Socio-economic status and access to fluoridated water in Queensland: an ecological data linkage study.

OBJECTIVES: To investigate the relationship between access to fluoridated drinking water and area-level socio-economic status in Queensland. STUDY DESIGN: Ecological, geospatial data linkage study. SETTING: Queensland, by statistical area level 2 (SA2), 2021. MAIN OUTCOME MEASURES: Proportion of SA2s and of residents with access to fluoridated drinking water (natural or supplemented); relationship at SA2 level between access to fluoridated water and socio-economic status (Index of Relative Socio-economic Advantage and Disadvantage, IRSAD; Index of Economic Resources, IER). RESULTS: In 2021, an estimated 4 050 168 people (79.4% of the population) and 397 SA2 regions (72.7%) in Queensland had access to fluoridated water. Access was concentrated in the southeastern corner of the state. After adjusting for SA2 population, log area, and population density, the likelihood of access to fluoridated drinking water almost doubled for each 100-rank increase in IRSAD (adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 1.59-2.36) or IER (aOR, 1.77; 95% CI, 1.50-2.11). CONCLUSIONS: The 2012 decision to devolve responsibility for water fluoridation decisions and funding from the Queensland government to local councils means that residents in lower socio-economic areas are less likely to have access to fluoridated water than those in more advantaged areas, exacerbating their already greater risk of dental disease. Queensland water fluoridation policy should be revised so that all residents can benefit from this evidence-based public health intervention for reducing the prevalence of dental caries.

Oral health related quality of life of oral cancer patients treated with radiotherapy alone or with chemotherapy in a tertiary referral centre in Sri Lanka.

BACKGROUND: Oral cancer is the number one cancer among males in Sri Lanka. Radiotherapy is a common treatment modality for oral cancer, but this can affect oral health related quality of life (OHRQOL). This study assessed the OHRQOL and its changes from baseline to the last week of radiotherapy and three months post radiotherapy among oral cancer patients who received this treatment alone or with chemotherapy. METHODS: A prospective longitudinal study was conducted among 90 oral cancer patients awaiting for radiotherapy alone or with chemotherapy. The modified Sinhala version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Oral Health Module (EORTC QLQ-OH15) was used to gather data related to OHRQOL before radiotherapy. Socio-demographic and clinical data were also recorded. The same cohort of patients were followed up and assessed their OHRQOL during the last week of radiotherapy and three months post radiotherapy. The Modified EORTC QLQ-OH15 assesses the OHRQOL under three domains namely 'Eating problem', 'Gum and speech problem' and 'Soreness', and one item named as 'Teeth'. RESULTS: The majority of the sample (88%) was males. The anterior two-thirds of the tongue (40%) and buccal mucosa (22%) were the most common sites. The median scores of 'Eating problem' domain at baseline, last week of radiotherapy and three months post radiotherapy were 20 (IQR = 6.7-33.3), 100 (IQR = 86.9-100.0) and 66.7 (IQR = 46.7-93.3) respectively. 'Gum and speech problem' was higher during last week of radiotherapy (median, 50.0, IQR, 25.0-58.3) than three months post radiotherapy (median, 8.3, IQR, 0.0-33.3). The changes of OHRQOL between the time frames were statistically significant (p < 0.05). Baseline OHRQOL in relation to 'Gum and speech problem' domain and 'Teeth' item was identified as an influential factor for OHRQOL during last week of radiotherapy. CONCLUSION: The OHRQOL of oral cancer patients who received radiotherapy alone or with chemotherapy had deteriorated from the baseline level to the last week of radiotherapy but then improved at three months post radiotherapy. The OHRQOL however did not return to the baseline level three months post radiotherapy. OHRQOL during the last week of radiotherapy was influenced by the OHRQOL at baseline, civil status and sites of metastasis.

Health professionals delivering oral health interventions in early childhood: A scoping review of Australian and New Zealand literature.

