Oral Health-Related Quality of Life from Young Adulthood to Mid-Life.

Quality of life varies with time, often worsening, and is affected by circumstances, events, and exposures at different stages of life. Little is known about how oral health-related quality of life (OHRQoL) changes during middle age. We investigated OHRQoL changes from age 32 to 45 years among participants in a population-based birth cohort, along with clinical and socio-behavioural associations. Generalised estimating equation models were used to investigate the association between OHRQoL (assessed at ages 32, 38, and 45 years; n = 844), and the socioeconomic position in childhood (up to age 15 years) and adulthood (ages 26 through to 45 years), dental self-care (dental services utilisation and tooth brushing), oral conditions (such as tooth loss), and experiencing a dry mouth. The multivariable analyses were controlled for sex and personality traits. At each stage of life, those of a lower socioeconomic status were at greater risk of experiencing OHRQoL impacts. Those who engaged in favourable dental self-care habits (the regular use of dental services and at least twice daily tooth brushing) experienced fewer impacts. A social disadvantage at any stage of life has enduring deleterious effects on one's quality of life in middle age. Ensuring access to timely and appropriate dental health services in adulthood may reduce the impacts of oral conditions on one's quality of life.

An assessment of compliance with optimal fluoride levels for oral health benefit by New Zealand drinking water suppliers.

OBJECTIVES: Community water fluoridation (CWF) has proven oral health benefits. We investigated whether drinking water suppliers are meeting New Zealand CWF targets (0.7-1.0 ppm) to ensure these benefits. METHODS: We retrieved fluoride testing data from 25 supplies serving 2,059,000 people (82% of people on a fluoridated supply), for the years 1992-2022 (22,220 weekly observations). We descriptively assessed compliance with fluoride targets in this convenience sample. RESULTS: The mean fluoride level was 0.66 ppm (SD 0.28). Water suppliers achieved fluoride targets 54.1% of the time (range 4.2%-77.9%). Fluoride concentration fell short of the target in 42.2% of observations, exceeded but under the maximum acceptable value (MAV) in 3.6%, and in excess of the MAV in 0.1%. The percentage of compliant observations was greater in larger than smaller supplies. CONCLUSIONS: Noncompliance with CWF targets was common. Epidemiological studies that rely on fluoridation status as their exposure may underestimate the oral health benefits of CWF. Our results highlight future challenges with the feasibility of expanding CWF under new legislation as well as the weaknesses in drinking water surveillance.

Inequalities in dental caries experience among 4-year-old New Zealand children.

OBJECTIVES: To investigate ethnic-specific deprivation gradients in early childhood dental caries experience considering different domains of deprivation. METHODS: We used cross-sectional near whole population-level data on 318 321 four-year-olds attending the "B4 School check," a national health and development check in New Zealand, across 6 fiscal years (2010/2011 to 2015/2016). The "lift the lip" screening tool was used to estimate experience of any caries and severe caries. We investigated deprivation gradients using the Index of Multiple Deprivation (IMD), which measures seven domains of deprivation across 5958 geographical areas ("data zones"). Ethnicity was categorized into five groups: (i) Maori, (ii) Pacific, (iii) Asian, (iv) Middle Eastern, Latin American and African (MELAA) and (v) European & Other (combined). We used a random intercepts model to estimate mutually adjusted associations between deprivation, ethnicity, age, fiscal year, and evidence of any dental caries experience. RESULTS: Reports of any caries experience decreased from 15.8% (95% CI: 15.7; 15.9%) to 14.7% 95% CI: 14.4; 14.8%), while reports of severe caries experience increased from 3.0% (95% CI: 3.0; 3.1%) to 4.4% (95% CI: 4.3; 4.5%) from 2010/2011 to 2015/2016. This varied by ethnicity with larger increases in severe caries for Pacific children from 7.1% (95% CI: 6.8; 7.4%) to 14.1% (95% CI: 13.7; 14.5%). There were deprivation gradients in dental caries experience with considerable variation by ethnicity and by domain of deprivation. The association between deprivation and dental caries experience was weakest for Asian children and was most pronounced for Pacific and Maori children. CONCLUSION: Socioeconomic gradients in dental caries experience are evident by age 4 years, and these gradients vary by ethnicity and domain of deprivation.

