Commonality of Risk Factors for Mothers' Poor Oral Health and General Health: Baseline Analysis of a Population-Based Birth Cohort Study.

Objective The association between and commonality of risk factors for poor self-rated oral health (SROH) and general health (SRGH) among new mothers has not been reported. The purpose of this paper is to assess the commonality of risk factors for poor SROH and SRGH, and self-reported obesity and dental pain, among a population-based sample of new mothers in Australia. It also investigated health conditions affecting new mothers' general health. Methods Data collected at baseline of a population-based birth cohort was used. Mothers of newborns in Adelaide were approached to participate. Mothers completed a questionnaire collecting data on socioeconomic status (SES), health behaviours, dental pain, SROH, self-reported height and weight and SRGH. Analysis was conducted sequentially from bivariate to multivariable regression to estimate prevalence rate (PR) of reporting poor/fair SROH and SRGH. Results of the 1895 new mothers, some 21 and 6% rated their SROH and SRGH as poor/fair respectively. Dental pain was associated with low income and smoking status, while being obese was associated with low SES, low education and infrequent tooth brushing. SROH and SRGH was associated with low SES, smoking, and dental pain. SROH was also associated with SRGH [PR: 3.06 (2.42-3.88)]. Conclusion for practice There was a commonality of factors associated with self-rated oral health and general health. Strong associations between OH and GH were also observed. Given the importance of maternal health for future generations, there would be long-term societal benefit from addressing common risk factors for OH and GH in integrated programs.

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.

Root caries experience among Australian adults.

BACKGROUND: Increase in life expectancy and tooth retention in contemporary Australian adults may increase population-level burden of having root caries. This study aimed to describe patterns and evaluate associations of root caries with socio-demographic, socio-economic, clinical and behavioural factors. METHODS: A secondary analysis was undertaken using data from the National Survey of Adult Oral Health 2004-2006, which included 5505 randomly general adults 15+ years old. Participants underwent an oral examination and completed an interview and a questionnaire. Prevalence and mean number of decayed/filled root (root DFS), untreated root (root DS), filled root (root FS), gingival recession, oral hygiene and gingival status were derived from examinations. Socio-demographic, socio-economic and behavioural factors were self-reported. Multivariable models were generated to estimate prevalence ratios (PR), mean ratios (MR) and confidence intervals (95% CI), adjusting for number of surfaces with gingival recession. Additional analysis for older adults 60+ years old was presented. RESULTS: The prevalence of root caries was 25.3% (CI=23.6-27.1) and 62.0% [CI=58.7-65.1] among general and older adults, respectively. Risk factors found were similar in both populations. Smokers had higher prevalence and mean number of root DFS, DS and FS than never-smokers. In contrast with poor oral hygiene, high income and frequent brushing were significantly associated with lower mean root DS. Frequent dental visiting was associated with higher root FS and DFS. CONCLUSIONS: Root caries affected about a quarter of Australian general adults and more than a half of older adults. People who were smokers presented a significantly higher prevalence and severity of root caries.

Natural history and long-term impact of dental fluorosis: a prospective cohort study.

OBJECTIVE: The study assessed longitudinal changes in the presentation of dental fluorosis and evaluated the impact of fluorosis on the perception of oral health among young adults. DESIGN AND SETTING: Prospective follow-up study during 2011-12 of a population-based study in South Australia conducted between 2003 and 2004. PARTICIPANTS: 8-13-year-old children initially examined in 2003 and 2004. MAIN OUTCOMES: Dental fluorosis was assessed with the Thylstrup and Fejerskov (TF) Index. The impact on perceptions of oral health by the study participants and their parents was assessed with the Global Rating of Oral Health (GROH). Pairwise comparative analysis of the presentation of fluorosis was conducted at the individual and tooth levels. Multivariable models of changes in fluorosis were generated. An ordinal logistic regression model was used to evaluate the association between GROH with dental fluorosis, caries and other factors. RESULT: A total of 314 participants completed the follow-up questionnaires and dental examination. Over 60% of teeth scored as TF 1 at baseline were scored as TF 0 at follow-up; 66% of teeth scored as TF 2 or 3 at baseline were scored as TF 0 or 1 at follow-up. In multivariable models, changes in fluorosis were not significantly associated with socio-economic factors or oral health behaviours, confirming that they were the result of a natural process. Perceptions of poor oral health were significantly associated with the number of untreated decayed tooth surfaces at follow-up, but not with fluorosis. CONCLUSION: Very mild and mild dental fluorosis diminished with time. Dental fluorosis did not have a negative impact on perceptions of oral health.

