander conceptualisations of health and wellbeing. In order to address chronic diseases in South Australian Aboriginal and Torres Strait Islander populations, the South Australian Aboriginal Chronic Disease Consortium (Consortium) is fostering action in ways that align both with the Wellbeing Economy and with Health in All Policies (HiAP) approaches. METHODS: In June 2017, the Consortium was established as a collaborative partnership between government and non-government organisations, researchers, Aboriginal organisations and communities to lead the effective implementation of three state-wide chronic disease plans. A coordinating centre was funded to support and progress the work of the Consortium. RESULTS: During its first 5 years, the Consortium has developed a foundation for sustained system reform through partnering with stakeholders, leading projects and initiatives, advocating for key priorities, leveraging existing infrastructure and funding, supporting services, and coordinating delivery of priority actions using innovative approaches. CONCLUSIONS: Through the Consortium governance structure, Aboriginal and Torres Strait Islander community members, policy actors, service providers and researchers oversee, drive, influence and support the implementation of priority action initiatives. Sustained funding, competing priorities of partner organisations and project evaluation are constant challenges. SO WHAT?: A consortium approach provides direction and shared priorities, which foster collaboration across and between organisations, service providers and the Aboriginal community. Aligning with HiAP approaches and the Wellbeing Economy, it harnesses knowledge, networks and partnerships that support project implementation and reduce duplication.

Use of oral health care services in the United States: unequal, inequitable-a cross-sectional study.

BACKGROUND: Social determinants drive disparities in dental visiting. Disparities can be measured simply by comparing outcomes between groups (inequality) but can also consider concepts of social justice or fairness (inequity). This study aimed to assess differences in dental visiting in the United States in terms of both social inequality and inequity. METHODS: Data were obtained from a cross-sectional study-the National Health and Nutrition Examination Survey (NHANES) 2015-2016, and participants were US adults aged 30+ years. The outcome of interest, use of oral health care services, was measured in terms of dental visiting in the past 12 months. Disparity was operationalized through education and income. Other characteristics included age, gender, race/ethnicity, main language, country of birth, citizenship and oral health status. To characterize existing inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration index (ACI and RCI), the slope index of inequality (SII) and relative index of inequality (RII) and through concentration curves (CC). Indirect standardization with a non-linear model was used to measure inequity. RESULTS: A total of 4745 US adults were included. Bivariate analysis showed a gradient by both education and income in dental visiting, with a higher proportion (> 60%) of those with lower educational attainment /lower income having not visited a dentist. The concentration curves showed pro-higher education and income inequality. All measures of absolute and relative indices were negative, indicating that from lower to higher socioeconomic position (education and income), the prevalence of no dental visiting decreased: ACI and RCI estimates were approximately 8% and 20%, while SII and RII estimates were 50% and 30%. After need-standardization, the group with the highest educational level had nearly 2.5 times- and the highest income had near three times less probability of not having a dental visit in the past 12 months than those with the lowest education and income, respectively. CONCLUSION: The findings indicate that use of oral health care is threatened by existing social inequalities and inequities, disproportionately burdening disadvantaged populations. Efforts to reduce both oral health inequalities and inequities must start with action in the social, economic and policy spheres.

Determinants of infant mortality for children of women prisoners: a longitudinal linked data study.

