Self-efficacy and oral health outcomes in a regional Australian Aboriginal population.

BACKGROUND: Perceived self-efficacy has been associated with psychological well-being, health behaviours and health outcomes. Little is known about the influence of self-efficacy on oral health outcomes for Aboriginal adults in Australia, a population experiencing high levels of oral health conditions. This study examines associations between oral health-related self-efficacy and oral health outcomes in a regional Aboriginal Australian population and investigates whether the associations persist after adjusting for sociodemographic characteristics and other general and oral health-related psychosocial factors. METHODS: Cross-sectional data were obtained from the baseline questionnaire of the Indigenous Oral Heath Literacy Project, South Australia. Oral health-related self-efficacy was measured using a six item scale, with total sum scores dichotomised into high/low self-efficacy. Oral health outcomes included self-rated oral health and oral health impacts, measured using the Oral Health Impact Profile (OHIP-14). Generalized linear models with a log-Poisson link function were used to estimate Prevalence Ratios (PR) of poor self-rated oral health according to levels of oral health-related self-efficacy. Multivariable linear regressions were used to estimate the association between oral health-related self-efficacy and OHIP-14 scores. Blocks of confounders were subsequently added into the models, with the final model including all factors. RESULTS: Complete data were available for 252 participants (63%) aged 18 to 82 years (mean age of 37.6 years). Oral health-related self-efficacy was associated with poor self-rated oral health, with a 43% (PR = 1.43 (95% CI 1.09, 1.88)) greater prevalence of poor self-rated oral health among those with low self-efficacy. Oral health-related self-efficacy was associated with OHIP-14 severity scores, with a score over six points higher for those with low self-efficacy (B = 6.27 95% CI 2.71, 9.83). Although addition of perceived stress into the models attenuated the relationship, associations remained in the final models. CONCLUSION: Lower levels of oral health-related self-efficacy were associated with a higher prevalence of poor self-rated oral health and greater impacts of oral health among Aboriginal adults in regional South Australia. These associations persisted after controlling for sociodemographic and psychosocial confounders, suggesting that increasing self-efficacy may provide an opportunity for improving oral health outcomes for Aboriginal adults.

Self-Rated Oral Health and Associated Factors among an Adult Population in Rural India-An Epidemiological Study.

BACKGROUND: To determine the perception of oral health status and its associated factors among adults living in rural areas in Karnataka state, India. METHODS: A cross-sectional study was conducted among adults in the age group of 35-54 years old residing in villages in a southern state in India. The main outcome measure was poor self-rated oral health (SROH) among adults in rural India. RESULTS: About 873 adults participated in the study. The prevalence of poor SROH was 15.2%. Adults of age 40-44 years, females, those in lower socioeconomic conditions, and those with high caries experience (DMFT ≥ 4) and periodontal disease were associated with poor SROH. Those who had visited a dentist in the previous one year were 1.9 times more likely to report poor oral health. CONCLUSIONS: Nearly 15% of rural people reported poor oral health. Socioeconomic conditions, sex, age, smoking, and dental visiting were associated with poor SROH. People's perception of poor oral health was associated with severe periodontitis and DMFT ≥ 4. A dose-response relationship was observed between experience with dental caries and poor SROH.

Oral epidemiological examination - protocol: the National Study of Adult Oral Health 2017-18.

The National Study of Adult Oral Health (NSAOH) 2017-18 aimed to collect data on population oral health status of the Australian adult population. This complex nation-wide project required reliable data collection procedures. The NSAOH 2017-18 Oral Epidemiological Examination Protocol has been developed based on internationally accepted examination procedures. Examiners have been trained and calibrated in using the protocol. Details of the clinical examination components are provided. Examiner reliability has been tested and presented.

Dental fluorosis in the Australian adult population.