ISSUE ADDRESSED: Dental caries is highly prevalent in very young Australian and New Zealand children. Health professionals other than registered dental professionals can help prevent early childhood caries, promoting oral health to assist families establish preventative oral health habits at a child's early age. This review identifies oral health promotion (OHP) delivered by nondental health professionals in Australia and New Zealand involving very young children. METHODS: Databases (MEDLINE, CINAHL, Embase, Emcare, Web of Science, Scopus, ProQuest, Google Scholar, TROVE) and digital libraries were searched between 2001 and 2021 for eligible studies and grey literature. Studies with a focus on preventative oral health strategies in a primary health care context were included. RESULTS: The review identified 76 studies. Seven met the inclusion criteria, and were conducted in Australia across metropolitan, rural, and remote settings. Studies that successfully engaged nondental health professionals to promote oral health to families reported a positive change in oral health practices among very young children. Delivering OHP during a child's early life stage positively influenced their oral health outcomes. CONCLUSIONS: Integration of dental and primary health care increased access to oral health care and advanced positive oral health outcomes for children. With adequate training, resources, and support mechanisms, nondental health professionals can deliver oral health strategies that facilitate behaviour change in parents to improve children's oral health. So What? Health promotion generates enabling conditions that support and empower families to improve and maintain their oral health. Nondental health professionals can play a crucial role promoting oral health for very young children and improving equitable access to preventative oral health care.

Sources of occupational stress amongst dentistry academics.

BACKGROUND: Dentistry professionals may experience significantly higher occupational stress than other health professionals and dentistry academics may have specific work content and context sources of stress. AIMS: The aim of this study is to identify common sources of occupational stress, and how these are associated with wellbeing, in dentistry academics. MATERIALS & METHODS: A cross-sectional online survey with staff in Dentistry departments in Australia and New Zealand. Assessment included 23 items from five general domains of occupational stress from the NIOSH-Generic Job Stress Questionnaire, a 23-item list of sources of stress and the 22-item Psychological General Well-Being Index. Analyses used descriptive statistics and multiple linear regression. RESULTS: A total of 107 respondents (average age 50 ± 11.7 years, 56.8% men) completed the survey. Leading sources of occupational stress were job future, time pressure at work, work overload, and administration demands. A multiple linear regression model significantly predicted wellbeing, F(8,77) = 13.141, p = .000, adj.R2  = .53, but there were no significant associations for any of the specific sources of stress. CONCLUSION: The combination of time pressure, workload and responsibility, job dissatisfaction, low social support, and uncertain job future was inversely associated with wellbeing amongst these dentistry academics. Future studies should consider the development and evaluation of interventions to address these concerns.

Positive oral health outcomes: A partnership model improves care in a rural Indigenous community.

OBJECTIVE: The purpose of this study was to explore the benefits of a partnership between a university dental school and a Community Controlled Health Service, specifically in relation to improving the oral health of an underserved rural Indigenous community. We sought community opinions on health and social outcomes arising from the service provided by the dental student clinical outplacement. SETTING: In Dalby, Queensland. PARTICIPANTS: In total, 38 participants in five focus groups were representative of local Indigenous community Elders, community health support group members and management and staff. DESIGN: A descriptive qualitative study employing semi-structured audio-recorded focus group discussions conducted with purposefully selected Indigenous community groups to explore participant views and experience of the partnership model. Qualitative data were analysed using thematic content analysis. RESULTS: The Indigenous community representatives expressed positive benefit in both their general and oral health awareness, in improved access to dental care provided in their own safe space, while they were pleased to assist with students' learning. They viewed the partnership as mutually beneficial. Suggestions for enhancement of the oral health service were also offered. CONCLUSION: This partnership between a university and a Community Controlled Health Service provides sustainable positive social and health benefits for the targeted Indigenous community and for the wider local population, while simultaneously providing enhanced educational benefits for students on clinical outplacement. Translation and uptake of this successful model of care would benefit both underserved communities and dental and other health care professional educators worldwide.

Translation and validation of Sinhala version of modified EORTC QLQ-OH15 in oral cancer patients who receive radiotherapy with or without chemotherapy in Sri Lanka.

