The effect of education on dental service utilization patterns in different sectors: A multiple mediation analysis.

OBJECTIVE: The aim of this study was to investigate how education level affects dental service utilization patterns in the Australian adult population. This study tested how education level mediated these service patterns through behavioural mediators such as smoking, tooth brushing and oral health status and investigated these mediation effects in different dental service providers. METHOD: Following the flexible mediation approach, the direct and indirect effects of education through behavioural mediators on dental service utilization patterns (time of last dental visit, reason for last dental visit and frequency of seeking dental care) were calculated for the South Australian population from the Dental Care and Oral Health Study. RESULTS: Participants with lower educational attainment were 33% (Odds Ratio: 0.67, 95% CI 0.56-0.78) and 38% (Odds Ratio: 0.62, 95% CI 0.53-0.74), less likely than their counterparts with higher education to visit a dentist or to receive dental care in the last 12 months, respectively. Low education was associated with a 23% increase in odds of receiving emergency and treatment services (Odds Ratio: 1.23, 95% CI 1.05-1.43) compared to routine dental check-ups or examinations. CONCLUSION: Low education, regardless of oral health behaviours and status, reduces the odds of dental service utilization in terms of frequency of seeking dental care and time of last dental visit. There is more tendency towards receiving emergency and treatment services compared to routine dental check-ups or examinations in participants with lower educational attainment.

Obesity, dietary sugar and dental caries in Australian adults.

OBJECTIVES: To determine the association of overweight/obesity, dental caries and dietary sugars in Australian adults. MATERIALS AND METHODS: The National Survey of Adult Oral Health (NSAOH) 2004-2006 provided data for analysis of dental caries experience. Self-reported body weight and height were used to calculate body mass index (BMI) for a subsample (n = 3,745, 89.8%) of the NSAOH data. A self-report questionnaire of 13 food items estimated the daily intake of added sugar, total sugars and total carbohydrate, using food composition estimates from the AUSNUT2011-2013. Bivariate analyses (Pearson's Chi-square with Rao-Scott adjustment and Student's t-tests) were used to determine the association of overweight/obesity, dental caries, sugar variables and putative confounders. Poisson regression models for the Decayed, Missing and Filled Teeth Index and individual measures of decayed, missing and filled teeth were constructed, with models containing BMI, dietary added sugar, total sugar and total carbohydrate, controlling for putative confounders. RESULTS: There was a positive association between dental caries experience and being overweight or obese compared with having normal weight or being underweight as well as between sugar consumption with all four dental caries outcome measures. When controlled for putative confounders where sugar consumption was identified as a key determinant, the statistical significance between dental caries experience and being overweight or obese disappeared. The demographic and socioeconomic factors associated with dental caries experience were age, sex, education, smoking status and usual reason for dental visit. CONCLUSION: Analysis of the relationship between dental caries and obesity must include data about sugar and carbohydrate consumption.

Psychosocial factors and self-reported transitions in oral and general health.

Psychosocial factors may explain variance in health beyond conventional indicators, such as behaviours. This study aimed to examine changes in health associated with perceived stress, social support, and self-efficacy, controlling for sociodemographic characteristics and health behaviour. A random sample of 45- to 54-yr-old subjects was surveyed in 2004-2005, with a follow-up 2 yr later. The outcomes were self-reported changes in oral and general health. Explanatory variables included stress, social support, and perceived health competence with covariates of income, gender, dentition status, toothbrushing, and smoking. Responses were collected from 986 persons (response = 44.4%). At the 2-yr follow-up, 25.6% reported worsening in oral health and 15.3% reported worsening in general health. Prevalence ratios (PR) from adjusted log-binomial regression showed an association between worsening oral health and higher perceived health competence (PR = 0.75, 95% CI: 0.57-0.99), and worsening general health was associated with perceived health competence (PR = 0.82, 95% CI: 0.72-0.94) and stress (PR = 1.17, 95% CI: 1.03-1.32). Worsening oral and general health were seen for male subjects (PR = 1.33, 95% CI: 1.06-1.68 and PR = 1.14, 95% CI: 1.01-1.29) and low income (PR = 1.40, 95% CI: 1.04-1.89 and PR = 1.20, 95% CI: 1.03-1.40). Health-related self-efficacy representing psychosocial resilience was associated with oral and general health, while stress was associated with general health. Psychosocial factors were independent predictors of change in health after controlling for sociodemographic characteristics and health behaviours.