BACKGROUND: The use of fluoride involves a balance between protection against caries and risk of dental fluorosis. Prevalence and trend of dental fluorosis in the adult population are not frequently reported. OBJECTIVE: To describe the prevalence of dental fluorosis in the Australian adult population. METHOD: Data from the National Study of Adult Oral Health (NSAOH) 2004-06 and 2017-18 were used. Prevalence of fluorosis was reported using data from the NSAOH 2017-18. Case definitions of fluorosis were as follows: having a TF score of 2+ (TF2+) or a TF score of 3+ (TF3+) on one or more maxillary central incisors. Synthetic cohorts were constructed by year of birth allowing for time trend analysis. RESULTS: One in ten Australian adults were found to have dental fluorosis at TF2+. The prevalence of TF3 + was low. Time trend analysis revealed an increase in the prevalence and severity of fluorosis among those born during 1970s to 1980s decade. Such prevalence declined among those who were born after measures were introduced in early 1990s to reduce exposure to discretionary fluorides. CONCLUSION: The prevalence of dental fluorosis in the Australian adult population was found to be related to population-level changes in fluoride exposure.

National Study of Adult Oral Health 2017-18: root caries.

BACKGROUND: The prevalence of root caries in Australia is expected to increase due to an ageing population and increase in tooth retention. This report presents findings from the Australian National Study of Adult Oral Health 2017-18. METHODS: A stratified random sample of 15 731 Australians aged ≥15 years participated in a telephone or online survey. Of those, 5022 dentate people underwent an oral assessment. Carious root surfaces were defined as ≥1 mm of affected dentine/cementum. Prevalence was defined as the percentage with ≥one natural tooth with untreated caries on root surfaces. Severity was measured as the mean number of root surfaces with caries. RESULTS: Prevalence of untreated root caries in the Australian adult dentate population was 8.2% and increased with increasing age (range 2%-17.8%). Men (9.3%) compared to women (7.2%), people living in remote (18.0%) versus regional (9.3%) and major cities (7.6%), and those with the lowest household income (15.4%) compared to middle (7.6%) and highest tertile (3.2%) had untreated root caries. The average number of decayed or filled root surfaces in the Australian adult population was 1.1 (95% CI 0.9, 1.2). CONCLUSIONS: Root caries was associated with older age, living outside a major city and lower income.

Trajectory of performance: The role of selection criteria on student achievement in a Bachelor of Oral Health programme.

BACKGROUND: To determine whether discontinuing the Undergraduate Medicine and Health Sciences Admissions Test (UMAT) in 2011 for selection and changes to the South Australian Certificate of Education (SACE) requirements in 2012 when the new Australian Tertiary Admissions Rank (ATAR) was introduced impacted on students' accumulative level of achievement and performance in the Bachelor of Oral Health (BOH) programme. METHODS: Board of Examiner's course results for end of year performance were collected for BOH cohorts from 2006 to 2017 (n = 347). Overall performance and achievement level attained were calculated and formed the dependent variables, Performance and Achievement. Group-based trajectory modelling (GBTM) characterised trajectories of yearly academic achievement and the likelihood of each case belonging to the latent group classified as individual group membership. Chi-square (or Fischer's exact) tests were conducted on groups and selected independent variables, using SAS 9.4. RESULTS: A 2-group academic Performance trajectory was selected as Consistent (n = 290; 83.6%) and Inconsistent (n = 57; 16.4%), and Achievement level (credit number) trajectory as Low (n = 154; 44.4%) and High (n = 193; 55.6%). Statistically significant findings in relation to achievement level were found; female students, those who enrolled after UMAT was discontinued, students enrolled since SACE changes, and those who nominated BOH as their first career preference, were more likely to achieve higher grades than their counterparts. CONCLUSION: Discontinuing the UMAT for selection and SACE changes have shown no adverse changes in students' level of achievement in the BOH programme, although enrolling in a course not their first preference was shown to affect performance level.

The prevalence and severity of root surface caries across Australian generations.