BACKGROUND: The recognition of patient-reported outcomes for oral cancer is important in improving patients' quality of life. The aim of this study was to translate and validate the modified Sinhala version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Oral Health Module (EORTC QLQ-OH15). METHODS: A cross-sectional study was conducted to validate the EORTC QLQ-OH15 that was modified after adding two questions to the original questionnaire. The two questions added were 'difficulty in opening the mouth wide' and 'trouble with talking' which affect oral health related quality of life (OHRQOL) of oral cancer patients receiving radiotherapy. The Sinhala translated modified EORTC QLQ-OH15 and already validated the core questionnaire EORTC QLQ-C30 were self-completed by 85 adult oral cancer patients who received initial anti-cancer treatment with radiotherapy with or without chemotherapy. Content and face validity were examined by an expert panel. Construct validity was confirmed by using factor analysis, multi-trait scaling analysis, and known group comparison. Reliability was assessed by internal consistency, test-retest reliability by Wilcoxon Signed Ranks Test and intra class correlation coefficient. Responsiveness to change was assessed. RESULTS: The majority of participants (58%) were aged 50-69 years and 84% were males. Nearly 32% had cancer of the anterior two thirds of the tongue. Of the sample, 66% received chemo radiotherapy. Thirteen items were included for the factor analysis. They were loaded for four factors. Three scales 'Eating problem', 'Gum and Speech problem' and 'Soreness' loaded with 5, 4 and 3 items respectively and single item 'teeth' to a one factor with the total variance explained was 72.74%. Mann-Whitney U tests for all three scales were statistically significant confirming the ability of the modified EORTC QLQ-OH15 to detect expected differences in OHRQOL in clinically different groups. Cronbach's alpha for all the scales were more than 0.8. Wilcoxon Matched Paired Sign Rank Test showed highly significant results (p < 0.05) for all three scales revealing high responsiveness. CONCLUSIONS: The modified Sinhala version of the EORTC QLQ-OH15 is a valid, reliable tool that can be used to measure OHRQOL in oral cancer patients who receive radiotherapy with or without chemotherapy.

Predicting dental caries increment using salivary biomarkers in a remote Indigenous Australian child population.

BACKGROUND: The burden of childhood dental caries amongst Indigenous Australians is higher than in other Australians. Because of differences in lifestyle and the evolutionary history of the oral microbiota, associated risk indicators may differ. Here, we evaluate associations between caries increment, salivary biomarkers and baseline caries among children aged 5-17 years residing in a remote rural Indigenous community. METHODS: This study was part of a trial assessing cost-effectiveness of an intervention to prevent dental caries among children. Baseline epidemiology and application of topical caries-preventive measures was conducted in 2015, followed-up in 2016 and 2017. Children who did not consent or failed to attend the prevention visits but did attend for follow-up epidemiology constituted a natural comparison group for evaluating the intervention. Saliva flow, pH, buffering and bacterial loads were measured at all visits. Caries was scored by the International Caries Detection and Assessment system. Outcome was caries increment. Explanatory variables were sex, being in experimental or comparison group, baseline caries, saliva flowrate and buffering, pH, and salivary loads of mutans streptococci (MS), Lactobacilli (LB), and yeast. Chi Square tests compared caries incidence in relation to explanatory variables and Generalised Linear Models explored associations between explanatory and outcome variables. RESULTS: Of 408 participants at baseline, only 208 presented at 2-year follow-up. Of caries-free children at baseline, significantly fewer had incipient (p = 0.01) and advanced (p = 0.04) caries after two years. Children in the experimental group experienced fewer tooth surfaces with advanced caries (p = 0.02) than comparison children. Having caries at baseline (p = 0.02) and low salivary flow-rates (p < 0.001) saw a significant increase in advanced caries after two years. Children with high salivary loads of MS (p = 0.03) and LB (p = 0.004) experienced more advanced carious surfaces. Multivariable analysis revealed 58% reduction (p = 0.001) in advanced caries among children with high salivary flow rates. Caries increment was 61% (p = 0.03) more for incipient and 121% (p = 0.007) more for advanced caries among children who harboured higher loads of MS. CONCLUSION: As with other ethnicities, children with low salivary flow and those with high MS had higher incipient and advanced caries increments after two years. Such risk assessments facilitate targeted preventive interventions for such communities. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527: 3 July 2015.

Demonstration of high value care to improve oral health of a remote Indigenous community in Australia.

