Salivary characteristics and dental caries experience in remote Indigenous children in Australia: a cross-sectional study.

BACKGROUND: While associations between salivary characteristics and dental caries have been well studied, we are not aware of this being assessed in a remote Indigenous child population, where lifestyles may be different from urban children. Our aim was to assess associations between caries experience and putative biomarkers in saliva, accounting for oral hygiene and dietary habits. METHODS: Children attending schools in an Indigenous community in remote north Queensland, Australia were invited to an oral examination by qualified and calibrated examiners. Salivary flow rate, pH, buffering capacity and loads of mutans streptococci (MS), lactobacilli (LB) and yeasts were determined. Also, data on tooth brushing frequency and soft drinks consumption were obtained via a questionnaire. Caries experience was recorded by the International Caries Detection and Assessment System (ICDAS-II), and quantified as decayed, missing and filled surfaces. Relationships between the salivary variables and the cumulative caries experience (dmfs+DMFS) in the deciduous and permanent dentitions were examined by multivariate analyses to control the effect of confounders. RESULTS: The mean cumulative decayed (DS + ds), missing (MS + ms) and filled (FS + fs) surfaces were 3.64 (SD: 4.97), 1.08 (4.38) and 0.79 (1.84) respectively. Higher salivary MS and LB counts, low tooth brushing frequency and daily soft drink consumption were significantly related to greater caries experience. Caries experience was about twice in those with ≥10^5 CFU/ml saliva counts of MS (mean = 6.33, SD: 8.40 vs 3.11, 5.77) and LB (7.03, 7.49 vs 4.41, 8.00). In the fully-adjusted multivariate model, caries experience in those with higher counts of MS and LB were 51 and 52% more than those with lower counts. CONCLUSIONS: As with studies in other populations, childhood salivary counts of MS and LB were significantly associated with greater caries experience in this remote Indigenous community. To address the serious burden of oral disease, we are researching ways to promote a healthy oral environment by encouraging good dietary habits, and emphasising the importance of daily tooth brushing with a fluoridated toothpaste. Our ongoing longitudinal studies will indicate the success of measures employed to reduce the counts of bacteria closely associated with cariogenesis and their impact on caries increment. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ( ANZCTR ), No: ACTRN12615000693527; date of registration: 3rd July 2015.

The role of parental rearing practices and family demographics on oral health-related quality of life in children.

OBJECTIVES: To evaluate the direct and indirect (via oral health-related behaviour) effects of parental rearing practices on children's Oral Health-Related Quality of Life (OHRQoL) within a family-focused, comprehensive predictive model. METHODS: Participants were 11- to 14-year-old children and their parents living in Telangana State, India (N = 1130). Children were clinically assessed for dental caries, gingivitis, oral hygiene status, fluorosis, and malocclusion, and completed a self-administered questionnaire on oral health-related behaviour and OHRQoL. Parents answered questions related to their socioeconomic status (SES), family circumstances, parent's perceptions of child's OHRQoL, and child rearing practices. Structural equation modelling was used to evaluate the pathways through which parenting practices were associated with children's OHRQoL. RESULTS: Parents with higher positive (ß = -0.106) and lower power assertion rearing practices (ß = 0.103) had children with better OHRQoL. Parental rearing practices did not have any effect on children's oral hygiene behaviour. Children who had malocclusion (ß = 0.076) and fluorosis (ß = 0.38) had lower OHRQoL. Family SES had a significant effect on children's oral hygiene behaviour and oral hygiene status with children of higher SES demonstrating better oral hygiene behaviour and status. Children living in single-parent families reported poorer oral hygiene behaviour (ß = -0.048) than those living in other types of families. CONCLUSIONS: Parental rearing practices had direct effects on OHRQoL. However, the hypothesised indirect effects of these practices on OHRQoL via poor oral health behaviour were not supported.

Endodontic treatment-related antibiotic prescribing patterns of South African oral health professionals.

AIM: To assess the antibiotic prescribing patterns of South African dentists for patients undergoing endodontic treatment. METHODOLOGY: This study used data from 2013 health insurance claims submitted by South African oral health professionals to determine the antibiotic prescribing patterns related to endodontic treatment. A logistic regression model was used to test the fully adjusted statistical significance of the association between the exploratory variables (gender, age group, event type, abscess treatment, chronic health) and the dependent variable (antibiotic prescription). Odds ratios with 95% confidence intervals (CI) are reported, and a 95% CI excluding 1 was considered statistically significant. RESULTS: Almost 10% of endodontic treatments were prescribed an antibiotic. There were no significant differences in prescribing patterns by gender, age and chronic health status. Prescriptions were more common at the preparatory stage (9.4%) of root canal treatment compared to the therapy (4.7%) and canal filling (2%) stages. Patients who received apical surgery (OR = 2.28; 95% CI 1.38-3.76) and treatment of an abscess (OR = 2.57; 95% 1.82-3.63) had a significantly increased odds of being prescribed an antibiotic. Almost three-quarters of prescriptions were for narrow spectrum antibiotics. CONCLUSION: The frequency of antibiotic prescribing by South African dental practitioners for patients undergoing endodontic treatment is relatively low and predominantly involved narrow spectrum antibiotics. It, however, remains important that antibiotics are only prescribed when clinically essential, such as when there are obvious systemic effects. These include fever above 37 degrees, malaise, lymphadenopathy, trismus, increase swelling, cellulitis, osteomyelitis and persistent infection. The wider dissemination and adherence to clear evidence-based prescribing guidelines for antibiotics in this clinical area are important.