BACKGROUND: The "failure of success" theory predicts that as subsequent generations of older adults retain more teeth, those additional teeth will experience more oral disease like root surface caries. The theory in relation to root surface caries has never been tested in a cross-generational study. This study aims to compare root surface caries across generations of South Australian older adults to test the theory and explore risk indicators for root surface caries. METHODS: Data were from the baseline of two South Australian studies separated by 22 years. In both studies, stratified random samples of people aged 60+ years from Adelaide and Mount Gambier were recruited. Dental examinations were performed by trained and calibrated dentists. One of the dental examiners from the earlier study was the gold standard examiner in the second study. Risk indicators included behavioural factors, clinical oral conditions, sociodemographic and socioeconomic status. Root surface caries was assessed as untreated root surface caries (root decayed surfaces [RDS]), treated root surface caries (root filled surfaces [RFS]) and treated or untreated root surface caries (root decayed and filled surfaces [RDFS]) and was presented as the prevalence and summed count. Multivariable models for Poisson and negative binomial distributions were used to estimate prevalence ratios (PR) and mean ratios (MR), respectively, and their 95% confidence intervals (95% CI). RESULTS: The current generation of South Australian older adults has significantly lower RDS (PR [95% CI] = 0.65 [0.47-0.89]; MR [95% CI] = 0.51 [0.35-0.73]) and RDFS (PR [95% CI] = 0.84 [0.71-0.99]; MR [95% CI] = 0.76 [0.65-0.90]) than the previous generation. The RFS in the previous and current generation was similar. Gingival recession, irregular brushing, dental visiting for a problem and smoking were the indicators for RDS, while age, gingival recession, tooth brushing frequency, time since last dental visit and reason of visiting were the indicators for RFS or RDFS. CONCLUSIONS: These results do not support the "failure of success" theory in relation to root surface caries among South Australian older adults. Despite the higher number of teeth retained, the current generation of older adults has less root surface caries than the previous generation. Behavioural factors remain the indicators of root surface caries across the generations.

Psychometric properties of the Child Oral-care Performance Assessment Scale.

OBJECTIVES: This study aimed to assess the psychometric properties of Child Oral-care Performance Assessment Scale (COPAS). METHODS: Items for the instrument were developed and pilot tested. This questionnaire was implemented in the Australian National Child Oral Health Study 2012-2014, whose aims included the assessment of oral care performance. This nationally representative sample of 23 538 respondents with complete data was divided into five groups: a main validation group and four cross-validation groups, using blocked randomization. Two scales were constructed, full scale with 37 items (COPAS) and a partial scale with a subset of 31 items (COPAS-Partial). Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed using correlation coefficients, and structural validity was ascertained in the main validation group and confirmed in the cross-validation groups using structural equation models. RESULTS: Cronbach's alpha for COPAS was 0.95, and for COPAS-Partial was 0.94. The convergent validity of global satisfaction with oral care and the subscales was r = 0.29-0.51, and that with the overall scales was r = 0.59 for COPAS and r = 0.59 for COPAS-Partial. COPAS (Root mean squared error of approximation (RMSEA) = 0.06, Comparative fit index (CFI) = 0.90, Tucker-Lewis index (TLI) = 0.89, and Coefficient of determination(COD) = 0.99) and COPAS-Partial (RMSEA = 0.07, CFI = 0.91, TLI = 0.90, COD = 0.97) had adequate fit. Structural invariance was present (P-value = 0.97). CONCLUSION: There was acceptable structural validity, construct validity and internal consistency in the models tested for COPAS and COPAS-Partial. COPAS has potential use in the evaluation of the delivery of dental services to children.

Risk indicators for untreated dental decay among Indigenous Australian children.