BACKGROUND: There is limited information on the determinants of infant mortality outcomes for the children of women prisoners. This study aimed to explore determinants of infant mortality for Indigenous and non-Indigenous children, with a specific focus on maternal imprisonment during pregnancy as a risk factor. METHODS: Using linked administrative data we obtained a longitudinal sample of 42,674 infants born in Western Australia between October 1985 and June 2013. Data were analysed by maternal contact with corrective services, including; (i) imprisonment during pregnancy, (ii) imprisonment before (but not during) pregnancy, (iii) imprisonment after birth, (iv) community-based correctional orders (but no imprisonment), and (v) no corrections record. Infant mortality rates were calculated. Univariate and multivariate log-binomial regression was undertaken to identify key demographic and pregnancy-related risk factors for infant mortality. Risk factor prevalence was calculated for infants by maternal corrections history. RESULTS: 430 Indigenous and 116 non-Indigenous infants died aged 0-12 months. For singletons, infant mortality rates were highest in Indigenous infants with mothers imprisoned during pregnancy (32.1 per 1000) and non-Indigenous infants whose mothers were first imprisoned after birth (14.2 per 1000). For all Indigenous children, the strongest determinants of infant mortality were: abruptio placentae and other placental disorders (RR = 2.85; 95%CI 1.46-5.59; p = 0.002), maternal imprisonment during pregnancy (RR = 2.55; 95%CI 1.69-3.86; p < 0.001), and multiple gestation (RR = 2.29; 95% CI1.51-3.46; p < 0.001). Indigenous and non-Indigenous infants with mothers imprisoned at any time, and particularly before or during pregnancy, experienced higher prevalence of key pregnancy risk factors. CONCLUSIONS: This is the first comprehensive study of the determinants of infant mortality for children of women prisoners. Infants with any maternal corrections history, including community-based orders or imprisonment outside of pregnancy, had increased infant mortality. Indigenous infants whose mothers were imprisoned during pregnancy were at particular risk. There was a low incidence of infant death in the non-Indigenous sample which limited the investigation of the impact of the specific aspects of maternal corrections history on infant mortality. Non-Indigenous Infants whose mothers were imprisoned before or during pregnancy experienced higher prevalence of pregnancy risk factors than infants of mothers first imprisoned after birth.

Socioeconomic status, oral health and dental disease in Australia, Canada, New Zealand and the United States.

BACKGROUND: Socioeconomic inequalities are associated with oral health status, either subjectively (self-rated oral health) or objectively (clinically-diagnosed dental diseases). The aim of this study is to compare the magnitude of socioeconomic inequality in oral health and dental disease among adults in Australia, Canada, New Zealand and the United States (US). METHODS: Nationally-representative survey examination data were used to calculate adjusted absolute differences (AD) in prevalence of untreated decay and fair/poor self-rated oral health (SROH) in income and education. We pooled age- and gender-adjusted inequality estimates using random effects meta-analysis. RESULTS: New Zealand demonstrated the highest adjusted estimate for untreated decay; the US showed the highest adjusted prevalence of fair/poor SROH. The meta-analysis showed little heterogeneity across countries for the prevalence of decayed teeth; the pooled ADs were 19.7 (95% CI = 16.7-22.7) and 12.0 (95% CI = 8.4-15.7) between highest and lowest education and income groups, respectively. There was heterogeneity in the mean number of decayed teeth and in fair/poor SROH. New Zealand had the widest inequality in decay (education AD = 0.8; 95% CI = 0.4-1.2; income AD = 1.0; 95% CI = 0.5-1.5) and the US the widest inequality in fair/poor SROH (education AD = 40.4; 95% CI = 35.2-45.5; income AD = 20.5; 95% CI = 13.0-27.9). CONCLUSIONS: The differences in estimates, and variation in the magnitude of inequality, suggest the need for further examining socio-cultural and contextual determinants of oral health and dental disease in both the included and other countries.

Genotypic Analysis of Genes Associated with Independent Resistance and Cross-Resistance to Isoniazid and Ethionamide in Mycobacterium tuberculosis Clinical Isolates.

Ethionamide (ETH) is an antibiotic used for the treatment of multidrug-resistant (MDR) tuberculosis (TB) (MDR-TB), and its use may be limited with the emergence of resistance in the Mycobacterium tuberculosis population. ETH resistance in M. tuberculosis is phenomenon independent or cross related when accompanied with isoniazid (INH) resistance. In most cases, resistance to INH and ETH is explained by mutations in the inhA promoter and in the following genes: katG, ethA, ethR, mshA, ndh, and inhA. We sequenced the above genes in 64 M. tuberculosis isolates (n = 57 ETH-resistant MDR-TB isolates; n = 3 ETH-susceptible MDR-TB isolates; and n = 4 fully susceptible isolates). Each isolate was tested for susceptibility to first- and second-line drugs using the agar proportion method. Mutations were observed in ETH-resistant MDR-TB isolates at the following rates: 100% in katG, 72% in ethA, 45.6% in mshA, 8.7% in ndh, and 33.3% in inhA or its promoter. Of the three ETH-susceptible MDR-TB isolates, all showed mutations in katG; one had a mutation in ethA, and another, in mshA and inhA. Finally, of the four fully susceptible isolates, two showed no detectable mutation in the studied genes, and two had mutations in mshA gene unrelated to the resistance. Mutations not previously reported were found in the ethA, mshA, katG, and ndh genes. The concordance between the phenotypic susceptibility testing to INH and ETH and the sequencing was 1 and 0.45, respectively. Among isolates exhibiting INH resistance, the high frequency of independent resistance and cross-resistance with ETH in the M. tuberculosis isolates suggests the need to confirm the susceptibility to ETH before considering it in the treatment of patients with MDR-TB.

