Applying Social Practice Theory to Explore Australian Preschool Children's Oral Health.

INTRODUCTION: Despite substantial research and provision of dental care, significant morbidity remains for children's oral health. Guided by social practice theory (SPT), this research moves away from the often-ineffective focus on changing individual behavior to rethinking the centrality of the social world in promoting or undermining oral health outcomes. We define social practice as a routinized relational activity linking and integrating certain elements (competence, materials, and meanings) into the performance of a practice that is reproduced across time and space. OBJECTIVE: To investigate oral health in preschool children in Perth, Western Australia, using social practice theory. METHODS: With no definitive methodology for investigating SPT, we chose focused ethnography as a problem-focused, context-specific approach using mainly interviews to investigate participants' experience caring for their children's oral health. The focus of analysis was the practice of oral health care, not individual behavior, where themes identified from participants' transcripts were organized into categories of elements and performance. RESULTS: Eleven parents, all of whom were married or partnered, were interviewed in 2021. Findings identified social practices relevant to oral health within parenting and family relations linked to routine daily activities, including shopping, consumption of food and beverages, and toothbrushing. Oral health literacy was reflected in integrating competence, materials, and meanings into performing oral health care, notably preferences for children to drink water over sugary beverages and information often being sourced from social media and mothers' groups rather than health providers. CONCLUSION: Focusing on social practices as the unit of analysis offers a more layered understanding of elements in young children's oral health care that can indicate where the problem may lie. Findings provide an opportunity to consider future research and policy directions in children's oral health. KNOWLEDGE TRANSFER STATEMENT: Examining social practices related to young children's oral health care identifies parents/carers' knowledge about, for example, toothbrushing, the resources required, and why toothbrushing is important. Analyzing these separate elements can reveal both enablers and barriers to oral health care. This provides researchers, clinicians and policymakers an opportunity to focus on not changing individual behavior but understanding how social context impacts parents/carers' capacity to make optimum decisions around young children's oral health.

Cost-effectiveness analysis of silver diamine fluoride to divert dental general anaesthesia compared to standard care.

BACKGROUND: The aim is to perform a model-based cost-effectiveness analysis of a silver diamine fluoride (SDF) protocol intervention to divert dental general anaesthesia (DGA) among Victorian children aged 2-10 years. METHODS: Data inputs were based on an Australian single-cohort 2017/18 study. Intervention costs for standard care were derived from two subgroups of children: (1) children who received standard care without DGA, and (2) children who received standard care with DGA. Two scenarios were modelled due to limited post-follow-up data: (1) children receiving SDF had standard care without DGA (base-case scenario), and (2) children receiving SDF did not receive standard care without DGA (alternative scenario). A simple decision-tree model with probabilistic sensitivity analysis (PSA) estimated the incremental costs per diverted DGA. RESULTS: The probability of children requiring specialist referral and offered SDF, but the primary carer opted for DGA is 0.124 (SD 0.034), and the probability of children requiring DGA in standard care is 0.346 (SD 0.036). For both the base-case and alternative scenario, the incremental cost-effectiveness ratio outcome is dominant and their cost-effectiveness being either 74.8% or 100% respectively. CONCLUSIONS: The SDF protocol intervention is cost-effective dental caries management option for young children where referral for DGA is considered. © 2022 Australian Dental Association.

Choosing foods for infants: a qualitative study of the factors that influence mothers.

BACKGROUND: Examining the experiences of parents making food choices for infants is important because ultimately this influences what infants eat. Infancy is a critical period when food preferences and eating behaviour begin to develop, shaping dietary patterns, growth and health outcomes. There is limited evidence regarding what or why foods are chosen for infants. OBJECTIVE: To describe the experiences of mothers making food choices for their infant children. METHODS: Semi-structured interviews with 32 Australian mothers of infants aged four to 15 months from a range of socioeconomic backgrounds. An inductive thematic analysis through a process of constant comparison was conducted on transcribed interviews. RESULTS: Mothers described many ideas and circumstances which influenced food choices they made for infants. Themes were developed which encapsulate how the wider environment and individual circumstances combine to result in the food choices made for infants. Beliefs, values, norms and knowledge were a central influence on choices. Cost, quality and availabilities of various foods were also key factors. Related to this, and combined with inherent factors such as perishability and infant acceptability, fresh fruits and vegetables were often singled out as an easy or difficult choice. Influences of time, parents' capacities, social connections and different information sources were clearly apparent. Finally infants' own preferences and how parents helped infants with learning to eat were also key influences on food choices. CONCLUSIONS: Choosing foods for infants is a complex social practice. An ecological framework depicting the multiple influences on what people eat and sociological theory on food choice regarding the role of 'social structure' and 'human agency' are both applicable to the process of choosing foods for infants. Equity issues may be key regarding the degree to which mothers can choose particular foods for infants (e.g. choosing foods which promote health).