OBJECTIVE: To investigate risk indicators for untreated dental decay among Indigenous Australian children using a national representative sample. METHODS: Data were from the National Child Oral Health Study 2012-2014, which included a nationally representative sample of Indigenous Australian children aged 5-14 years. Outcomes were the prevalence (% ds/DS >0) and severity (mean ds/DS) of untreated dental decay at the tooth surface level. Caries of the primary dentition was estimated among 5- to 10-year-olds, while that of the permanent dentition was among 8- to 14-year-olds. Independent variables included residential location, household income, frequency and age commencement of toothbrushing, sugar-sweetened beverages (SSB) consumption, dental visiting and residential fluoridation status. Multivariable log-Poisson regression models with robust standard error estimation were used to identify risk indicators for untreated decay. The complex sampling design was taken into account in all analyses. RESULTS: There were 720 5- to 10-year-old and 736 8- to 14-year-old Indigenous children. Indigenous children experienced significant amount of untreated dental caries. Among 5- to 10-year-olds, % ds >0 was 43.1 (95% CI: 36.8-49.6) and mean ds was 3.4 (95% CI: 2.4-4.4). Among 8- to 14-year-olds, % DS >0 was 27.3 (22.3-32.9), while mean DS was 0.8 (0.6-1.0). In multivariable modelling, risk indicators for % ds >0 among 5- to 10-year-olds were low household income, commencing toothbrushing after 30 months of age, consuming 2+ cups of SSB per day and not residing in fluoridated areas. Risk indicators for mean ds among 5- to 10-year-olds included infrequent toothbrushing and consuming 2+ cups of SSB per day. Risk indicators for % DS >0 among 8- to 14-year-olds were low household income, while risk indicators for mean DS among 8- to 14-year-olds were residing in non-capital city, low household income, consuming 2+ cups of SSB per day and not residing in fluoridated areas. CONCLUSION: Indigenous Australian children experienced significant amount of untreated dental caries. Risk indicators for untreated decay included demographic factors, socioeconomic factors, oral hygiene behaviours, dietary behaviours and environmental factors.

Is Periodontitis Independently Associated with Potentially Malignant Disorders of the Oral Cavity?

Objective: To examine if periodontitis is independently associated with oral potentially malignant disorders (OPMD) in a rural Indian adult population aged 35-54 years. Methods: A population-based cross-sectional study was conducted in rural India from 2011 to 2012. Multistage stratified cluster random sampling was followed to recruit 1401 participants aged 35-54 years. Face-to-face interviews were conducted to collect data on sociodemographic factors, tobacco and alcohol use. Oral examinations were done to record OPMD, periodontal findings and missing teeth. Univariate, bivariate and multivariable analyses were achieved using SPSS version 16 Chicago, SPSS Inc. OPMDs (leukoplakia, erythroplakia, oral submucous fibrosis (OSF) and suspicious malignant lesion) whether present or absent were selected as outcome variables; age, sex, socioeconomic factors, smoking, tobacco-chewing status, alcohol use, and periodontitis were considered as the predictor variables. Results: Among 873 participants, 44 demonstrated 47 lesions. Leukoplakia (n=21), erythroplakia (n=3), OSF (n=21), and suspicious malignant lesions (n=2) were present, strongly associated with past tobacco-chewing status [OR=9.22 (2.57-33.15)], current tobacco-chewing status [OR=15.49 (6.20-38.74)] and moderate/severe periodontitis [OR=3.19 (1.11-9.12)]. Conclusion: Periodontitis is a risk indicator for OPMD, independent of socioeconomic factors and tobacco-chewing. Tobacco-chewing status, both past and current, was strongly associated with OPMD in our rural Indian population.

Socioeconomic and psychosocial associations with oral health impact and general health.