Estimating the effect of childhood socioeconomic disadvantage on oral cancer in India using marginal structural models.

BACKGROUND: Early life socioeconomic disadvantage could affect adult health directly or indirectly. To the best of our knowledge, there are no studies of the direct effect of early life socioeconomic conditions on oral cancer occurrence in adult life. METHODS: We conducted a multicenter, hospital-based, case-control study in India between 2011 and 2012 on 180 histopathologically confirmed incident oral and/or oropharyngeal cancer cases, aged 18 years or more, and 272 controls that included hospital visitors, who were not diagnosed with any cancer in the same hospitals. Life-course data were collected on socioeconomic conditions, risk factors, and parental behavior through interview employing a life grid. The early life socioeconomic conditions measure was determined by occupation of the head of household in childhood. Adult socioeconomic measures included participant's education and current occupation of the head of household. Marginal structural models with stabilized inverse probability weights were used to estimate the controlled direct effects of early life socioeconomic conditions on oral cancer. RESULTS: The total effect model showed that those in the low socioeconomic conditions in the early years of childhood had 60% (risk ratio [RR] = 1.6 [95% confidence interval {CI} = 1.4, 1.9]) increased risk of oral cancer. From the marginal structural models, the estimated risk for developing oral cancer among those in low early life socioeconomic conditions was 50% (RR = 1.5 [95% CI = 1.4, 1.5]), 20% (RR = 1.2 [95% CI = 0.9, 1.7]), and 90% (RR = 1.9 [95% CI = 1.7, 2.2]) greater than those in the high socioeconomic conditions when controlled for smoking, chewing, and alcohol, respectively. When all the three mediators were controlled in a marginal structural model, the RR was 1.3 (95% CI = 1.0, 1.6). CONCLUSION: Early life low socioeconomic condition had a controlled direct effect on oral cancer when smoking, chewing tobacco, and alcohol were separately adjusted in marginal structural models.

Clinical oral health of Australia's rural children in a sample attending school dental services.

OBJECTIVE: To examine the association between children's clinical oral health status and their residential location using the latest available data (2009) and to ascertain whether poor oral health among rural children is related to being Indigenous, having less access to fluoridated water or being of lower socioeconomic status (SES), than children from urban areas. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANT: Data were collected on 74, 467 children aged 5-12 years attending school dental services in Australia (data were not available for Victoria or New South Wales). MAIN OUTCOME MEASURES: Clinical oral health was determined by the mean number of permanent teeth with untreated caries, missing and filled permanent teeth, and the mean decayed, missing and filled permanent teeth index (DMFT) of 8 to 12-year-old-children and the mean number deciduous teeth with untreated caries, missing and filled deciduous teeth, and the mean decayed, missing and filled deciduous teeth index (dmft) of 5-10-year-olds. RESULTS: The multivariable models that included coefficients on whether the child was Indigenous, from an area with fluoridated water and SES, were controlled for age and sex. The mean DMFT of 8-12-year-old children and the mean dmft of 5-10-year-old-children were significantly higher in rural areas compared with urban centres after accounting for Indigenous status, fluoridated water and SES. CONCLUSION: Children's oral health was poorer in rural areas than in major city areas.

Supporting best practice in the management of chronic diseases in primary health care settings: a scoping review of training programs for Indigenous Health Workers and Practitioners.

