Predictors for oral and general health outcomes and quality of life among older people attending general practice clinics in South Australia.

BACKGROUND: As the proportion and number of older people in Australia continue to grow, innovative means to tackle primary care and prevention are necessary to combat the individual, social and economic challenges of non-communicable diseases. OBJECTIVE: To assess risk factors (or predictors) for oral and general health outcomes and quality of life of older people (75+ years.) attending general practice (GP) clinics in South Australia. METHODS: Data were collected from older people attending 48 GP clinics in metropolitan South Australia. Age, sex, education, living arrangement, material standards, chronic conditions and nutrition were assessed as risk factors. Global self-rated oral and general health and quality of life (OHIP Severity and EQ-5D Utility) were included as outcome measures. RESULTS: A total of 459 participants completed the study; response rate was 78%. In the adjusted models, high satisfaction with material standards and good nutritional health were positively associated with all four oral and general health measures. Sex (ß = -0.08), age (ß = -0.09) and number of chronic conditions (ß = -0.12) were negatively associated with EQ-5D, while living arrangement (ß = 0.07) was positively associated. Further, having four or more chronic conditions (RR:1.47) was significantly associated with self-rated general health. CONCLUSION: Satisfaction with material standards and nutritional risk were consistent predictors for oral and general health outcomes and quality of life of older people visiting GP clinics.

Temporomandibular dysfunction experience is associated with oral health-related quality of life: an Australian national study.

BACKGROUND: There are very few studies of the association between temporomandibular dysfunction (TMD) and oral health-related quality of life (OHRQoL) in a representative sample from the Asia-Pacific region. Accordingly, we aimed to quantify the association of TMD with OHRQoL dimensions and overall measurement scores in a representative sample of Australian adults while accounting for a range of confounders, and statistically estimating whether TMD experience is meaningfully associated with OHRQoL. METHOD: Australia's National Survey of Adult Oral Health 2004-2006 data were used. The outcome variables were the Oral Health Impact Profile (OHIP-14) domains and overall scores while the main exposure was self-reported Diagnostic Criteria Question for TMD. The analysis accounted for confounders including oral health status obtained from the oral examination, demographics, socioeconomics, health behaviours and health including perceived stress subscales of the PSS-14. We conducted complex samples analysis while using Cohen's f2 effect size to estimate whether the association is meaningful. RESULTS: TMD prevalence was 9.9% (95% CI: 8.4-11.6%) among 4133 Australian adults. TMD experience was associated with impairments to the seven OHIP-14 OHRQoL domains (P < .05) with higher impairments observed in physical pain (B = 0.82, 95% CI: .45-1.20, P < .001), psychological discomfort (B = 0.68, 95% CI: .29-1.06, P = .001) and psychological disability (B = 0.52, 95% CI: .20-.84, P = .001) in adjusted multivariate analyses. The difference in the mean OHIP-14 scores for those reporting TMD (Mean = 13.1, 95% CI: 12.0-14.0) and those who did not (Mean = 6.6, 95% CI: 6.0-6.8) was significant (t = 7.51, P < .001). In an adjusted multivariable model for OHIP-14 scores, TMD experience was associated with higher OHIP-14 scores (B = 3.34, 95% CI: 1.94-4.75, P < .001) where the Cohen's f2 was .022. Further, perceived stress subscales: perceived distress and perceived control were associated with TMD experience and OHIP-14 scores (P < .05). CONCLUSION: Lower OHRQoL was observed in Australian adults who reported TMD experience but with small clinical importance which might support considering TMD in regular dental care. The higher impairments observed in physical pain, psychological discomfort and psychological disability domains of OHRQL can help clinicians and researchers focus their attention on these domains. The confounding effect exhibited by the perceived stress subscale might support their inclusion in future TMD and OHRQoL research.

General health, wellbeing and oral health of patients older than 75 years attending health assessments.