BACKGROUND: There is debate whether both subjective and objective measures of socioeconomic status (SES) are needed to predict health, and whether these factors are explained by psychosocial characteristics. The aims were to investigate the association of socioeconomic and psychosocial variables with oral health impact and general health utility. METHODS: A random sample of 45- to 54-year-olds from Adelaide, South Australia, was surveyed by self-complete questionnaire in 2004-2005. Oral health impact was assessed using OHIP-14 and general health utility by EQ-5D. SES was determined using objective (income, education) and subjective (McArthur scale) measures. Psychosocial variables comprised social support, health self-efficacy, well-being, coping and affectivity. RESULTS: Data were collected from 879 participants (response rate = 43.8%). Both objective and subjective socioeconomic status measures were associated with OHIP and EQ-5D scores. Higher income and subjective social status were both associated (P < 0.05) with less oral health impact (ß = -0.28 and ß = -0.73, respectively) and better general health utility (both with ß = 0.01, respectively). Psychosocial variables accounted for a relatively large percentage of variance in OHIP (20.7%) and EQ-5D (21.9%) scores. CONCLUSIONS: For both oral health impact and general health utility, objective SES was significant in the presence of subjective SES. Psychosocial variables had important independent associations with both oral and general health.

What factors are associated with dental general anaesthetics for Australian children and what are the policy implications? A qualitative study.

BACKGROUND: Dental general anaesthetics undertaken on young children are amongst the most common of all potentially preventable hospitalisations of children in Australia. They are costly for families and the community and entail some risk. The aim of the study was to explore the views of stakeholders about factors associated with children's dental general anaesthetics in Victoria, Australia and to identify policy implications. METHODS: Interviews with stakeholders were used to develop a framework of factors. Interview data were subject to qualitative analysis, informed by Interpretative Phenomenological Analysis. RESULTS: Eight themes that encompassed 30 main factors were identified through focused discussions with 16 stakeholders. While the safety of dental general anaesthetics has improved and mortality rates are low, side effects are common. Push factors for children's dental general anaesthetics include a perceived greater 'child-focus'; preferred models of care; low oral health literacy; parent guilt; convenience; and some dentists reluctance to treat high needs children in the clinic. Factors that may decrease the prevalence of dental general anaesthetics include: prevention of dental caries; using alternative approaches; an appropriate workforce mix; enhancing oral health literacy; and development of guidelines. CONCLUSION: The prevalence of hospitalisation of children to treat dental caries is increasing. Many factors influence the prevalence of paediatric dental general anaesthetics - relating to the child, parent, oral health professional, financial impact, health risk, and accessibility to facilities. There are quality of care and convenience benefits but also high costs and possible health risks. Family, workforce and health system factors have been identified that could decrease the prevalence of paediatric dental general anaesthetics.

Dental knowledge and dental service utilization: A 2-year follow-up study.

OBJECTIVES: To investigate associations of dental knowledge with dental service utilization over 2 years in South Australians aged 45-54 years. METHODS: In 2004-2005, a random sample of 2469 adults aged 45-54 years from Adelaide, South Australia, who were selected from the Australian electoral roll was surveyed. The outcome variables were the numbers of visits and dental services received over 2 years. Data were analysed using log-binomial and Poisson regression. Statistical significance was determined at P < .05. RESULTS: The response rates were 43.8% in the study group (n = 879) and 50.7% in the comparison group (n = 107). Oral examinations were conducted on 709 persons (81% of study group participants). Dental services data were collected from approximately 60% of participants at the end of years 1 and 2. After adjusting for sex, education, health card status, toothbrushing and inadequate dentition, higher caries knowledge and periodontal knowledge scores were associated with higher percentages of persons making dental visits (prevalence ratio, 95% CI: 1.2, 1.1-1.3 and 1.1, 1.0-1.3), and lower rates of extraction (rate ratio, 95% CI: 0.2, 0.1-0.4 and 0.4, 0.3-0.7) and endodontic services (0.5, 0.3-0.9 and 0.5, 0.3-0.7). Higher caries knowledge was associated with lower rates of fillings (0.8, 0.7-0.9) and denture services (0.1, 0.0-0.6), while higher periodontal knowledge was associated with higher numbers of visits (1.3, 1.2-1.5), and prophylaxis services (1.4, 1.1-1.8) and crowns (1.7, 1.1-2.5). CONCLUSION: South Australians aged 45-54 years with higher dental knowledge had lower rates of invasive treatment over 2 years. These findings warrant policy initiatives that highlight the importance of dental knowledge in improving oral health.

