Oral microbiome research - a call for equity and inclusion.

Over 700 oral bacterial species have been identified in human populations, with ~200 bacterial species identified in any given individual mouth. The relationship between the oral microbiome and health is evidenced in many studies, with dysbiosis (a shift from a healthy to less healthy state of microbial community) associated with dental caries, periodontitis, halitosis and oral cancer. However, oral microbiome research to date has focused primarily on European populations, particularly those in large urban centres housing academic institutions with access to research funding. Key anthropological perspectives examining the sociocultural, epidemiological, genetic and environmental factors that influence the oral microbiome have also been Euro-centric. Very little is known about how the oral microbiome mediates both oral and general disease risks specifically within Indigenous and other vulnerable populations. Undertaking oral microbiome research in under-served communities requires consideration of many issues often unfamiliar in the broader research community, including being acceptable, relevant and of perceived benefit to the communities being studied. Research materials need to be managed respectfully in a culturally safe way, sharing/translating the knowledge obtained. These approaches will likely provide unique insights into the complex connections between environment and biology, people and place, and culture and science in relation to the oral microbiome. The ongoing development of oral microbiome research must facilitate frameworks that are equitable and inclusive to better enable clinical and scientific expertise within marginalised communities.

Transnational corporations and oral health inequalities; an introduction.

In an increasingly globalised world, Trans-National Corporations (TNCs) wield considerable social, economic and political influence, both in the international market economy and within individual countries. The practices of TNCs can have positive or adverse effects on population health through production methods and products, shaping social determinants of health, or influencing the regulatory structures governing their activities. TNCs can contribute to health inequities if the health consequences arising from their practices have disproportionate adverse impacts on vulnerable populations or positive benefits for less vulnerable groups. Despite growing recognition of the implications for health, including oral health, arising from TNC practices, little research has sought to systematically assess the oral health and/or oral health equity impacts of TNCs. In the four papers that follow, we contribute to the discourse around oral health-related inequalities through the lens of power, human agency and TNCs. The papers formed the basis of a symposium entitled 'Transnational Corporations and oral health inequalities' at the 97th General Session of the International Association of Dental Research held June 2019 in Vancouver, British Columbia. The authors responded to the 2014 Lancet-University of Oslo Commission on Global Governance for Health call for greater attention to the health effects of TNC practices and the regulatory regimes in which they operate. The papers overview the role of TNCs in oral health inequalities at an international level, with a specific focus on illuminating their far-reaching influence on our everyday lives, from both epidemiological and sociological perspectives, and the multi-faceted positive or adverse effects on oral health this might have. Key TNC examples are provided by way of the sugar and the tobacco industries, with their impact on dental caries, periodontal diseases and head and neck cancers.

Are Stage of Change constructs relevant for subjective oral health in a vulnerable population?

UNLABELLED: Stage of Change constructs may be proxy markers of psychosocial health which, in turn, are related to oral health. OBJECTIVE: To determine if Stage of Change constructs were associated with subjective oral health in a population at heightened risk of dental disease. METHODS: Stage of Change constructs were developed from a validated 18-item scale and categorised into 'Pre-contemplative', 'Contemplative' and 'Active'. A convenience sample of 446 Australian non-Aboriginal women pregnant by an Aboriginal male (age range 14-43 years) provided data to evaluate the outcome variables (self-rated oral health and oral health impairment), the Stage of Change constructs and socio-demographic, behavioural and access-related factors. Factors significant at the p < 0.05 level in bivariate analysis were entered into prevalence regression models. RESULTS: Approximately 54% of participants had fair/poor self-rated oral health and 34% had oral health impairment. Around 12% were 'Pre-contemplative', 46% 'Contemplative' and 42% 'Active'. Being either 'pre-contemplative' or 'contemplative' was associated with poor self-rated oral health after adjusting for socio-demographic factors. 'Pre-contemplative' ceased being significant after adjusting for dentate status and dental behaviour. 'Pre-contemplative' remained significant when adjusting for dental cost, but not 'Contemplative'. The Stages of Change constructs ceased being associated with self-rated oral health after adjusting for all confounders. Only 'Contemplative' (reference: 'Active') was a risk indicator in the null model for oral health impairment which persisted after adding dentate status, dental behaviour and dental cost variables, but not socio-demographics. When adjusting for all confounders, 'Contemplative' was not a risk indicator for oral health impairment. CONCLUSIONS: Both the 'Pre-contemplative' and 'Contemplative' Stage of Change constructs were associated with poor self-rated oral health and oral health impairment after adjusting for some, but not all, covariates. When considered as a proxy marker of psychosocial health, Stage of Change constructs may have some relevance for subjective oral health.