Annual health assessments by general practices for community-dwelling people aged 75 years and over are important for the early intervention and monitoring of chronic health conditions, including oral disease. Uptake of the health assessment to date has been poor, and little is known of the general and oral health profile of patients. Older patients attending health assessments at general practices in South Australia were sampled for this study. Data on demographic and socioeconomic characteristics, and patients' general and oral health, were collected by mailed questionnaire from 459 respondents. By comparison with national estimates, patients attending health assessments fared worse in many of the measures, such as self-rated general health, quality of life and the prevalence of most chronic conditions, as well as their socioeconomic circumstances. Also identified were a high degree of nutritional risk and clear need for oral health treatment, with poor self-rated oral health being three-fold higher than the national age-eligible population. Patients attending health assessments would likely benefit from nutritional screening (by a validated tool) and specific assessment of their oral health and dentition, supported by appropriate referral or intervention.

Effect of Different Frequencies of Dental Visits on Dental Caries and Periodontal Disease: A Scoping Review.

Recommending dental visits every six months is commonplace among dental practitioners worldwide. A scoping review was conducted by electronically searching PubMed, Scopus and Embase to identify and map the nature of evidence for the effect of different frequencies of dental visits on dental caries and periodontal disease. Studies were written in English on the frequency of dental visits and published between January 2008 and April 2023. Three systematic reviews that evaluated the risk of bias, strength of studies and certainty of evidence were included from the 4537 articles yielded through the search strategy. The available evidence was weak and of low quality for the currently recommended frequencies of dental visits, whether these are fixed or universal. For adults, there was little to no effect of making biannual, biennial or risk-based dental visits on dental caries and periodontal disease, which was supported by moderate- to high-certainty evidence. Accordingly, it is suggested that dental professionals and dental insurance providers make individually tailored, customised and risk-based recommendations for dental visits, rather than encouraging fixed or universal frequencies of dental visits. For children and adolescents, further research on this issue warrants well-designed randomised controlled trials (RCTs) and cohort studies of sufficient duration with an adequate number of participants.

Oral Health of Australian Adults: Distribution and Time Trends of Dental Caries, Periodontal Disease and Tooth Loss.

This study was conducted to describe the distribution and trends in dental caries, periodontal disease and tooth loss in Australian adults based on the findings of the National Study of Adult Oral Health 2017-18. A cross-sectional study of a random sample of Australians aged 15+ years was carried out, employing a three-stage stratified probability sampling design. Data were collected via online survey/telephone interviews using a questionnaire to elicit self-reported information about oral health and related characteristics. Participants were then invited to have an oral examination, conducted by calibrated dental practitioners following a standardised protocol in public dental clinics. A total of 15,731 Australians aged 15+ years were interviewed, of which 5022 dentate participants were orally examined. Results showed that nearly one third of Australian adults had at least one tooth surface with untreated dental caries and, on average, 29.7 decayed, missing or filled tooth surfaces per person. Almost 29% of adults presented with gingivitis while the overall prevalence of periodontitis was 30.1%. Overall, 4% of adults were edentulous while, on average, 4.4 teeth were lost due to pathology. Poorer oral health was evident in Australians from lower socioeconomic backgrounds, indicating socioeconomic inequalities in oral health. Time trends revealed that dental caries experience and tooth retention of Australian adults has improved over 30 years, while periodontal health has deteriorated between 2004-06 and 2017-18. These findings can be used to assist policy makers in planning and implementing future oral healthcare programs.

Effect of antimicrobial periodontal treatment and maintenance on serum adiponectin in type 2 diabetes mellitus.

AIMS: The aims of this study were to evaluate the effect of mechanical periodontal treatment with local application of minocycline (APT) on serum adiponectin as a marker of insulin resistance improvement in type 2 diabetes mellitus (T2DM) patients and to investigate if effect of APT on serum adiponectin level was sustained by periodontal maintenance (PM). MATERIAL AND METHODS: Twenty-seven T2DM patients were randomly assigned into test or control groups. Test received scaling with ultrasonic devices at baseline and APT biweekly for 2 months while control received scaling at baseline and mechanical tooth cleaning (MPT) at the same interval. At 6 months, all patients received mechanical tooth cleaning as PM. Periodontal examination and blood measurements were performed at baseline, 4 and 9 months. RESULTS: Adiponectin concentrations in test had significantly increased by 31.4% after APT (p=0.024) and by 30.4% after PM (p=0.002) compared with baseline. The percentage of >or=4 mm probing depths (PD) had shown 8.3% and 9.3% reduction after APT and PM (p=0.046, 0.02) in test while 5.0% reduction after MPT in control group (p=0.031). CONCLUSIONS: Our results suggested that APT and PM not only improve periodontal disease but also increase serum adiponectin in T2DM patients.