Background To improve diabetes management in primary health care for the Aboriginal and Torres Strait Islander peoples population, training programs that are culturally and contextually relevant to the local context are required. Using a scoping review methodology, the aim of this review was to describe the characteristics of chronic disease management training programs for Aboriginal Health Workers and Practitioners, their effectiveness on knowledge and skills, and client-related outcomes, and the enablers, barriers to delivery and participation. Methods Following protocol parameters, a systematic search was conducted in relevant databases and grey literature. Two independent reviewers screened the title and abstract of each paper to determine if the study met the inclusion criteria. Results Of the 23 included studies, most were developed with stakeholders, profession facilitated and delivered by cultural facilitators. All training programs included content knowledge, two included a professional support network, four provided on-the-job support and six had follow-up support post-training. Modes of delivery ranged from didactic, storytelling and hands-on learning. Two studies reported significant improvement in participants' knowledge and confidence; one reported improvement in knowledge (12.7% increase pre-post training), and an increase in confidence in both clinical and non-clinical skills. Enablers (relevance, modes of learning, power of networking, improved knowledge, confidence and clinical practice) and barriers (adult learning capabilities, competing work-family commitments) were reported. Few studies reported on knowledge transfer into clinical practice and client-related outcomes. Conclusions Multifaceted training programs for Aboriginal health workers are well received and may improve workforce capability.

Socioeconomic and psychosocial correlates of oral health.

BACKGROUND: It has been proposed that psychosocial variables are important determinants of oral health outcomes. In addition, the effect of socioeconomic factors in oral health has been argued to work through the shaping of psychosocial stressors and resources. This study therefore aimed to examine the role of psychosocial factors in oral health after controlling for selected socioeconomic and behavioural factors. METHODS: Logistic and generalised linear regression analyses were conducted on self-rated oral health, untreated decayed teeth and number of decayed, missing and filled teeth (DMFT) from dentate participants in a national survey of adult oral health (n = 5364) conducted in 2004-2006 in Australia. RESULTS: After controlling for all other variables, more frequent dental visiting and toothbrushing were associated with poorer self-rated oral health, more untreated decay and higher DMFT. Pervasive socioeconomic inequalities were demonstrated, with higher income, having a tertiary degree, higher self-perceived social standing and not being employed all significantly associated with oral health after controlling for the other variables. The only psychosocial variables related to self-rated oral health were the stressors perceived stress and perceived constraints. Psychosocial resources were not statistically associated with self-rated oral health and no psychosocial variables were significantly associated with either untreated decayed teeth or DMFT after controlling for the other variables. CONCLUSION: Although the role of behavioural and socioeconomic variables as determinants of oral health was supported, the role of psychosocial variables in oral health outcomes received mixed support.

Oral Health Inequities among CALD and Non-CALD Older Australians: A Decomposition Analysis.

BACKGROUND: Among Australia's older population, the burden of oral disease is disproportionality borne by culturally and linguistically diverse (CALD) communities. This study aims to examine changes in untreated decay surfaces (DS) between 2004-2006 and 2017-2018 among older CALD and non-CALD Australians. METHODS: Data were sourced Australian national oral health surveys conducted in 2004-2006 and 2017-2018. An Oaxaca-Blinder decomposition analysis was used to assess the contribution of socio-demographics and dental behaviours. RESULTS: A total of 246 CALD and 2853 non-CALD dentate participants aged 60+ years took part in 2004-2006, and 363 and 4278 in 2017-2018, respectively. There were increases in mean DS for both CALD (0.74 to 1.42) and non-CALD (0.72 to 1.50) groups between 2004-2006 and 2017-2018. The decomposition model showed that, for CALD participants in 2004-2006 with untreated DS, 40% of the contribution was from not having dental insurance; nearly three-quarters of the contribution was from last dental visit being over one year ago (72.9%) in 2017-2018. Among non-CALD participants in 2017-2018 with untreated DS, 42.5% of the contribution was from the last dental visit being over one year ago. CONCLUSIONS: Our findings suggest that social determinants, including increased access to dental insurance, could mitigate the oral health inequities observed.

Oral Health, Social and Emotional Well-Being, and Economic Costs: Protocol for the Second Australian National Child Oral Health Survey.