The costs and benefits of water fluoridation in NZ.

BACKGROUND: Implementing community water fluoridation involves costs, but these need to be considered against the likely benefits. We aimed to assess the cost-benefit and cost-effectiveness of water fluoridation in New Zealand (NZ) in terms of expenditure and quality-adjusted life years. METHODS: Based on published studies, we determined the risk reduction effects of fluoridation, we quantified its health benefits using standardised dental indexes, and we calculated financial savings from averted treatment. We analysed NZ water supplies to estimate the financial costs of fluoridation. We devised a method to represent dental caries experience in quality-adjusted life years. RESULTS: Over 20 years, the net discounted saving from adding fluoride to reticulated water supplies supplying populations over 500 would be NZ$1401 million, a nine times pay-off. Between 8800 and 13,700 quality-adjusted life years would be gained. While fluoridating reticulated water supplies for large communities is cost-effective, it is unlikely to be so with populations smaller than 500. CONCLUSIONS: Community water fluoridation remains highly cost-effective for all but very small communities. The health benefits-while (on average) small per person-add up to a substantial reduction in the national disease burden across all ethnic and socioeconomic groups.

Half-century of Dental Public Health research: bibliometric analysis of world scientific trends.

OBJECTIVES: To describe the characteristics of Dental Public Health (DPH) scientific publications within core DPH journals over time and to compare DPH journals with DPH content from other journal types. METHODS: The Scopus database was used to identify DPH-relevant articles published from 1965 to 2014 in three core DPH journals (DPHJs) and from 2005 to 2014 in Dental Journals (DJs), Public Health (PHJs) and General Journals (GJs). To identify DPH-relevant articles, a search strategy with words about oral health and public health was applied to each group of journals. Research themes were created by grouping similar keywords to report changes in the focus of articles over time. The most productive journals, countries, institutions and authors were also estimated for each set of journals. RESULTS: In 2005-2014, 60 297 articles were identified, of which 2.7% in DPHJs, 10.4% from PHJs, 38.2% from GJs and 48.7% from DJs. DPH-relevant articles published in the core DPHJs, DJs and PHJs tended to share a strong emphasis on dental caries, healthcare/services research on children and adolescents. Over time, the focus in the DPHJs has increased towards health behaviour/promotion/education, quality of life and socioeconomic factors. In the last decade, those themes were more frequent in DPH journals than in the other groups. CONCLUSIONS: DPH research published in DPHJs had some unique features and greater focus on the themes of quality of life, socioeconomic factors and health behaviour/education/promotion than other groups of journals.

Deciduous-dentition malocclusion predicts orthodontic treatment needs later: findings from a population-based birth cohort study.

INTRODUCTION: Estimating orthodontic treatment need in the permanent dentition using information from the deciduous-dentition malocclusion may assist in defining the time for appropriate orthodontic intervention. Our objective was to investigate whether malocclusion in the deciduous teeth predicts orthodontic treatment need in the permanent dentition. METHODS: Two oral health studies nested in a birth cohort were carried out at ages 6 (n = 359) and 12 (n = 339) years. Open bite, crossbite, and canine malocclusion were assessed in the deciduous teeth. Orthodontic treatment need was determined in the permanent dentition using the dental esthetic index. Prevalence ratios were estimated using 2 dental esthetic index cutoff points: highly desirable/mandatory orthodontic treatment and only mandatory orthodontic treatment. We tested all combinations of the deciduous malocclusion and the outcomes, controlling for confounders. RESULTS: Children with only open bite and those with concurrent open bite and canine malocclusion were more likely to have either highly desirable/mandatory orthodontic treatment or only mandatory orthodontic treatment needs by age 12. The combination of crossbite and open bite in the deciduous teeth was associated with the highest risk of need for mandatory orthodontic treatment. CONCLUSIONS: Malocclusion in the deciduous teeth is a risk factor for orthodontic treatment need in the permanent dentition. Children with malocclusion at a young age should be monitored regularly, and caregivers may be able to better prepare for possible orthodontic treatment.