General health and well-being among primary care patients aged 75+ years: Associations with living conditions, oral health and dependency.

OBJECTIVE: Our aim was to examine the associations between general health and well-being with living conditions, oral health and degree of dependency. METHODS: We surveyed people from a primary care service and collected data on sociodemographic characteristics, general health, health utility, well-being, activities, living conditions and oral health impact. RESULTS: Overall, 459 participated (78% response rate). Poor general health was associated with decreased instrumental activities of daily living scores (18% of those with poor general health were independent vs 60% with good general health). Greater oral health impact was also related to poor general health. Health utility was lower for some dependency, for renting and oral health impact. Well-being was also lower for some dependency, for renting, not speaking English and oral health impact. CONCLUSION: In addition to the well-known association of poor general health with dependency, our results also illustrate the potential importance of living conditions and oral health.

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.

Variations in Australian dental therapy practice by practitioner and workplace characteristics.

INTRODUCTION: Understanding dental therapy practice across clinical settings is useful for education and service planning. This study assessed if dental therapy service provision varied according to practitioner and workplace characteristics. METHODS: Members of professional associations representing dental therapists (DT) and oral health therapists (OHT) were posted a self-complete survey collecting practitioner and workplace characteristics, together with clinical activity on a self-selected typical day of practice. Differences in service provision according to characteristics were assessed by comparing mean services per patient visit. Negative binomial regression models estimated adjusted ratios (R) of mean services per patient. RESULTS: The response rate was 60.6%. Of practitioners registered as an OHT or a DT, 80.0% (n = 500) were employed in general clinical practice. Nearly one-third of OHT and nearly two-thirds of DT worked in public sector dental services. Patterns of service provision varied significantly according to practice sector and other characteristics. After adjusting for characteristics, relative to private sector, public sector practitioners had higher provision rates of fissure sealants (R = 3.79, 95% confidence interval [95% CI]: 2.84-5.06), restorations (R = 3.78, 95% CI: 2.94-4.86) and deciduous tooth extractions (R = 3.58, 95% CI: 2.60-4.93) per patient visit, and lower provision rates of oral health instruction (R = 0.86, 95% CI: 0.76-0.98), fluoride applications (R = 0.43, 95% CI: 0.33-0.56), scale and cleans (R = 0.39, 95% CI: 0.34-0.45) and periodontal services (R = 0.20, 95% CI: 0.14-0.28) per patient visit. CONCLUSION: Differences in service provision according to sector indicate that OHT and DT adapt to differing patient groups and models of care. Variations may also indicate that barriers to utilising the full scope of practice exist in some settings.

Factors Associated with Routine Dental Attendance among Aboriginal Australians.

OBJECTIVES: To determine factors associated with routine dental attendance in Aboriginal Australians. METHODS: Data of 271 Aboriginal adults residing in Australia's Northern Territory were used. Routine dental attendance was defined as last visiting a dentist less than one year ago or visiting a dentist for a check-up. Both bivariate and multivariable analytical techniques were used. RESULTS: While 27% visited a dentist in the past year, 29% of these visited for a check-up. In bivariate analysis, being female, low psychological distress, and low clinical attachment loss (CAL) were associated with visiting a dentist within last year. Being aged younger than 39 years, male, no oral health impairment, being caries-free, low CAL, and low apolipoprotein B were associated with visiting for a check-up. Clinical attachment loss remained associated with visiting a dentist less than one year ago while being younger than 39 years and having no oral health impairment remained associated with usually visiting for a check-up in multivariable analysis. CONCLUSIONS: Younger age, no oral health impairment, and low CAL were associated with routine dental attendance among Indigenous Australians.

Factors Associated with Routine Dental Attendance among Aboriginal Australians.