BACKGROUND: Given the significant investment of governments and families into the provision of child dental care services in Australia, continued population oral health surveillance through national oral health surveys is imperative. OBJECTIVE: The aims of this study are to conduct a second National Child Oral Health Survey (NCOHS-2) to (1) describe the prevalence, extent, and impact of oral diseases in contemporary Australian children; (2) evaluate changes in the prevalence and extent of oral diseases in the Australian child population and socioeconomic subgroups since the first National Child Oral Health Study (NCOHS-1) in 2012-2013; and (3) use economic modeling to evaluate the burden of child oral disease from the NCOHS-1 and NCOHS-2 and to estimate the cost-effectiveness of targeted programs for high-risk child groups. METHODS: The NCOHS-2 will closely mimic the NCOHS-1 in being a cross-sectional survey of a representative sample of Australian children aged 5-14 years. The survey will comprise oral epidemiological examinations and questionnaires to elucidate associations between dental disease in a range of outcomes, including social and emotional well-being. The information will be analyzed within the context of dental service organization and delivery at national and jurisdictional levels. Information from the NCOHS-1 and NCOHS-2 will be used to simulate oral disease and its economic burden using both health system and household costs of childhood oral health disease. RESULTS: Participant recruitment for the NCOHS-2 will commence in February 2024. The first results are expected to be submitted for publication 6 months after NCOHS-2 data collection has been completed. Thematic workshops with key partners and stakeholders will also occur at this time. CONCLUSIONS: Regular surveillance of child oral health at an Australian level facilitates timely policy and planning of each state and territory's dental public health sector. This is imperative to enable the most equitable distribution of scarce public monies, especially for socially disadvantaged children who bear the greatest dental disease burden. The last NCOHS was conducted in 2012-2014, meaning that these data need to be updated to better inform effective dental health policy and planning. The NCOHS-2 will enable more up-to-date estimates of dental disease prevalence and severity among Australian children, with cost-effective analysis being useful to determine the economic burden of poor child dental health on social and emotional well-being and other health indicators. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52233.

Effect of oral health literacy on self-reported tooth loss: A multiple mediation analysis.

BACKGROUND: This study aims to investigate the mediating pathways of oral health literacy (OHL) and oral health-related behaviours on the relationship between education and self-reported tooth loss among Australian adults. METHODS: Data used for studying the effects of mediating pathways are from the National Dental Telephone Interview Survey 2013, a random sample survey of Australian adults aged 18+ years. To study the mediating effects, we use counterfactual-based analysis. To decompose the effect of multiple mediator's alternate, to natural effect, methods such as interventional effects have been proposed. In this paper, we use these approaches to decompose the effect between education, OHL and oral health-related behaviours on self-reported tooth loss. Sensitivity analysis was performed for unmeasured confounding with multiple mediators. RESULTS: Data were available for 2936 Australian adults. The prevalence of persons with ≥12 self-reported tooth loss was approximately 15%. The average total causal effect from the low education group was nearly 150%, and the interventional indirect effect through OHL and the dependence of oral health-related behaviours on OHL to more than 12 missing teeth were 20% and 120%, respectively, higher than in the high education group. Sensitivity analysis indicated if the difference in the prevalence of unmeasured confounder is as big as 6% the direct effect and the indirect effect remains as observed. CONCLUSIONS: An additional two-fifths reduction on having more than 12 missing teeth for Australian adults with lower education level could be achieved if the proportion of lower OHL was decreased and optimal dental behaviours were increased.

A Longitudinal Study of Chronic Periodontitis in Two Cohorts of Community-Dwelling Elderly Australians.

Background: The study aimed to estimate and compare the incidence and progression of chronic periodontitis among two generations of older Australian adults. Methods: Data were from two population-based cohort studies of Australian older adults aged 60+ years South Australian Dental Longitudinal Studies (SADLS), SADLS I (1991-1992) and SADLS II (2013-2014). American Academy of Periodontology/the U.S. Centres for Disease Control and Prevention (CDC/AAP), and the 2018 European Federation of Periodontology classification (EFP/AAP) case definitions were used to define and calculate the incidence and progression of chronic periodontitis. Multivariable Poisson regression models were used to estimate incidence risk ratios (IRRs) of periodontitis. Results: A total 567 and 201 dentate respondents had periodontal exams in SADLS I and II, respectively. The incidence rate was greater in SADLS II than in SADLS I, approximately 200 vs. 100/1000 person years, respectively. Current smokers had more than two times higher IRRs, 2.38 (1.30-4.34) and 2.30 (1.24-4.26), than their non-smoking counterparts in the previous generation under the CDC/AAP and EFP/AAP, respectively. Conclusions: The most recent generation of older adults has greater incidence and progression of periodontitis than the previous generation. Being a current tobacco smoker was a significant risk factor for both the incidence and progression of periodontitis.