BACKGROUND: The oral health of Indigenous children in remote communities is much worse than other population groups in Australia. Providing and maintaining an oral health service is challenging due to the remoteness of communities, the associated high cost, and the low retention of clinical staff. An annual preventive intervention delivered by fly-in clinicians may be a more cost-effective way to manage this problem. In this analysis we estimate the cost-effectiveness of an annual professional intervention for the prevention of dental caries in children of a remote Indigenous community in Far North Queensland. METHODS: A cost-effectiveness analysis was conducted based on an annual preventive intervention protocol. This included treating all dental decay in those with disease, applying fissure sealants, a disinfectant swab, fluoride varnish and providing oral hygiene instructions and dietary advice to all participating school children. This study included an intervention group and a natural comparison group and both groups were followed-up for 2 years after the initial preventive intervention. A Markov model was built to assess the cost-effectiveness of the intervention compared with the usual care. Costs of treatment from the Queensland Department of Health were used and effectiveness was measured as quality-adjusted life years (QALYs) with the CHU-9D. One-way and probabilistic sensitivity analyses were conducted to identify key drivers and quantify uncertainty. RESULTS: The preventive intervention was found to be highly cost-effective. The incremental cost per QALY gained was AU$3747. Probability of new caries and seeking treatment were identified as the main drivers of the model. In probabilistic sensitivity analysis intervention was cost effective in 100% of simulations. CONCLUSION: An annual preventive intervention for remote Indigenous communities in Australia is a highly cost-effective strategy to prevent dental caries and improve the quality of life of children.

Epidemiology of facial fractures: incidence, prevalence and years lived with disability estimates from the Global Burden of Disease 2017 study.

BACKGROUND: The Global Burden of Disease Study (GBD) has historically produced estimates of causes of injury such as falls but not the resulting types of injuries that occur. The objective of this study was to estimate the global incidence, prevalence and years lived with disability (YLDs) due to facial fractures and to estimate the leading injurious causes of facial fracture. METHODS: We obtained results from GBD 2017. First, the study estimated the incidence from each injury cause (eg, falls), and then the proportion of each cause that would result in facial fracture being the most disabling injury. Incidence, prevalence and YLDs of facial fractures are then calculated across causes. RESULTS: Globally, in 2017, there were 7 538 663 (95% uncertainty interval 6 116 489 to 9 493 113) new cases, 1 819 732 (1 609 419 to 2 091 618) prevalent cases, and 117 402 (73 266 to 169 689) YLDs due to facial fractures. In terms of age-standardised incidence, prevalence and YLDs, the global rates were 98 (80 to 123) per 100 000, 23 (20 to 27) per 100 000, and 2 (1 to 2) per 100 000, respectively. Facial fractures were most concentrated in Central Europe. Falls were the predominant cause in most regions. CONCLUSIONS: Facial fractures are predominantly caused by falls and occur worldwide. Healthcare systems and public health agencies should investigate methods of all injury prevention. It is important for healthcare systems in every part of the world to ensure access to treatment resources.

Effect of family characteristics on periodontal diseases in children and adolescents-A systematic review.

AIM: To synthesize the literature on the influence of family/parents characteristics on periodontal diseases in children and adolescents. METHODS: An electronic search for relevant literature published between 2007 and 2017 was undertaken in PubMed, Embase, Cinahl and Cochrane databases; the search was updated in April 2018. Two reviewers independently reviewed the abstracts of these; of which, 43 articles were reviewed in full. RESULTS: Of the 746 retrieved titles, 649 remained after removing duplicates. Thirty articles met the inclusion criteria, and 13 were excluded. Also, two were included from the updated search. Data from the reviewed articles indicate that all three indicators of parent's socioeconomic status (income, education and occupation) are significantly associated with periodontal diseases in children. Better periodontal status was observed in children of parents with higher SES than those whose parents were of lower SES. Although the association between parent's smoking practices, level of periodontal diseases and children's periodontal status was explored only in few studies, findings indicate that children exposed to passive smoking and having parents with periodontal diseases are more likely to present with periodontal diseases as well. CONCLUSIONS: Most of the studies considered socioeconomic factors and had not attempted to explore the impact of parental psychosocial variables on periodontal diseases in children. The literature indicates that these variables significantly influence health practices, including oral hygiene practices, which could ultimately affect periodontal health. More studies are required to explore the association of these variables with periodontal outcomes in children.