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.

Health-related quality of life and income-related social mobility in young adults.

BACKGROUND: To assess the association of income-related social mobility between the age of 13 and 30 years on health-related quality of life among young adults. METHODS: In 1988-89 n = 7,673 South Australian school children aged 13 years were sampled with n = 4,604 children (60.0%) and n = 4,476 parents (58.3%) returning questionnaires. In 2005-06 n = 632 baseline study participants responded (43.0% of those traced and living in Adelaide). RESULTS: Multivariate regressions adjusting for sex, tooth brushing and smoking status at age 30 showed that compared to upwardly mobile persons social disadvantage was associated (p < 0.05) with more oral health impact (Coeff = 5.5), lower EQ-VAS health state (Coeff = -5.8), and worse satisfaction with life scores (Coeff = -3.5) at age 30 years, while downward mobility was also associated with lower satisfaction with life scores (Coeff = -1.3). CONCLUSIONS: Stable income-related socioeconomic disadvantage was associated with more oral health impact, and lower health state and life satisfaction, while being downwardly mobile was associated with lower life satisfaction at age 30 years. Persons who were upwardly mobile were similar in health outcomes to stable advantaged persons.

Impact of dental visiting trajectory patterns on clinical oral health and oral health-related quality of life.

BACKGROUND: Previous studies have shown variation in long-term dental visiting but little is known about the oral health outcomes of such variation. OBJECTIVE: The objective of this study is to determine the association of different dental visiting trajectories with dental clinical and oral health-related quality of life (OHRQoL) indicators. METHODS: This study utilized data from the Dunedin Multidisciplinary Health and Development Study, a continuing longitudinal study of 1,037 babies born in Dunedin (New Zealand) between April 1, 1972 and March 31, 1973. Data presented here were collected at ages 15, 18, 26, and 32 years. Three categories of dental attendance were identified in earlier research, namely: regulars (n = 285, 30.9 percent of the cohort), decliners (441, 55.9 percent), and opportunistic users (107, 13.1 percent). RESULTS: There was a statistically significant association between opportunistic dental visiting behavior and decayed missing and filled surfaces score (Beta = 3.9) as well as missing teeth because of caries (Beta = 0.7). Nonregular dental visiting trajectories were associated with higher Oral Health Impact Profile (OHIP-14) scores (Beta = 2.1) and lower self-rated oral health scores (prevalence ratio = 0.8). CONCLUSION: Long-term, postchildhood dental attendance patterns are associated with oral health in adulthood, whether defined by clinical dental indicators or OHRQoL. Improving dental visiting behavior among low socioeconomic status groups would have the greatest effect on improving oral health and reducing oral health impacts.

Practice activity trends among oral and maxillofacial surgeons in Australia.

BACKGROUND: The aim of this study was to describe practice activity trends among oral and maxillofacial surgeons in Australia over time. METHODS: All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. RESULTS: Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). The rate of provision of services per visit changed over time with increased rates observed overall (from 1.43 +/- 0.05 services per visit in 1990 to 1.66 +/- 0.06 services per visit in 2000), reflecting increases in pathology and reconstructive surgery. No change over time was observed in the provision of services per year (4,521 +/- 286 services per year in 1990 and 4,503 +/- 367 services per year in 2000). Time devoted to work showed no significant change over time (1,682 +/- 75 hours per year in 1990 and 1,681 +/- 94 hours per year in 2000), while the number of visits per week declined (70 +/- 4 visits per week in 1990 to 58 +/- 4 visits per week in 2000). CONCLUSIONS: The apparent stability in the volume of services provided per year reflected a counterbalancing of increased services provided per visit and a decrease in the number of visits supplied.