Trends and ethnic disparities in oral and oro-pharyngeal cancers in South Africa, 1992-2001.

OBJECTIVE: To describe trends in the epidemiology of oral and of oro-pharyngeal (OAP) cancers in South Africa for the atest period available. METHODS: Data were obtained from the South African pathology-based National Cancer Registry. All new cases of OAP cancers diagnosed and confirmed histologically from 1992 to 2001 are included for the ICD-10 sites C00 to C14, excluding those involving the major salivary glands (C07-C08) and the nasopharynx (C11). OAP cancer incidence is reported by demographics (gender, age, race/ethnicity) and the anatomical sites involved. The analysis on anatomical sites was restricted to squamous cell carcinomas. RESULTS: Overall, males had a much higher OAP cancer incidence rate (world age-Standardised incidence rate [ASIR] = 7.01/100 000 per year) than females (ASIR = 1.99). However, among Asian/Indian South Africans, OAP cancer incidence was higher among females (ASIR = 4.60) than among males (ASIR = 3.80). OAP cancer, excluding those involving the lip, was highest among Coloureds (ASIR = 5.72) and lowest among Blacks (ASIR = 3.16). OAP cancer incidence was stable overall, but incidence rates increased significantly among Coloured South Africans over the period under review (p < 0.05). Cancer specifically involving the oro-pharyngeal was most common among Coloureds and showed an increasing trend during the period under review. CONCLUSIONS: Variations in the incidence of OAP cancers by gender, race/ethnicity and anatomic site indicate a need for culturally-targeted reductions in major risk factors, including promoting tobacco cessation and prevention of risky alcohol use. The implications of the role of the human papillomavirus (HPV) in the prevention of squamous cell carcinomas involving the oro-pharyngeal in South Africa require further investigation.

Gender diversity of the oral health leadership in Australia.

BACKGROUND: Gender diversity in oral health leadership is important. Globally, this is dominated by men and does not equitably represent the increasing women in the workforce. METHODS: Publicly available and gathered data on leadership positions for Australian professional associations, accrediting body, specialist academies, training institutions and the public dental sector were analysed for gender (men and women) diversity. RESULTS: The gender diversity of the leadership varies across the oral health organizations and training institutions. Of the 383 identified leadership positions, 229 (60%) are held by men. Of the eight national dentist association presidents, six (75%) are men. Of the 65 leadership positions across 13 training institutions, 39 (59%) are held by men, and all schools training dentists are led by men. Men also dominate leadership roles in the specialist academies (62%), the research organizations (56%) and public dental sector (67%). Women do have the majority of senior leadership roles in the accrediting body (67%). CONCLUSION: Gender diversity of the oral health leadership shows some positive findings, but there is still an effort required to increase women leaders across many areas of this leadership. This should urgently be recognized as a problem, with the implementation of strategies to address this important issue. © 2023 Australian Dental Association.

Positive impacts of oral health services provision by a student-led primary care clinic to an Australian rural indigenous community.

BACKGROUND: This study aimed to determine whether oral health services provision by a dental student clinical outplacement embedded within a Community Controlled Health Service positively impacted a rural Indigenous community and to explore the nature of these benefits. METHODS: Aggregated and de-identified 2017, 2018 and 2019 student-led clinic services provision data were retrospectively analysed. The change in services mix over time was measured. Rural outplacement clinic operational costs to the university were estimated. Government-funded local public dental clinic waiting list and services provision data were used to identify any student clinic establishment effect. RESULTS: The student-led clinic services mix shifted over time from mainly acute care for toothache towards prevention of disease and tooth restoration, indicating an improvement in patient oral health and correspondingly reduced system costs. Imputed value of 2017-2019 student-led clinic services provision totalled almost AUD$1 million. Government public clinic waiting list times decreased after full establishment of the student-led clinic, indicating decreased pressure on the public system. CONCLUSION: The Community Controlled Health Service and university partnership improved community oral health care access, its timely delivery and simultaneously provided valuable human capital development from the student training experience. The student-led clinic's targeted Indigenous community showed oral health improvement over time. © 2023 Australian Dental Association.

Workforce Planning Models for Oral Health Care: A Scoping Review.