OBJECTIVES: To determine factors associated with routine dental attendance in Aboriginal Australians. METHODS: Data of 271 Aboriginal adults residing in Australia's Northern Territory were used. Routine dental attendance was defined as last visiting a dentist less than one year ago or visiting a dentist for a check-up. Both bivariate and multivariable analytical techniques were used. RESULTS: While 27% visited a dentist in the past year, 29% of these visited for a check-up. In bivariate analysis, being female, low psychological distress, and low clinical attachment loss (CAL) were associated with visiting a dentist within last year. Being aged younger than 39 years, male, no oral health impairment, being caries-free, low CAL, and low apolipoprotein B were associated with visiting for a check-up. Clinical attachment loss remained associated with visiting a dentist less than one year ago while being younger than 39 years and having no oral health impairment remained associated with usually visiting for a check-up in multivariable analysis. CONCLUSIONS: Younger age, no oral health impairment, and low CAL were associated with routine dental attendance among Indigenous Australians.

Psychological distress and self-rated oral health among a convenience sample of Indigenous Australians.

OBJECTIVES: This study sought to: a) estimate the frequency of poor self-rated oral health as assessed by a summary measure; b) compare frequency according to sociodemographic, behavioral, and psychological distress factors; and (3) determine if psychological distress was associated with poor self-rated oral health after adjusting for confounding. METHODS: Data were from a convenience sample of Indigenous Australian adults (n = 289) residing in Australia's Northern Territory. Poor self-rated oral health was defined as reported experience of toothache, poor dental appearance or food avoidance in the last 12 months. A logistic regression model was used to evaluate socio-demographic, behavioral, and psychological distress associations with poor self-rated oral health (SROH). Effects were quantified as odds ratios (OR). RESULTS: The frequency of poor SROH was 73.7 percent. High psychological distress, measured by a Kessler-6 score ≥8, was experienced by 33.9 percent of participants. Poor SROH was associated with high levels of psychological distress, being older, being female, and usually visiting a dentist because of a problem. In the multivariable model, factors that were significantly associated with poor SROH after adjustment for other covariates included having a high level of psychological distress (OR 2.74, 95% CI 1.25-6.00), being female (OR 2.22, 95% CI 1.03-4.78), and usually visiting a dentist because of a problem (OR 3.57, 95% CI 1.89-6.76). CONCLUSIONS: Poor self-rated oral health and high levels of psychological distress were both highly frequent among this vulnerable population. Psychological distress was significantly associated with poor self-rated oral health after adjustment for confounding.

Tobacco use and oral hygiene as risk indicators for periodontitis.

OBJECTIVE: To detect the periodontal status of male smokers and betel chewers in a rural community in Sri Lanka and compare it with that of male non-tobacco users of the same community. METHODS: A cross-sectional community based study was carried out in a sample of 2277 rural adult males aged 20-60 years, adopting multistage cluster sampling technique. The present analysis was confined to 2178 subjects who were mutually exclusive smokers, betel chewers or non-tobacco users. The periodontal status was assessed by clinical measurement of levels of bacterial plaque (PLI), gingival inflammation (GI) and loss of epithelial attachment (LA). All measurements were carried out on four sites of all teeth present except third molars and the mean values for periodontal parameters were calculated. RESULTS: Bivariate analysis revealed that the overall periodontitis levels were significantly higher in betel chewers and smokers than in non-tobacco users. Multiple linear regression analysis showed that there were no significant effects of smoking and betel chewing per se on LA, independent of age, socioeconomic status (SES) and whether or not controlled for PLI. The effect of the quantified tobacco use on LA was statistically significant regardless of age, PLI or SES. However, the effect of the quantified tobacco use was considered limited when compared to that of oral hygiene. CONCLUSIONS: The findings highlighted the importance of oral hygiene in the aetiology of periodontitis while confirming the statistical significance of the quantified tobacco use on LA. Oral hygiene and the quantified tobacco use may be considered as risk indicators for periodontitis.

Periodontal status of rural inhabitants in Prek Russey, Cambodia.

There is a paucity of information pertaining to oral disease patterns including periodontal disease in Cambodia, which is just emerging from a 20-year ruin. A house-to-house survey was conducted to assess the periodontal status of 1948 subjects aged 15-74 years in a rural commune in Cambodia using Community Periodontal Index (CPI) and measuring Attachment Loss (LA). The periodontal status of Cambodians increased with age as indicated by both CPI and LA. Calculus was the most common finding among Cambodians pointing to overall poor oral hygiene levels. Notwithstanding the poor oral hygiene, however, the severe periodontitis as denoted by > or = 6mm periodontal pockets was rare even in the elderly while edentulousness was not frequently observed until 65 years. Preventive programmes targeting periodontal disease in Cambodia should focus on oral health education and simple oral hygiene instructions while the ubiquitous calculus could be dealt with oral prophylaxis.