Association between dental visiting and missing teeth: Estimation using propensity score adjustment.

AIM: The aim of the present study was to determine the association between dental visiting and missing teeth using propensity score (PS) adjustment to control for confounding bias, and to compare the estimates with those obtained from traditional regression models. METHODS: A population-based study was conducted on adults aged 35-54 years in India. Multistage stratified cluster random sampling was used. Data were collected through interviews and oral examinations. The exposure factor was 'dental visiting', and the outcome was number of missing teeth. Sociodemographic factors, oral hygiene practices, periodontal disease, and caries experience were the covariates. Inverse probability weight (IPW) calculated from the PS for dental visiting from a logistic regression model was used to balance the covariates. The association between dental visiting and missing teeth was estimated from log-binomial regression models with and without using IPW. RESULTS: Of the 873 participants, 77.7% visited a dentist. The ≥1 missing teeth prevalence was 65.3%. Post-IPW adjustment covariate standardized bias between groups with or without dental visit was lower than the pre-IPW adjustment. Those who visited a dentist had an adjusted prevalence ratio of 2.40 when IPW was used, and 2.03 when IPW was not used. CONCLUSION: Dental visiting was strongly associated with missing teeth in this rural population.

Work-Family Conflict Modifies the Association of Smoking and Periodontal Disease.

PURPOSE: The aims of the study were to assess the association of periodontal loss of attachment with smoking and work-family conflict and assess whether work-family conflict modifies the association of smoking and periodontal disease. METHOD: A random sample of 45-54 year olds from metropolitan Adelaide, South Australia, was surveyed by mailed self-complete questionnaire during 2004-2005. Oral examinations were performed on persons who responded to the questionnaire, providing an assessment of periodontal status. RESULTS: A total of 879 responded (participation rate = 43.8 %), with n = 709 oral examinations (completion rate = 80.7 %). Prevalence of periodontal loss of attachment (LOA) of 6+ mm was higher (p < 0.05) for smokers (23.8 %) compared to non-smokers (7.8 %) among employed adults. The adjusted prevalence ratio for LOA 6+ mm was prevalence ratio (PR) = 4.9 (95 % CI 2.2-8.8) for smokers, and there was a significant interaction (p < 0.05) between smoking status and work-family conflict. CONCLUSION: Work-family conflict modified the association of smoking with periodontal disease. Higher levels of work interfering with family were associated with higher levels of periodontal LOA for smokers compared with non-smokers.

Changes in the oral health of the children of Dili, Timor Leste, between 2002 and 2014.

INTRODUCTION: This research compared the oral health status of school children in Dili (the capital of Timor Leste) in 2002 and 2014. METHODS: The 2014 oral health survey of Dili's children replicated the methods of an AusAID-supported oral health survey conducted in 2002. Equal numbers of children were invited to participate from four age groups (6-8, 9-11, 12-14 and 15-17 years). For the 2014 survey, the subdistricts of Dom Aleixo, Cristo Rei, Metinaro and Vera Cruz were randomly selected for inclusion. A questionnaire was used to collect data on demographics and oral health behaviours. Oral epidemiological examinations were conducted by four dentists and five dental nurses. RESULTS: The 2014 survey in Dili recruited 758 participants for the questionnaire and 655 children for the oral examination. In 2014, a lower proportion of children reported brushing their teeth the previous day (97% vs 100%, p=0.01) and a larger proportion reported having toothache (40% vs 19%, p<0.001) (sometimes to very often) during the previous 12 months. The mean number of decayed, missing or filled teeth in the primary plus permanent dentition (dmft + DMFT) was greater in 2014 than in 2002 (4.2 vs 3.5, p=0.01). There was no difference in the prevalence of decay in the primary dentition (39% vs 37%, p=0.61) or the mean number of decayed, missing or filled (dmft) teeth in the primary dentition in 2014 compared to 2002 (2.0 vs 1.8, p=0.47). However, the prevalence of decay in the permanent dentition was greater in 2014 (70% vs 53%, p<0.001) as was the mean DMFT (2.3 vs 1.7, p=0.04). The prevalence of gingival bleeding (65% vs 81%, p<0.001) and calculus (57% vs 86%, p<0.001) was lower in 2014. CONCLUSIONS: There was an increase in dental caries experiences in Dili school children between 2002 and 2014, associated with more permanent teeth dental caries experiences.