Is New Zealand water fluoridation justified?

Public health programmes extend beyond the clinical context and focus on measures that affect the lives of large subgroups or the population as a whole. An example of this is community water fluoridation (CWF), the altering of fluoride levels in the water supply with the aim of preventing the initiation and slowing the progression of dental caries lesions for the benefit of entire populations. Despite the unfeasibility of randomised controlled trials of CWF, a large volume of evidence is available on the topic. However, CWF remains a polarising and keenly contested issue. CWF is also an intervention where it is difficult to provide everyone affected with a choice. The Nuffield Council on Bioethics is an independent body that examines and reports on ethical questions, and they have provided a useful ethical framework for considering CWF via the 'stewardship' model. This commentary aims to discuss each of the public health aims and how they can be applied and weighed to reach a justified position about CWF.

Family history and oral health: findings from the Dunedin Study.

CONTEXT: The effects of the oral health status of one generation on that of the next within families are unclear. OBJECTIVES: To determine whether parental oral health history is a risk factor for oral disease. METHODS: Oral examination and interview data were collected during the age-32 assessments in the Dunedin Study. Parental data were also collected on this occasion. The sample was divided into two familial-risk groups for caries/tooth loss (high risk and low risk) based on parents' self-reported history of tooth loss at the age-32 assessment interview. MAIN OUTCOME MEASURES: Probands' dental caries and tooth loss status at age 32, together with lifelong dental caries trajectory (age 5-32). RESULTS: Caries/tooth loss risk analysis was conducted for 640 proband-parent groups. Reference groups were the low-familial-risk groups. After controlling for confounding factors (sex, episodic use of dental services, socio-economic status and plaque trajectory), the prevalence ratio (PR) for having lost 1+ teeth by age 32 for the high-familial-risk group was 1.41 [95% confidence interval (CI) 1.05, 1.88] and the rate ratio for DMFS at age 32 was 1.41 (95% CI 1.24, 1.60). In the high-familial-risk group, the PR of following a high caries trajectory was 2.05 (95% CI 1.37, 3.06). Associations were strongest when information was available about both parents' oral health. Nonetheless, when information was available for one parent only, associations were significant for some outcomes. CONCLUSIONS: People with poor oral health tend to have parents with poor oral health. Family/parental history of oral health is a valid representation of the intricacies of the shared genetic and environmental factors that contribute to an individual's oral health status. Associations are strongest when data from both parents can be obtained.

Challenges in comparing the methods and findings of cohort studies of oral health: the Dunedin (New Zealand) and Pelotas (Brazil) studies.

OBJECTIVE: to systematically compare methods and some findings from two prospective cohort studies of oral health. METHODS: This paper describes and compares two such population-based birth cohort studies of younger adults: the Dunedin Multidisciplinary Health and Development Study (conducted in New Zealand); and the 1982 Pelotas Birth Cohort Study (conducted in Brazil). RESULTS: The two cohorts showed socio-demographic similarities and differences, with their gender mixes being similar, but their ethnic compositions differing markedly. There were some important similarities and differences in methods. Overall dental caries experience was higher among the Dunedin cohort. Each of the studies has examined the association between childhood-adulthood changes in socio-economic status and oral health in the mid-20s. Both studies observed the greatest disease experience among those who were of low SES in both childhood and adulthood, and the least among those who were of high SES in both childhood and adulthood. In each cohort, disease experience in the upwardly mobile and downwardly mobile groups lay between those two extremes. CONCLUSIONS AND IMPLICATIONS: There are important similarities and differences in both methods and findings. While the need for a degree of methodological convergence in future is noted, the two studies are able to use each other as replicate samples for research into chronic oral conditions.