The impact of a sugar-sweetened beverages tax on oral health and costs of dental care in Australia.

Background: Despite a clear causal link between frequent consumption of sugar-sweetened beverages (SSBs) and dental disease, little is known about the implications of a tax on SSBs in the context of oral health. The aim of our study was to estimate the impacts of a SSB tax on the Australian population in the context of oral health outcomes, dental care utilisation and associated costs. Methods: We designed a cohort model that accounted for the consequences of the tax through the mechanisms of consumer response to price increase, the effect on oral health due to change in sugar intake, and the implications for dental care use. Results: Our results indicate that in the adult population an ad valorem tax of 20% would lead to a reduction in decayed, missing and filled teeth (DMFT) by 3.9 million units over 10 years, resulting in cost savings of A$666 million. Scenario analyses show that the outcomes are sensitive to the choice of the time horizon, tax rate, price elasticity of demand for SSBs, and the definition of target population. Conclusion: We found that the total and per-person consequences of SSB tax were considerable, both in terms of dental caries (tooth decay) averted and dental care avoided. These results have to be compounded with the implications of SSB tax for other aspects of health and health care, especially in the context of chronic diseases. On the other hand, the improved outcomes have to be weighted against a welfare loss associated with introducing a tax.

Oral health in the Longitudinal Study of Australian Children: An age, period, and cohort analysis.

BACKGROUND: Oral health policy and funding must be informed by well-designed studies which monitor oral health and the factors which influence it. AIM: This study aimed to analyse the oral health of the Longitudinal Study of Australia Children (LSAC). DESIGN: The LSAC is a dual-cohort cross-sequential study run biennially since 2004. Carer-report measures for oral health were measured across six biennial waves and included frequency of tooth brushing, dental service use, and dental problems since the previous wave. RESULTS: A total of 10 090 Australian children participated at baseline (birth [B] n = 5017 and kindergarten [K] n = 4983). Most carers reported that children brushed daily and had regular access to dental care. Increasing age was a significant predictor of dental caries, whereas no differences were observed between time periods and cohorts. Dental caries was more frequently reported than dental injuries. Caries was highest at age eight for the B (n = 1234, 30.5%) and K (n = 1355, 31.5%) cohorts. CONCLUSIONS: By the age of six, caries prevalence had already begun to climb despite the majority of carers reporting good oral health behaviours for their children. Early intervention in the prevention of dental caries is essential, as children appear to attend dental services when caries is already occurring.

Impact of oral potentially malignant disorders on quality of life.

BACKGROUND: Oral potentially malignant disorders (OPMDs) could have a significant psychological impact on patients, principally because of the unknown risk of malignant transformation, while the physical and functional impairments could differ. This study aimed to assess the impact of three different OPMDs and their disease stages on the quality of life (QoL) of affected patients. METHODS: Oral leukoplakia (OL), oral lichen planus (OLP) and oral submucous fibrosis (OSF) patients who were undergoing treatment at an oral medicine clinic of a dental teaching hospital in India were the study population. All subjects completed the recently developed OPMDQoL questionnaire and a short form 12 item (version 2) health survey questionnaire (SF-12v2). OPMDQoL questionnaire consists of 20 items over four dimensions. A higher score denotes poor OHRQoL. SF-12v2 has two components, a Physical Component Summary (PCS) and Mental Component Summary (MCS). RESULTS: A total of 150 subjects (50 each of OL, OLP and OSF) participated. OL patients (37.7 ± 7.9) reported significantly better OPMDQoL scores than OLP (47.3 ± 5.8) and OSF (45.4 ± 9.2) patients. OLP patients reported significant problems in obtaining a clear diagnosis for their condition, more so than the other OPMDs. OL patients reported fewer problems for the dimension, "physical impairment and functional limitations" than the OLP and OSF patients. A significant trend was observed with the overall OPMDQoL and MCS, deteriorating as the disease stage increased. CONCLUSIONS: OLP and OSF have a significant impact on the QoL of affected individuals: OL less so. Increasing stage of the disease is associated with worsening QoL.