Association between serum calcium and periodontal disease progression in non-institutionalized elderly.

OBJECTIVE: To assess the effect of baseline serum calcium on the progression of periodontal disease in non-institutionalized elderly. BACKGROUND: Although a few studies have found some evidence of the role played by dietary calcium in periodontal disease process, there is a paucity of information pertinent to longitudinal assessment of serum calcium-periodontal relationships. MATERIAL AND METHODS: Clinical attachment levels of 266 Japanese subjects aged 70 years were recorded at baseline and annually for six consecutive years. Progression of periodontal disease (PPD) was defined as the number of teeth that showed additional attachment loss of > or =3 mm during the 6 years. The number of PPD was calculated for each subject and categorised into four levels, namely, PPD(0), PPD(1), PPD(2) and PPD(3) where the number of teeth with additional attachment loss ranged from 0, 1-10, 11-20 and >20 respectively. The levels of serum calcium, albumin, random blood sugar, immunoglobulin (IgG, IgA and IgM), gender, smoking habits, education, gingival bleeding and the number of teeth present were obtained at baseline. RESULTS: Serum calcium, IgA, smoking, gingival bleeding and teeth present were associated with PPD at p < or = 0.10 and were included in a multinomial logistic regression analysis. Serum calcium was the only variable that was significantly associated with PPD with relative risks of 100 at PPD(1) and PPD(2), respectively, and 1000 at PPD(3). CONCLUSION: Serum calcium may be considered a risk factor for periodontal disease progression in non-institutionalized elderly.

Association between serum albumin and periodontal disease in community-dwelling elderly.

AIM: The purpose of this study was to evaluate the relationship between periodontal disease and general health status in community-dwelling elderly using serum albumin concentration as a criterion index of the severity of an underlying disease and nutrition status. METHODS: Serum albumin level was detected by the bromcresol green albumin (BCG) method and the data for serum albumin were available in 368 subjects aged 75 years. Pressure-sensitive probes were used to measure loss of attachment (LA) on six sites of all teeth present. Information relevant to gender and smoking habit was obtained by means of a personal interview, while body mass index (BMI) and biochemical serum markers were investigated. RESULTS: Serum albumin concentration ranged from 3.2 to 4.8 g/dl with a mean of 4.1+/-0.2. More than 70% of subjects had at least one site with LA 6+ mm, while 91 exhibited 10% or more sites with LA 6+ mm. Using a multiple regression analysis, we found that sites of LA 6+ mm had a significant effect on serum albumin level (correlation coefficient=-0.14; p<0.05), which was independent of the other covariates. CONCLUSIONS: The findings of the present study indicated that there might be an inverse relationship between periodontal disease and serum albumin concentration in these elderly subjects.

Association between smoking, betel chewing and gingival bleeding in rural Sri Lanka.

OBJECTIVE: To ascertain the association between tobacco use and gingival bleeding in a rural community in Sri Lanka. MATERIAL AND METHODS: A cross-sectional field-based study was carried out in 2178 rural males aged 20-60 years, employing a multistage cluster sampling technique. The levels of plaque and gingivitis were recorded on four sites of all teeth present excluding third molars, using the plaque index (PLI) and gingival index (GI). Information pertaining to sociodemographic variables, oral hygiene practices and tobacco consumption habits was obtained from all subjects. RESULTS: One-way anova combined with the Bonferroni test disclosed that betel chewers had a significantly higher mean number of sites with gingival bleeding (22.6+/-21.8) than smokers (10.8+/-11.2) and nontobacco users (8.7+/-6.8) (p<0.0001). A higher proportion of betel chewers (55.1%) showed > or =12 bleeding sites compared to smokers (27.6%). Logistic regression analysis revealed that the association between betel chewing and gingival bleeding was positive (OR=2.41; p<0.0001) whereas that of smoking and gingival bleeding was negative (OR=0.75; p<0.05). Oral hygiene had the strongest relationship with gingival bleeding (OR=18.11). CONCLUSION: While confirming the masking effect of smoking on gingival bleeding, these findings indicate that betel chewing might significantly enhance gingival bleeding in the population studied.