'Newness-struggle-success' continuum: a qualitative examination of the cultural adaptation process experienced by overseas-qualified dentists in Australia.

Objectives Overseas-qualified dentists constitute a significant proportion of the Australian dental workforce (approximately one in four). The aim of the present study was to provide a better understanding of the cultural adaptation process of overseas-qualified dentists in Australia, so as to facilitate their integration into the Australian way of life and improve their contribution to Australian healthcare, economy and society. Methods Life stories of 49 overseas-qualified dentists from 22 countries were analysed for significant themes and patterns. We focused on their settlement experience, which relates to their social and cultural experience in Australia. This analysis was consistent with a hermeneutic phenomenological approach to qualitative social scientific research. Results Many participants noted that encounters with 'the Australian accent' and 'slang' influenced their cultural experience in Australia. Most of the participants expressed 'fascination' with the people and lifestyle in Australia, primarily with regard to the relaxed way of life, cultural diversity and the freedom one usually experiences living in Australia. Few participants expressed 'shock' at not being able to find a community of similar religious faith in Australia, as they are used to in their home countries. These issues were analysed in two themes; (1) language and communication; and (2) people, religion and lifestyle. The cultural adaptation process of overseas-qualified dentists in Australia is described as a continuum or superordinate theme, which we have entitled the 'newness-struggle-success' continuum. This overarching theme supersedes and incorporates all subthemes. Conclusion Family, friends, community and organisational structures (universities and public sector) play a vital role in the cultural learning process, affecting overseas-qualified dentist's ability to progress successfully through the cultural continuum. What is known about the topic? Australia is a popular host country for overseas-qualified dentists. Migrant dentists arrive from contrasting social and cultural backgrounds, and these contrasts can be somewhat more pronounced in dentists from developing countries. To date, there is no evidence available regarding the cultural adaptation process of overseas-qualified dentists in Australia or elsewhere. What does this paper add? This study provides evidence to support the argument that the cultural adaptation process of overseas-qualified dentists in Australia can be viewed as a continuum state, where the individual learns to adapt to the people, language and lifestyle in Australia. The ongoing role of family and friends is primary to a successful transition process. Our research also identifies the positive role played by community and organisational structures, such as universities and public sector employment schemes. What are the implications for practitioners? A potential implication for policy makers is to focus on the positive roles played by organisational structures, particularly universities and the public sector. This can inform more supportive migration policy, as well as strengthen the role these organisations play in providing support for overseas-qualified dentists, thus enabling them to integrate more successfully into Australia's health care system, economy and society.

Work-Family Conflict and Oral and General Health-Related Quality of Life.

BACKGROUND: The characteristics of the work environment and relationships with family roles may impact on health and be of public health significance. PURPOSE: The aims were to investigate the cross-sectional association of work-family conflict with oral- and general health-related quality of life, and well-being. METHOD: A random sample of 45-54-year olds from Adelaide, South Australia, was surveyed by self-complete questionnaire in 2004-2005 (n = 879, response rate = 43.8%). Health-related quality of life was measured with the OHIP-14 and EQ-VAS instruments, and well-being by the Satisfaction With Life Scale. RESULTS: In adjusted analyses controlling for sex, income, education, tooth brushing frequency and social support, the higher Family Interferes with Work (FIW) tertile and the middle tertile of Work Interferes with Family (WIF) were associated with more oral health-related impacts as measured by OHIP-14 in relation to problems with teeth, mouth or dentures (Beta = 1.64, P < 0.05 and Beta = 2.85, P < 0.01). Both middle and higher tertiles of WIF were associated with lower general health (Beta = -4.20 and -5.71, P < 0.01) and well-being (Beta = -1.17 and -1.56, P < 0.01). CONCLUSION: Work-family conflict was associated with more oral health impacts and lower general health and well-being among employed middle-aged adults. This supports the view of work-family conflict as a psychosocial risk factor for health outcomes spanning function, health perceptions and well-being, and encompassing both oral health and general health.