Systematic Review and Quality Appraisal of Economic Evaluation Publications in Dentistry.

Economic evaluation (EE) studies have been undertaken in dentistry since the late 20th century because economic data provide additional information to policy makers to develop guidelines and set future direction for oral health services. The objectives of this study were to assess the methodological quality of EEs in oral health. Electronic searching of Ovid MEDLINE, the Cochrane Library, and the NHS Economic Evaluation Database from 1975 to 2013 were undertaken to identify publications that include costs and outcomes in dentistry. Relevant reference lists were also searched for additional studies. Studies were retrieved and reviewed independently for inclusion by 3 authors. Furthermore, to appraise the EE methods, 1 author applied the Drummond 10-item (13-criteria) checklist tool to each study. Of the 114 publications identified, 79 studies were considered full EE and 35 partial. Twenty-eight studies (30%) were published between the years 2011 and 2013. Sixty-four (53%) studies focused on dental caries prevention or treatment. Median appraisal scores calculated for full and partial EE studies were 11 and 9 out of 13, respectively. Quality assessment scores showed that the quality of partial EE studies published after 2000 significantly improved (P = 0.02) compared to those published before 2000. Significant quality improvement was not found in full EE studies. Common methodological limitations were identified: absence of sensitivity analysis, discounting, and insufficient information on how costs and outcomes were measured and valued. EE studies in dentistry increased over the last 40 y in both quantity and quality, but a number of publications failed to satisfy some components of standard EE research methods, such as sensitivity analysis and discounting.

Practical considerations for conducting dental clinical trials in primary care.

There is increasing importance placed on conducting clinical trials in dentistry to provide a robust evidence base for the treatment provided, and models of care delivered. However, providing the evidence upon which to base such decisions is not straightforward, as the conduct of these trials is complex. Currently, only limited information is available about the strategies to deliver successful clinical trials in primary care settings, and even less available on dental clinical trials. Considerable knowledge and experience is lost once a trial is completed as details about effective management of a trial are generally not reported or disseminated to trial managers and researchers. This leads to loss of vital knowledge that could assist with the effective delivery of new trials. The aim of this study is to examine the conduct and delivery of five dental clinical trials across both Australia and the UK and identify the various factors that impacted upon their implementation. Findings suggest that early stakeholder engagement, and well-designed and managed trials, lead to improved outcomes for researchers, clinic staff and patients, and increases the potential for future dissemination and translation of information into practice.

Exploring child dental service use among migrant families in metropolitan Melbourne, Australia.

BACKGROUND: This study describes and explores factors related to dental service use among migrant children. METHODS: A cross-sectional analysis of baseline data from Teeth Tales, an exploratory trial implementing a community based child oral health promotion intervention. The sample size and target population was 600 families with 1-4 year old children from Iraqi, Lebanese and Pakistani backgrounds residing in metropolitan Melbourne. Participants were recruited into the study using purposive and snowball sampling techniques. RESULTS: Most (88%; 550/625) children had never visited the dentist (mean (SD) age 3.06 years (1.11)). In the fully adjusted model the variable most significantly associated with child dental visiting was parent reported 'no reason for child to visit the dentist' (OR = 0.07, p < 0.001). Of those children whose parents reported their child had no reason to visit the dentist, 22% (37/165) experienced dental caries with 8% (13/165) at the level of cavitation. CONCLUSIONS: Dental service use by migrant preschool children was very low. The relationship between perceived dental need and dental service use is currently not aligned. One in 10 children of select migrant background had visited a dentist, which is in the context of 1 in 3 with dental caries. To improve utilization, health services should consider organizational cultural competence, outreach and increased engagement with the migrant community.

Self-reported and clinically determined oral health status predictors for quality of life in dentate older migrant adults.

OBJECTIVE: This paper reports the impact of oral health on the quality of life (QOL) of Southern European, dentate older adults, living independently in Melbourne, Australia. Participants were recruited through ethnic social clubs and interviewed about oral health, general health, socio-demographics, and QOL using the Medical Outcomes Study Short-Form 12 (SF-12). The SF-12's physical and mental health component summary scores (PCS and MCS, respectively) were computed. The Oral Health Impact Profile (OHIP-14) assessed the specific impact of oral health on QOL. Participants were also given a clinical oral examination. RESULTS: A total of 603 eligible older adults volunteered; 308 were from Greek background and 295 were from Italian background. Mean age was 67.7 years (SD 6.2), with 63.7% being female. The PCS score had a mean value of 45.8 (SD 11.8), and MCS had a mean of 47.8 (SD 5.7). PCS was associated with, periodontal status, chronic health condition, self-perceived oral health needs, self-assessed oral health status, oral health impact score and the interaction between gender and level of education [F(11 552) = 10.57; P < 0.0001]. These independent variables accounted for 16% of the variance in PCS. The multivariate model predicting MCS had only one significant variable (self-reported gingival bleeding), explaining 1.5% of the variance. The OHIP-14 ranged from 0 to 48 with a mean score of 5.6 (SD 9.3). The model predicting OHIP-14 contained four significant variables: perceived oral health treatment needs, number of missing natural teeth, reports of having to sip liquid to help swallow food, and gender [F(4576) = 33.39; P < 0.0001], and explained 18% of the variance. The results demonstrated a negative association between oral health indicators and both the oral health-related QOL and the physical component of the SF-12. CONCLUSION: The present findings support a growing recognition of the importance of oral health as a mediator of QOL. However, the self-selected sample and modest predictive power of the multivariate models suggest that further research is needed to expand this explanatory model.