The influence of family income trajectories from birth to adulthood on adult oral health: findings from the 1982 Pelotas birth cohort.

OBJECTIVES: We assessed whether 3 models of life course socioeconomic status (critical period, accumulation of risk, and social mobility) predicted unsound teeth in adulthood among a Brazilian cohort. METHODS: Life course data were collected on the 5914 live-born infants in the 1982 Pelotas Birth Cohort study. Participants' oral health was assessed at 15 (n = 888) and 24 (n = 720) years of age. We assessed family income trajectories and number of episodes of poverty in the life course through Poisson regressions, yielding unadjusted and adjusted prevalence ratios for number of unsound teeth at age 24 years. RESULTS: The adjusted prevalence ratio for participants born into poverty was 30% higher than for those who were not. Participants who were always poor had the highest prevalence of unsound teeth; those who were downwardly or upwardly mobile also had more unsound teeth than did other participants, after adjustment for confounders. More episodes of poverty were associated with greater prevalence of unsound teeth in adulthood. CONCLUSIONS: Poverty at birth and during the life course was correlated with the number of unsound teeth at 24 years of age.

Dental visiting trajectory patterns and their antecedents.

OBJECTIVE: This study aimed to test whether socioeconomic status (SES) in childhood may affect dental visiting patterns between ages 18 and 32 years. METHODS: Using data from a complete birth cohort, childhood SES status was measured (using the New Zealand Elley-Irving index) at each study stage between birth and 15 years. Longitudinal dental visiting data were available for 833 study participants from ages 15, 18, 26, and 32, and these were analyzed by trajectory analysis. RESULTS: Three separate dental visiting trajectories were identified; these were categorized as opportunists (13.1%), decliners (55.9%), and routine attenders (30.9%). Bivariate analyses showed low SES in childhood, male sex, and dental anxiety to be associated with membership of the "opportunist" dental visiting trajectory. Multinomial logistic regression showed that low childhood SES and dental anxiety were statistically significant predictors for membership in the opportunist or decliner trajectories after accounting for potential confounding variables. CONCLUSION: Individuals who grew up experiencing low childhood SES were less likely to adopt a routine dental visiting trajectory in adulthood than those with a high childhood SES. Dental anxiety was also an important predictor of dental visiting patterns.

Oral health-related quality of life in a birth cohort of 32-year olds.

OBJECTIVES: To describe oral health-related quality of life (OHRQoL) among New Zealand adults and assess the relationship between clinical measures of oral health status and a well-established OHRQoL measure, controlling for sex, socioeconomic status (SES) and use of dental services. METHODS: A birth cohort of 924 dentate adults (participants in the Dunedin Multidisciplinary Health and Development Study) was systematically examined for dental caries, tooth loss, and periodontal attachment loss (CAL) at age 32 years. OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14). The questionnaire also collected data on each study member's occupation, self-rated oral health and reasons for seeing a dental care provider. SES was determined from each individual's occupation at age 32 years. RESULTS: The mean total OHIP-14 score was 8.0 (SD 8.1); 23.4% of the cohort reported one or more OHIP problems 'fairly often' or 'very often'. When the prevalence of impacts 'fairly/very often' was modeled using logistic regression, having untreated caries, two or more sites with CAL of 4+ mm and 1 or more teeth missing by age 32 years remained significantly associated with OHRQoL, after adjusting for sex and 'episodic' dental care. Multivariate analysis using Poisson regression determined that being in the low SES group was also associated with the mean number of impacts (extent) and the rated severity of impacts. CONCLUSIONS: OHIP-14 scores were significantly associated with clinical oral health status indicators, independently of sex and socioeconomic inequalities in oral health. The prevalence of impacts (23.4%) in the cohort was significantly greater than age- and sex-standardized estimates from Australia (18.2%) and the UK (15.9%).