Trends in dental service provision in Australia: 1983-1984 to 2009-2010.

OBJECTIVE: To investigate time trends in dental service provision. METHODS: A random sample of Australian dentists was surveyed by mailed questionnaires in 1983-1984, 1993-1994, 2003-2004, and 2009-2010 (response rates 67-76%). The service rate per visit was collected from a log of services. RESULTS: The rate of service provision per visit [rate ratio (RR)] increased from 1983-1984 to 2009-2010 for the service areas of diagnostic (RR=1.8; 1.6-1.9), preventive (RR=1.9; 1.6-2.1), endodontic (RR=2.1; 1.7-2.6), and crown and bridge (RR=2.9; 2.3-3.8), whereas prosthodontic services decreased (RR=0.7; 0.6-0.9). CONCLUSIONS: The profile of services provided by dentists changed over the study period to include less emphasis on replacement of teeth and more on diagnosis, prevention, and retention of natural dentitions.

Characteristics and practice profiles of migrant dentist groups in Australia: implications for dental workforce policy and planning.

INTRODUCTION: Migrants comprise a growing proportion of the dental workforce in Australia. To date, research on migrant dentists is limited, raising policy questions regarding the motivations for migration, demographic profiles and work patterns. The purpose of this paper was to present findings from the first national survey of migrant dentists in Australia. METHODS: All dentists with a primary dental qualification from an overseas institution and registered with the Australian Dental Association (n=1,872) or enrolled as a graduate student in any of the nine dental schools in Australia (n=105) were surveyed between January and May 2013. RESULTS: A total of 1,022 participants (response rate=54.5%) were classifiable into three migrant dentist groups: direct recognition (n=491); Australian Dental Council (ADC) (n=411); and alternative pathway (n=120). Overall, 41.8% of migrant dentists were female. More than half of the ADC group (54.1%) were from lower middle income countries. The most frequent motivation for migration according to the direct recognition group (21.1%) was 'adventure', whereas other groups migrated for 'better opportunity'. The majority of ADC respondents (65%) were under 45 years of age, and a larger proportion worked in the most disadvantaged areas (12.4%), compared with other groups. Gender, marital status, years since arrival in Australia and having children varied between the groups (chi square; P<0.05). CONCLUSION: Dentist groups migrate to Australia for different reasons. The large proportion of the migrant dentist workforce sourced from lower middle income countries points towards deficiencies in oral health systems both for these countries and for Australia. The feminisation of the migrant dentist profile could in future affect dentist-practice activity patterns in Australia. Further research, especially on the settlement experiences of these dentists, can provide better insights into issues faced by these dentists, the nature of support that migrant dentists receive in Australia, the probable future patterns of work and potential impact on the dental workforce and dental service provision.

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.

Common risk factor approach to address socioeconomic inequality in the oral health of preschool children--a prospective cohort study.

BACKGROUND: Dental caries remains the most prevalent chronic condition in children and a major contributor to poor general health. There is ample evidence of a skewed distribution of oral health, with a small proportion of children in the population bearing the majority of the burden of the disease. This minority group is comprised disproportionately of socioeconomically disadvantaged children. An in-depth longitudinal study is needed to better understand the determinants of child oral health, in order to support effective evidence-based policies and interventions in improving child oral health. The aim of the Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) project is to identify and evaluate the relative importance and timing of critical factors that shape the oral health of young children and then to seek to evaluate those factors in their inter-relationship with socioeconomic influences. METHODS/DESIGN: This investigation will apply an observational prospective study design to a cohort of socioeconomically-diverse South Australian newborns and their mothers, intensively following these dyads as the children grow to toddler age. Mothers of newborn children will be invited to participate in the study in the early post-partum period. At enrolment, data will be collected on parental socioeconomic status, mothers' general and dental health conditions, details of the pregnancy, infant feeding practice and parental health behaviours and practices. Data on diet and feeding practices, oral health behaviours and practices, and dental visiting patterns will be collected at 3, 6, 12 and 24 months of age. When children turn 24-30 months, the children and their mothers/primary care givers will be invited to an oral examination to record oral health status. Anthropometric assessment will also be conducted. DISCUSSION: This prospective cohort study will examine a wide range of determinants influencing child oral health and related general conditions such as overweight. It will lead to the evaluation of the inter-relationship among main influences and their relative effect on child oral health. The study findings will provide high level evidence of pathways through which socio-environmental factors impact child oral health. It will also provide an opportunity to examine the relationship between oral health and childhood overweight.