Oral Health Impact among Rural-dwelling Indigenous Adults in South Australia.

AIMS: The aim of this study was to describe the impact of oral health conditions among a convenience sample of Indigenous Australian adults and compare findings with nationally representative data. METHODS: Data were obtained from the Indigenous Oral Health Literacy Project (IOHLP) based in South Australia. Nationally representative data were obtained from the National Survey of Adult Oral Health (NSAOH). The impact of oral disease was measured using the shortened form of the oral health impact profile, OHIP-14. All data were standardised by age group and sex utilising Census data. RESULTS: For each OHIP-14 measure the impact was greater for IOHLP participants. There was considerable variation in the degree of difference between IOHLP and NSAOH participants for individual OHIP-14 items. CONCLUSION: High levels of effects of oral health conditions were reported by rural-dwelling Indigenous adults. This may exacerbate the health and social disadvantage experienced by this marginalised group.

Oral Health Impact among Rural-dwelling Indigenous Adults in South Australia.

AIMS: The aim of this study was to describe the impact of oral health conditions among a convenience sample of Indigenous Australian adults and compare findings with nationally representative data. METHODS: Data were obtained from the Indigenous Oral Health Literacy Project (IOHLP) based in South Australia. Nationally representative data were obtained from the National Survey of Adult Oral Health (NSAOH). The impact of oral disease was measured using the shortened form of the oral health impact profile, OHIP-14. All data were standardised by age group and sex utilising Census data. RESULTS: For each OHIP-14 measure the impact was greater for IOHLP participants. There was considerable variation in the degree of difference between IOHLP and NSAOH participants for individual OHIP-14 items. CONCLUSION: High levels of effects of oral health conditions were reported by rural-dwelling Indigenous adults. This may exacerbate the health and social disadvantage experienced by this marginalised group.

A screening model for oral cancer using risk scores: development and validation.

OBJECTIVE: A study was conducted to develop and validate a screening model using risk scores to identify individuals at high risk for developing oral cancer in an Indian population. METHODS: Life-course data collected from a multicentre case-control study in India were used. Interview was conducted to collect information on predictors limited to the time before the onset of symptoms or cancer diagnosis. Predictors included statistically significant risk factors in the multivariable model. A risk score for each predictor was derived from respective odds ratios (OR). Discrimination of the final model, risk scores and various risk score cut-offs was examined using the c statistic. The optimal cut-off was determined as the one with good area under curve (AUC) and high sensitivity. Predictive ability of the regression model and cut-off risk score was determined by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Models were validated from a bootstrap sample. RESULTS: Smoking, chewing quid and/or tobacco, alcohol, a family history of upper aero-digestive tract cancer, diet and oral hygiene behaviour were the predictors. Risk scores ranged from 0 to 28. Area under the receiver operating characteristic (ROC) curve for risk scores was good (0.866). The sensitivity (0.928) and negative predictive value (0.927) were high, while specificity (0.603) and positive predictive value (0.607) were low for a risk score cut-off of 6. CONCLUSION: A risk score model to screen for individuals with high risk of oral cancer with satisfactory predictive ability was developed in the Indian population. Validation of the model in other populations is necessary before it can be recommended to identify subgroups of the population to be directed towards more extensive clinical evaluation.