Development and validation of a composed canine simulator for advanced veterinary laparoscopic training.

The development of innovative simulation models for veterinary laparoscopic surgery training is a priority today. This study aimed to describe a didactic simulation tool for the training of total laparoscopic gastropexy (TLG) with intracorporeal sutures in dogs. CALMA Veterinary Lap-trainer composite simulator (CLVTS) was developed from a plaster cast of 2 Great Dane canines mimicking the space and the correct position to carry out a TLG. After video instruction, 16 veterinarians with different degrees of experience in minimally invasive surgery (Experts, n = 6 and intermediates, n = 10) evaluated four sequential simulating TLG with intracorporeal suturing in the CLVTS. Subsequently, they completed an anonymous questionnaire analyzing the realism, usefulness, and educational quality of the simulator. The CLVTS showed a good preliminary acceptance (4.7/5) in terms of the usefulness and adequacy of the exercises that, in the participants' opinion, are appropriate and are related to the difficulty of the TLG. In addition, both experienced and intermediate surgeons gave high marks (4.5/5) to the feeling of realism, design, and practicality. There were no significant differences between the responses of the two groups. The results suggest that the CVLTS has both face and content validity. Where it can be practiced in a structured environment for the development of a total laparoscopic gastropexy with intracorporeal suture and without compromising patient safety, but still has some limitations of the scope of the study. Further studies are needed to establish the ability to assess or measure technical skills, including the degree of transferability to the actual surgical environment.

Risk factors for impaired oral health among 18- to 34-year-old Australians.

OBJECTIVES: The objective of this study was to determine risk factors for a summary measure of oral health impairment among 18- to 34-year-olds in Australia. METHODS: Data were from Australia's National Survey of Adult Oral Health, a representative survey that utilized a three-stage, stratified, clustered sampling design. Oral health impairment was defined as reported experience of toothache, poor dental appearance, or food avoidance in the last 12 months. Multivariate Poisson regression models were used to evaluate effects of sociodemographic characteristics, self-perceived oral health, dental service utilization, and clinical oral disease indicators on oral health impairments. Effects were quantified as prevalence ratios (PR). RESULTS: The estimated percent of 18- to 34-year-olds with oral health impairment was 42.4 [95 percent confidence interval (CI) 37.7-47.2]. In the multivariate model, oral health impairment was associated with untreated dental decay (PR 1.38, 95 percent CI 1.13-1.68) and presence of periodontal pockets 4 mm+ (PR 1.29, 95 percent CI 1.03-1.61). In addition to those clinical indicators, greater prevalence of oral health impairment was associated with trouble paying a $100 dental bill (PR 1.37, 95 percent CI 1.12-1.68), usually visiting a dentist because of a dental problem (PR 1.46, 95 percent CI 1.15-1.86), reported cost barriers to dental care (PR 1.46, 95 percent CI 1.16-1.85), and dental fear (PR 1.43, 95 percent CI 1.18-1.73). CONCLUSIONS: Oral health impairment was highly prevalent in this population. The findings suggest that treatment of dental disease, reduction of financial barriers to dental care, and control of dental fear are needed to reduce oral health impairment among Australian young adults.

An introduction to oral health inequalities among Indigenous and non-Indigenous populations.

This overview revealed that substantial oral health inequalities exist between Indigenous and non-Indigenous child and adult populations in the United States, Canada, Brazil, Australia and New Zealand, with evidence suggesting that these inequalities are increasing. Despite the marked differences in geography, culture, language and history experienced by these groups, it is notable how similar the oral health inequalities were. A number of reasons are discussed in the paper.