Age, period and cohort analysis of patient dental visits in Australia.

BACKGROUND: Understanding dentists' capacity to supply dental services over time is a key element in the process of planning for the future. The aim was to identify time trends and estimate age, period and cohort effects in patients' visits supplied per dentist per year. METHODS: Mailed questionnaires were collected from a random sample of Australian private general practice dentists. The response rates were 73%, 75%, 74%, 71%, 76% and 67% in 1983, 1988, 1993, 1998, 2003 and 2009, respectively. The time trends in the mean number of patient visits supplied per dentist per year (PPY) was described by using a standard cohort table and age-period-cohort analyses applying a nested general linear regression models approach. RESULTS: The mean number of PPY decreased across most age groups of dentists over the time of study. The age-period model showed that younger dentists (20-29 years) and older dentists (65-74 and 80-84 years) had lower PPY than middle-aged dentists, and the age-cohort model showed higher PPY among earlier cohorts, and lower PPY among more recent cohorts. CONCLUSION: The study found a period effect of declining PPY over the observation period. More recent cohorts of dentists provide lower numbers of PPY than earlier cohorts at similar ages, but the provision of PPY among these younger cohorts appeared to be stable as they moved into middle age.

Overseas-qualified dentists' experiences and perceptions of the Australian Dental Council assessment and examination process: the importance of support structures.

OBJECTIVE: The Australian Dental Council is responsible for the assessment of overseas-qualified dentists seeking to practice dentistry in Australia. The aim of this paper is to reflect on the Council's assessment and examination process through the experiences and perceptions of overseas-qualified dentists in Australia. METHODS: Qualitative methods were used. Life stories of 49 overseas-qualified dentists from 22 nationalities were analysed to discern significant themes and patterns. We focused on their overall as well as specific experiences of various stages of the examination. The analysis was consistent with a hermeneutic phenomenological approach to social scientific research. RESULTS: Most participants referred to 'cost' of the examination process in terms of lost income, expenses and time. The examination itself was perceived as a tough assessment process. Some participants seemed to recognise the need for a strenuous assessment due to differences in patient management systems in Australia compared with their own country. Significantly, most of the participants stressed the importance of support structures for overseas-qualified dentists involved in or planning to undertake the examination. These considerations about the examination experience were brought together in two themes: (1) 'a tough stressful examination'; and (2) 'need for support.' CONCLUSION: This paper highlights the importance of support structures for overseas-qualified dentists. Appropriate support (improved information on the examination process, direction for preparation and training, further counselling advice) by recognised bodies may prevent potential exploitation of overseas-qualified dentists. Avenues that have been successful in providing necessary support, such as public sector schemes, offer policy options for limited recruitment of overseas-qualified dentists in Areas of Need locations. Such policies should also be in line with the local concerns and do not reduce opportunities for Australian-qualified dentists.

Water fluoridation and the association of sugar-sweetened beverage consumption and dental caries in Australian children.

OBJECTIVES: We examined demographic and socioeconomic differences in the consumption of sugar-sweetened beverages (SSBs), its association with dental caries in children, and whether exposure to water fluoridation modifies this association. METHODS: In a cross-sectional study, we used a stratified, clustered sampling design to obtain information on 16 508 children aged 5 to 16 years enrolled in Australian school dental services in 2002 to 2005. Dental staff assessed dental caries, and parents completed a questionnaire about their child's residential history, sources of drinking water, toothbrushing frequency, socioeconomic status (SES), and SSB consumption. RESULTS: Children who brushed their teeth less often and were older, male, of low SES, from rural or remote areas consumed significantly more SSBs. Caries was significantly associated with greater SSB consumption after controlling for potential confounders. Finally, greater exposure to fluoridated water significantly reduced the association between children's SSB consumption and dental caries. CONCLUSIONS: Consumption of SSBs should be considered a major risk factor for dental caries. However, increased exposure to fluoridated public water helped ameliorate the association between SSB consumption and dental decay. These results reconfirm the benefits of community water fluoridation for oral health.