Validity and reliability of short forms of parental-caregiver perception and family impact scale in a Telugu speaking population of India.

BACKGROUND: Parental-Caregiver Perception Questionnaire (P-CPQ) and Family Impact Scale (FIS) are commonly used measures to evaluate the parent's perception of the impact of children's oral health on quality of life and family respectively. Recently, shorter forms of P-CPQ and FIS have been developed. No study has sought to validate these short forms in other languages and cultures. This study aimed to evaluate the validity and reliability of FIS, 8 and 16-item P-CPQ in a Telugu speaking population of India. METHODS: For this cross-sectional study, a multi-stage random sampling technique was used to recruit 11-13 year-old schoolchildren of Medak district, Telangana, India and their parents (n = 1342). Parents were approached with questionnaires through their children who underwent clinical examinations for dental caries, fluorosis and malocclusion. The translated versions underwent pilot testing (n = 40), test-retest reliability was also assessed (n = 161). RESULTS: The overall summary scale and subscales of the short forms of P-CPQ and FIS failed to discriminate between the categories of dental caries severity. Also, malocclusion status was not related to the domain or overall scores of both the short forms of P-CPQ. There were significant differences in subscale and overall scores of 16 and 8-item P-CPQ and FIS between the fluorosis categories. Both 16 and 8-item P-CPQ summary scales were significantly related to parent's global rating of oral health (16-item, r = 0.30, p < 0.01; 8-item, r = 0.28, p < 0.01) and overall wellbeing (16-item, r = 0.22, p < 0.01; 8-item, r = 0.22, p < 0.01), thereby exhibiting good construct validity. However, the correlation of emotional and social wellbeing scales of short forms of P-CPQ and FIS with global ratings was of low strength. Cronbach's alphas for FIS, 16-items and 8-items P-CPQ scales were 0.78, 0.83 and 0.71 respectively, while the Intra-Class Correlation coefficients were 0.752, 0.812 and 0.816 respectively. Cronbach's alphas for most of the subscales of short forms of P-CPQ were less than 0.7. CONCLUSIONS: The overall scales of 16 and 8-items P-CPQ scales demonstrated good construct validity while the construct validity of FIS was questionable. Discriminant validity of all the three instruments was good only in relation to fluorosis. Overall scales of all three short forms exhibited acceptable internal consistency and reliability on repeated administrations.

Associations between social inequality and tooth loss in a household sample of elderly Thai people aged ≥60 years old.

OBJECTIVE: To assess the relationship between social inequality and the number of remaining teeth in an elderly Thai population. BACKGROUND: Having twenty or more remaining teeth is an important indicator of optimal oral health in the elderly. METHODS: The data for this study were derived from the Survey of Older Persons in Thailand, conducted by the National Statistical Office, based on face-to-face interviews with people aged ≥60. The total sample was 30 427. The oral health measure was self-reported remaining number of teeth. Income, education and possession of durable goods were utilised as measures of social inequality. RESULTS: More than half of the sample (57.0%) was women. The majority (73.2%) was in the age range 60-74 years old. Less than a fifth (15.5%) had 7 or more years of education. A third earned <20 000 Thai Baht (THB) per annum (defined as poor). More than half (52.8%) of the sample had <20 remaining teeth. There was a link between social inequalities and tooth loss. In the adjusted model, elderly people, who were older than 75, who were not under a married status, had a lower level of education, had a lower income, and who did not own luxury goods, were 2.84 (CI 95% 2.66-3.03), 1.31 (CI 95% 1.21-1.41), 1.44 (CI 95% 1.34-1.56), 1.12 (CI 95% 1.13-1.29) and 1.21 (CI 95% 1.13-1.29) times more likely to have 19 or fewer teeth remaining, respectively. CONCLUSION: Social inequality is related to the number of remaining teeth in elderly Thai people.

A systematic review and meta-analysis of the association between poor oral health and severe mental illness.