Profile of the oral health among ambulant older Greek and Italian migrants living in Melbourne.

BACKGROUND: Over the last 50 years an increasing number of migrants have settled in Australia. These immigrants now constitute a large proportion of the Australian population, and some research suggests that they may be at high-risk for oral diseases. METHODS: This paper presents data on the oral health status of a convenience sample of 721 ambulant Greek- (n = 367) and Italian-born (n = 354) adults aged 55 years or older. The volunteer participants were recruited through ethnic social clubs located in Melbourne, Australia. RESULTS: The sample was largely a dentate one (83.6 per cent); with a mean DMFS score of 67.5 (s.d. 37.4). Dentate participants had 13 per cent of their restorative care unmet, and 57.3 per cent needed oral hygiene instruction plus removal of stain and hard deposits on their teeth. Almost 8 per cent required complex periodontal therapy and 30 per cent of those fully edentulous were in need of full dentures. CONCLUSIONS: Comparing these findings with existing data on oral health of older adults in Australia, the participants in this study appear to have lower DMFS scores and a higher prevalence of gingivitis, but less need for complex periodontal treatment. Inequalities were apparent in the proportion of unmet restorative and prosthetics needs.

Holes a plenty: oral health status a major issue for newly arrived refugees in Australia.

BACKGROUND: Dental health needs of newly arrived refugees are much greater than for the wider Australian community. This paper identifies the disparities and highlights major dental health issues for Australia's growing and constantly changing refugee population. METHODS: Using available data and the decayed, missing and filled teeth (DMFT) index as a measure of oral health, the reported oral health status of refugee groups in Australia was compared with that of the general population, Indigenous Australians, recipients of public dental services, special needs groups in Australia and other refugee groups outside Australia. RESULTS: The reported oral health status of Australian refugees compared poorly with the comparison groups. Of particular concern was the number of reported untreated decayed teeth (D). This ranged from a mean of 2.0 to 5.2 compared with 0.6 to 1.4 for the general Australian population. Refugee groups also reported fewer filled teeth (1.0 to 5.8) compared with the general population (4.1 to 9.3). Similar results were found when reported D, M and F teeth for refugees were compared to Indigenous Australians, public dental service recipients, immigrants and special needs groups in Australia. CONCLUSIONS: Dental health of refugees, particularly untreated decay, compared poorly to that of Indigenous Australians, and special needs populations in Australia who all have known worse dental health than the general population. There is an urgent need for the inclusion of this at risk population among targeted dental services. In addition, sources of health related data must clearly identify refugees to enable appropriate comparisons with other population groups. Recommendations for refugees are made regarding on-arrival dental assessment and treatment, and community based oral health programmes.

A study of the dental treatment needs of children with disabilities in Melbourne, Australia.

A selected population of children with disabilities in Melbourne, Australia, was studied with reference to their oral disease and treatment needs. A total of 300 children (aged 9-13 years), 150 attending special developmental schools (SDS) and 150 attending special schools (SS), received an oral examination and the parent/guardian completed a questionnaire. Six levels of function were defined, based on the child's independence for five self-care activities (brushing teeth, feeding self, dressing self, walking and performing toilet). The caries experience of children in the SS was lower than in SDS (d + D: 1.3 +/- 1.6 versus 1.5 +/- 2.4; dmft + DMFT: 2.0 +/- 2.3 versus 2.5 +/- 3.1); those attending SDS had higher unmet preventive and restorative needs. Significant associations were seen between the number of decayed teeth, the dmft + DMFT index, and the level of function (p < 0.005). Periodontal disease was prevalent; significant associations were seen between periodontal status, the need for periodontal therapy, and the level of function (p < 0.005). Assessment of the level of function by staff could assist in triaging individuals for urgent dental examination. Despite 41 per cent of children requiring simple treatment, the preventive and treatment needs of many remained unmet. Following examination, diagnosis and treatment planning by a dentist, much of the preventive, simple treatment and oral health promotion could be performed by trained dental auxiliaries. An epidemiological survey followed by the implementation and evaluation of a long-range public dental health care plan for children and adolescents with disabilities is needed urgently.