Socioecological determinants of child oral health-A scoping review.

OBJECTIVES: Child oral health is a result of interactions between multilevel influences within a complex system. Understanding those interactions informs conceptualizing a socioecological framework of important influences on oral health. This paper aimed to present a scoping review on the determinants of dental caries and their interactions in childhood and adolescence. METHODS: The two review questions were as follows: Which factors are determinants of child dental caries? and, How do determinants interact within and across socioecological levels? The three main electronic databases for biomedical records, PubMed, Web of Science and Scopus were searched, followed by reference check. The search and screening/selection procedures followed an a priori strategy and inclusion/exclusion criteria were specified in advance. The main components of the strategy were participants, concept and context. Following the final selection, eligible studies were assessed with quality appraisal tools for the risk of methodologic biases. Determinants reported in the included studies were then assigned to the micro-, meso-, exo- or macro-systems levels in a socioecological framework. Interactions between determinants were also identified and reported. RESULTS: A total of 100 studies were included after removal of duplicates, screening on the title/abstracts and full-text assessment among 3313 records initially identified. A higher number of studies included were cross-sectional studies published in recent years. The majority of determinants found to influence child dental health were assigned to microsystem level within the framework. However, determinants were found at all levels and interactions were reported within and between socioecological levels. Determinants identified in the scoping review represent factors at different socioecological levels that influence child oral health. CONCLUSION: Application of a socioecological model through a complex systems approach should lead to valid and robust progress towards practical solutions for better child oral health globally.

Sociobehavioral aspects of periodontal disease.

As one of the most common chronic diseases suffered by adults, periodontitis affects sufferers' day-to-day lives and is a threat to the integrity of the dentition. An important part in the condition's occurrence is played by sociobehavioural factors, the understanding of which is facilitated by using a number of largely complementary theoretical frameworks. Differences among individuals with respect to their periodontal status at any particular point in their life-course (and particularly once they are into early middle-age and beyond) are likely to have resulted from prolonged and differential exposure to the various protective and risk factors that determine their periodontal status. Thus, a sound understanding of the psychosocial pathways of the behaviors that are strongly linked to periodontal disease - and how such psychological factors affect the response of the periodontal tissues to pathogens - is essential for improving periodontal health, whether at the personal level or at the population level. Controlling periodontitis in populations therefore requires a number of complementary strategies. The current state of knowledge of its risk factors means that there is sufficient information to enable control of the disease, and public health officials should include it alongside their efforts to control dental caries. Controlling periodontitis has three strategies: (i) a population strategy for altering life practices, particularly those determining smoking behavior and oral self-care (plaque removal) in the community; (ii) a secondary prevention strategy to detect and treat people with destructive periodontal disease; and (iii) a high-risk strategy for treating existing disease and preventing further disease in those at special risk. The Common Risk Factor Approach and the health promotion approach are key aspects of these strategies.

Association between infant formula feeding and dental fluorosis and caries in Australian children.

OBJECTIVE: The objective of this study was to evaluate associations between patterns of infant formula feeding and dental fluorosis and caries in a representative sample of Australian children. METHODS: A population-based study gathered information on fluoride exposure in early childhood. Information on infant formula feeding and fluoridation status was used to group children: three groups in nonfluoridated areas (formula nonuser, user for ≤6 months, and user for 6+ months) and four groups in fluoridated areas (nonuser, user with nonfluoridated water, user with fluoridated water for ≤6 months, and user with fluoridated water for 6+ months). Children aged 8-13 years were examined for fluorosis using the Thylstrup and Fejerskov (TF) Index. Primary tooth caries experience recorded at age 8-9 years was extracted from clinical records. Fluorosis cases were defined as having TF 1+ on maxillary incisors. Fluorosis prevalence and primary caries experience were compared across formula user groups in multivariable regression models adjusting for other factors. RESULTS: Total sample was 588 children. Children in fluoridated areas had higher prevalence of very mild to mild fluorosis, but lower caries experience than those in nonfluoridated areas. Among children in nonfluoridated areas, formula users for 6+ months had significantly higher prevalence of fluorosis compared with nonusers. There was no significant difference in fluorosis prevalence among the formula users in fluoridated areas. Among children in fluoridated areas, formula users with nontap water had higher caries experience. CONCLUSION: Infant formula use was associated with higher prevalence of fluorosis in nonfluoridated areas but not in fluoridated areas. Type of water used for reconstituting infant formula in fluoridated areas was associated with caries experience.