BACKGROUND: Psychiatric patients have increased comorbid physical illness. There is less information, however, on dental disease, especially tooth decay, despite life-style risk factors or psychotropic-induced dry mouth in this population. Importantly, poor oral health can predispose people to chronic physical disease leading to avoidable admissions to hospital for medical causes. METHODS: Using MEDLINE, PsycInfo, EMBASE, and article bibliographies, we undertook a systematic search for studies from the last 25 years regarding the oral health of people with severe mental illness (SMI). Results were compared with the general population. The two outcomes were total tooth loss (edentulism) and dental decay measured through the following standardized measures: the mean number of decayed, missing, and filled teeth or surfaces. RESULTS: We identified 25 studies that had sufficient data for a random-effects meta-analysis. These covered 5076 psychiatric patients and 39,545 controls, the latter from either the same study or community surveys. People with SMI had 2.8 the odds of having lost all their teeth compared with the general community (95% confidence interval [CI] = 1.7-4.6). They also had significantly higher decayed, missing, and filled teeth (mean difference = 5.0, 95% CI = 2.5-7.4) and surfaces scores (mean difference = 14.6, 95% CI = 4.1-25.1). CONCLUSION: The increased focus on the physical health of people with SMI should encompass oral health. Possible interventions could include oral health assessment conducted using standard checklists that can be completed by non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth, and early dental referral.

Association between poor oral health and eating disorders: systematic review and meta-analysis.

BACKGROUND: There is a well-established link between oral pathology and eating disorders in the presence of self-induced vomiting. There is less information concerning this relationship in the absence of self-induced vomiting, in spite of risk factors such as psychotropic-induced dry mouth, nutritional deficiency or acidic diet. AIMS: To determine the association between eating disorder and poor oral health, including any difference between patients with and without self-induced vomiting. METHOD: A systematic search was made of Medline, PsycINFO, EMBASE and article bibliographies. Outcomes were dental erosion, salivary gland function and the mean number of decayed, missing and filled teeth or surfaces (DMFT/S). RESULTS: Ten studies had sufficient data for a random effects meta-analysis (psychiatric patients n = 556, controls n = 556). Patients with an eating disorder had five times the odds of dental erosion compared with controls (95% CI 3.31-7.58); odds were highest in those with self-induced vomiting (odds ratio (OR) = 7.32). Patients also had significantly higher DMFS scores (mean difference 3.07, 95% CI 0.66-5.48) and reduced salivary flow (OR = 2.24, 95% CI 1.44-3.51). CONCLUSIONS: These findings highlight the importance of collaboration between dental and medical practitioners. Dentists may be the first clinicians to suspect an eating disorder given patients' reluctance to present for psychiatric treatment, whereas mental health clinicians should be aware of the oral consequences of inappropriate diet, psychotropic medication and self-induced vomiting.

Life course models for upper aero-digestive tract cancer.

Upper aero-digestive tract (UADT) cancers are collectively cancers of various human body sites, such as the oral cavity, pharynx, oesophagus and larynx. Worldwide, they are the fourth most frequent cancer type and the fourth most common cause of mortality from cancer. Many studies have shown that several chronic diseases, such as cancer, which occur more commonly in later adulthood, are influenced by social and psychological circumstances during birth, childhood, adolescence and early adult life. It is suggested that the build up of problematic circumstances throughout life is the cause of disease, rather than circumstances that happen at one point in time. UADT cancer is a chronic disease of complex multifactorial origin and most of the underlying exposures/risks cannot be considered as individual factors or in isolation, as they act at different levels, which differ from time to time. Thus, life-course epidemiology, rather than drawing false dichotomies between different risk factors of the underlying disease, attempts to integrate biological and social risk processes that cause the chronic disease. It studies how socially patterned exposures during all stages of life--childhood, adolescence and early adult--influence disease risk in adulthood and socio-economic position and hence may account for social inequalities in adult health and mortality. Furthermore, varying health effects, according to the timing or duration of exposure to socio-economic circumstances, may indicate important traces to the causes of cancer. In this paper, we have attempted to draw a conceptual framework on the relationships between socio-economic inequalities, oral health risk factors along the life-course of an individual and incidence of UADT cancer.

Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community.

BACKGROUND: The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention. METHODS/DESIGN: The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally. DISCUSSION: There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world. The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015.