Self-rated oral health and oral health-related factors: the role of social inequality.

BACKGROUND: The reasons why social inequality is associated with oral health outcomes is poorly understood. This study investigated whether stratification by different measures of socio-economic status (SES) helped elucidate these associations. METHODS: Cross-sectional survey data were used from Australia's 2004-06 National Survey of Adult Oral Health. The outcome variable was poor self-rated oral health. Explanatory variables comprised five domains: demographic, economic, general health behaviour, oral health-related quality of life and perceived need for dental care. These explanatory variables were each stratified by three measures of SES: education, income and occupation. RESULTS: The overall proportion of adults reporting fair or poor oral health was 17.0% (95% CI 16.1, 18.0). Of these, a higher proportion were older, Indigenous, non-Australian born, poorly educated, annual income <$20 000, unemployed, eligible for public dental care, smoked tobacco, avoided food in the last 12 months, experienced discomfort with their dental appearance, experienced toothache or reported a need for dental care. In stratified analyses, a greater number of differences persisted in the oral health impairment and perceived need for dental care domains. CONCLUSIONS: Irrespective of the SES measure used, more associations between self-rated oral health and dental-specific factors were observed than associations between self-rated oral health and general factors.

Ukaipo niho: the place of nurturing for oral health.

OBJECTIVES: To report on oral-health-related characteristics, beliefs, and behaviours among participants in a randomised control trial of an intervention to prevent early childhood caries (ECC) among Maori children, and to determine whether there were any systematic differences between the intervention and control groups at baseline. DESIGN: Baseline measurements from a randomised control trial (involving 222 pregnant Maori women allocated randomly to either Intervention or Delayed groups) which is currently underway. SETTING: The rohe (tribal area) of Waikato-Tainui. METHODS: Self-report information collected on sociodemographic characteristics, pregnancy details, self-reported general and oral health and health-related behaviours, and oral health beliefs. RESULTS: Other than those in the Delayed group being slightly older, on average, there were no significant differences between the two groups. Some 37.0% were expecting their first child. Most reported good health; 43.6% were current smokers, and 26.4% had never smoked. Only 8.2% were current users of alcohol. Almost all were dentate, and 57.7% described their oral health as fair or poor. One in six had had toothache in the previous year; 33.8% reported being uncomfortable about the appearance of their teeth, and 27.7% reported difficulty in eating. Dental service-use was relatively low and symptom-related; 78.9% needed to see a dentist. Overall, most of the sample believed that it was important to avoid sweet foods, visit dentists and to brush the teeth, while about half thought that using fluoride toothpaste and using floss were important. Some 38.2% felt that drinking fluoridated water was important. Oral-health-related fatalism was apparent, with 74.2% believing that most people usually get dental problems, 58.6% believing that most people will need extractions at some stage, and that most children eventually get dental caries. CONCLUSIONS: Mothers' important role in nurturing the well-being of the young child includes the protection and maintenance of the growing child's oral health (or ukaipo niho). The findings provide important insights into Maori mothers' oral health knowledge, beliefs and practices.

Oral health behaviours and perceptions reported by Indigenous Australians living in Darwin, Northern Territory.