Group-based trajectories of maternal intake of sugar-sweetened beverage and offspring oral health from a prospective birth cohort study.

OBJECTIVES: To investigate the trajectory of maternal intake of sugar-sweetened beverages (SSB) during the first five years of their child's life and its effect on the child's dental caries at five years-of-age. METHODS: This is an ongoing prospective population-based birth cohort study in Adelaide, Australia. Mothers completed questionnaires on their SSB intake, socioeconomic factors and health behaviors at the birth of their child and at the ages of one, two and five years. Child dental caries measured as decayed, missing, or filled tooth surfaces was collected by oral examination. Maternal SSB intake was used to estimate the trajectory of SSB intake. The trajectories then became the main exposure of the study. Dental caries at age five years were the primary outcomes. Adjusted mean- and prevalence-ratios were estimated for dental caries, controlling for confounders. RESULTS: 879 children had dental examinations at five years-of-age. Group-based trajectory modeling identified three trajectories of maternal SSB intake: 'Stable low' (40.8%), 'Moderate but increasing' (13.6%), and 'High early' trajectory (45.6%). Multivariable regression analysis found children of mothers in the 'High early' and 'Moderate but increasing' groups to have greater experience of dental caries (MR: 1.37 (95%CI 1.01-1.67), and 1.24 (95%CI 0.96-1.60) than those in the 'Stable low' trajectory, respectively. CONCLUSION: Maternal consumption of SSB during pregnancy and in the early postnatal period influenced their offspring's oral health. It is important to create a low-sugar environment from early childhood. The results suggest that health promotion activities need to be delivered to expecting women or soon after childbirth.

Responsibility loadings for dental services by general dentists.

BACKGROUND: Responsibility loadings determine relative value units of dental services that translate services into a common scale of work effort. The aims of this paper were to elicit responsibility loadings for a subset of dental services and to relate responsibility loadings to ratings of importance of the components of responsibility. METHODS: Responsibility loadings and ratings of components of responsibility were collected using mailed questionnaires from a random sample of Australian private general practice dentists in 2007 (response rate = 77%). RESULTS: Median responsibility loadings were 1.25 for an initial oral examination and for a 3+-surface amalgam restoration, 1.50 for a simple extraction and for root canal obturation (single canal), and 1.75 for subgingival curettage (per quadrant). Across the five services coefficients from a multivariate logit model showed that ratings of importance of knowledge (0.34), dexterity (0.24), physical effort (0.28) and mental effort (0.48) were associated with responsibility loadings (P < 0.05). CONCLUSIONS: The elicited median responsibility loadings showed agreement with previous estimates indicating convergent validity. Components of responsibility were associated with loadings indicating that components can explain and predict responsibility aspects of dental service provision.

Dental fluorosis in the Australian adult population.

BACKGROUND: The use of fluoride involves a balance between protection against caries and risk of dental fluorosis. Prevalence and trend of dental fluorosis in the adult population are not frequently reported. OBJECTIVE: To describe the prevalence of dental fluorosis in the Australian adult population. METHOD: Data from the National Study of Adult Oral Health (NSAOH) 2004-06 and 2017-18 were used. Prevalence of fluorosis was reported using data from the NSAOH 2017-18. Case definitions of fluorosis were as follows: having a TF score of 2+ (TF2+) or a TF score of 3+ (TF3+) on one or more maxillary central incisors. Synthetic cohorts were constructed by year of birth allowing for time trend analysis. RESULTS: One in ten Australian adults were found to have dental fluorosis at TF2+. The prevalence of TF3 + was low. Time trend analysis revealed an increase in the prevalence and severity of fluorosis among those born during 1970s to 1980s decade. Such prevalence declined among those who were born after measures were introduced in early 1990s to reduce exposure to discretionary fluorides. CONCLUSION: The prevalence of dental fluorosis in the Australian adult population was found to be related to population-level changes in fluoride exposure.