OBJECTIVE: To describe the reported oral health behaviours and perceptions of Indigenous Australians living in Darwin, Northern Territory and to compare those with estimates for Darwin and Australia derived from the National Survey of Adult Oral Health (NSAOH). PARTICIPANTS: A total of 181 Indigenous Australians aged 22 years and over living in Darwin, participating in screening for a wider randomised clinical trial, were included. METHOD: Information on socio-demographic characteristics, oral health status including oral health behaviours and perceptions was collected using a questionnaire. Differences between the Darwin study (DS) participants and Australians in NSAOH were made based on non-overlapping 95% confidence intervals. RESULTS: Almost 72% of DS participants had last seen a dentist over a year earlier, compared to 47% and 39% of NSAOH Darwin and Australian participants, respectively. A higher proportion of DS participants usually visited a dentist because of a problem than NSAOH Darwin and NSAOH Australian participants. A higher proportion of DS participants had avoided or delayed a dental visit because of cost than NSAOH participants. Over three times as many DS participants rated their oral health as fair/poor compared to NSAOH participants. A higher proportion of DS participants had perceived gum disease and one or more symptoms of gum disease than NSAOH participants. A higher proportion of DS participants experienced toothache, felt uncomfortable about appearance of their mouth and avoided eating because of oral problems than NSAOH participants. CONCLUSIONS: A higher proportion of Indigenous Australians living in Darwin presented with non-optimal oral health behaviours and perceptions compared with both the Darwin and Australian general populations.

Periodontal disease and dental caries among Indigenous Australians living in the Northern Territory, Australia.

BACKGROUND: The aim of this study was to describe the caries experience and severity of periodontal disease in a convenience sample of Indigenous Australians living in the Northern Territory. METHODS: Data were gathered via self-reported questionnaire and dental examination by calibrated examiners. Socio-demographic characteristics were compared with data from the 2011 Australian census while prevalence of periodontal disease and dental caries was compared against weighted estimates from the National Survey of Adult Oral Health 2004-2006. In each comparison, non-overlapping 95% confidence intervals inferred a significant difference. Within-study comparisons were assessed via chi-square, t-tests and analysis of variance for differences among study participants. RESULTS: A total of 312 Indigenous Australian participants provided completed data (average age 39.5 ± 10.5 years, 174 males). Of these, 87.5% were confirmed periodontitis cases; 3.5 times that of national-level estimates. The experience of untreated caries was five times that of national estimates (mean decayed 3.0 versus 0.6). Periodontitis case status was positively associated with older age, male gender and presence of diabetes. CONCLUSIONS: Periodontal disease and untreated caries were significantly more prevalent in this sample of Indigenous Australians compared to the general Australian population. The prevalence of periodontal disease was markedly higher than that previously described for Indigenous Australians.

Self-reported oral health of a metropolitan homeless population in Australia: comparisons with population-level data.

BACKGROUND: There is limited information on self-perceived oral health of homeless populations. This study quantified self-reported oral health among a metropolitan homeless adult population and compared against a representative sample of the metropolitan adult population obtained from the National Survey of Adult Oral Health. METHODS: A total of 248 homeless participants (age range 17-78 years, 79% male) completed a self-report questionnaire. Data for an age-matched, representative sample of metropolitan-dwelling adults were obtained from Australia's second National Survey of Adult Oral Health. Percentage responses and 95% confidence intervals were calculated, with non-overlapping 95% confidence intervals used to identify statistically significant differences between the two groups. RESULTS: Homeless adults reported poorer oral health than their age-matched general population counterparts. Twice as many homeless adults reported visiting a dentist more than a year ago and that their usual reason for dental attendance was for a dental problem. The proportion of homeless adults with a perceived need for fillings or extractions was also twice that of their age-matched general population counterparts. Three times as many homeless adults rated their oral health as 'fair' or 'poor'. CONCLUSIONS: A significantly greater proportion of homeless adults in an Australian metropolitan location reported poorer oral health compared with the general metropolitan adult population.