BACKGROUND: For health care services to address the health care needs of populations and respond to changes in needs over time, workforces must be planned. This requires quantitative models to estimate future workforce requirements that take account of population size, oral health needs, evidence-based approaches to addressing needs, and methods of service provision that maximize productivity. The aim of this scoping review was to assess whether and how these 4 elements contribute to existing models of oral health workforce planning. METHODS: A scoping review was conducted. MEDLINE, Embase, HMIC, and EconLit were searched, all via OVID. Additionally, gray literature databases were searched and key bodies and policy makers contacted. Workforce planning models were included if they projected workforce numbers and were specific to oral health. No limits were placed on country. A single reviewer completed initial screening of abstracts; 2 independent reviewers completed secondary screening and data extraction. A narrative synthesis was conducted. RESULTS: A total of 4,009 records were screened, resulting in 42 included articles detailing 47 models. The workforce planning models varied significantly in their use of data on oral health needs, evidence-based services, and provider productivity, with most models relying on observed levels of service utilization and demand. CONCLUSIONS: This review has identified quantitative workforce planning models that aim to estimate future workforce requirements. Approaches to planning the oral health workforce are not always based on deriving workforce requirements from population oral health needs. In many cases, requirements are not linked to population needs, while in models where needs are included, they are constrained by the existence and availability of the required data. It is critical that information systems be developed to effectively capture data necessary to plan future oral health care workforces in ways that relate directly to the needs of the populations being served. KNOWLEDGE TRANSFER STATEMENT: Policy makers can use the results of this study when making decisions about the planning of oral health care workforces and about the data to routinely collect within health services. Collection of suitable data will allow for the continual improvement of workforce planning, leading to a responsive health service and likely future cost savings.

A state-wide study of dental comorbidities in psychiatric disorders resulting in avoidable emergency department presentations.

BACKGROUND: Attendances at emergency departments (EDs) for dental conditions are unnecessary and come at a significant cost to health services. METHODS: A population-based record-linkage analysis of a retrospective cohort over 2 years across state-based facilities in Queensland. This was to determine if people with mental illness were more likely than the general population to attend EDs for a range of non-traumatic or avoidable dental conditions. RESULTS: There were 1 381 428 individuals in the linked database, of whom 177 157 (13%) had a psychiatric history and 22 046 (1.5%) had one or more avoidable dental presentations. These were toothache (n = 9619), dental abscesses (n = 8449), caries (n = 1826), stomatitis (n = 1213) and gum disease (n = 939). After adjusting for confounders, psychiatric patients were significantly more likely to present with toothache, dental abscesses and caries but not stomatitis or gum disease. Depending on the dental outcome, other risk factors were male sex, lower income, rurality and Indigenous status. CONCLUSIONS: Given these findings, possible interventions should include an increased emphasis on assessing oral health in mental health or primary care, especially in non-metropolitan areas, as well as early dental referral. Service planning for this population should including easier navigation of dental services, availability outside normal office hours and free outreach dental clinics.

A Causative Approach to Demographic and Socioeconomic Factors Affecting Parental Ratings of Child Oral Health.

INTRODUCTION: Many studies have investigated associations between demographic, socioeconomic status (SES), behavioral, and clinical factors and parental ratings of child oral health. Caries experience, pain, missing teeth, malocclusions, and conditions and treatments likely to negatively affect the child or family in the future have been consistently associated with poorer parental ratings. In contrast, effect sizes for associations between demographic and SES indicators (race/ethnicity, country of birth, family structure, household income, employment status, and parental education levels) and parental ratings vary greatly. OBJECTIVES: The primary objectives of this study were to estimate effect sizes for associations between demographic and SES variables and parental ratings of child oral health and then to consider possible causal implications. METHODS: This article uses a nationally representative data set from 24,664 Australian children aged 5 to 14 y, regression analyses guided by a directed acyclic graph causal model, and sensitivity analyses to investigate effects of demographic and SES factors on parental ratings of oral health. RESULTS: One in 8 children had oral health rated as fair or poor by a parent. Indigenous children, older boys, young children with a migrant parent, children from single-parent families, low-income households and families where no parent worked full-time, and children whose parents had lower education levels were much more likely to receive a fair or poor parental oral health rating in crude and adjusted models. CONCLUSION: This cross-sectional study helps to clarify inconsistent findings from previous research and shows many demographic and SES variables to be strong determinants of parental ratings of child oral health, consistent with the effects of these variables on other health outcomes. Sensitivity analyses and consideration of the potential for chance and bias to have affected these findings suggest that many of these associations may be causal. KNOWLEDGE TRANSFER STATEMENT: Based on regression analyses driven by a directed acyclic graph causal model, this research shows a strong impact of demographic and socioeconomic determinants on parental ratings of child oral health, consistent with associations between these variables and other oral and general health outcomes. Many of these associations may be causal. We demonstrate the value of causal models and causal thinking when analyzing complex multilevel observational data.

An exploratory study of perfectionism, professional factors and psychological well-being of dentistry academics.

BACKGROUND: Well-being might be lower among dentistry professionals than other health professionals, and differ by personal, professional and sociodemographic factors. Few studies have considered dentistry academics who have different work roles and functions than clinicians. This exploratory study focused on well-being among dentistry academics and aimed to explore associations with perfectionism, professional factors and sociodemographics. METHOD: An online survey was carried out with academic staff in Dentistry and Oral Health departments of nine Universities in Australia and New Zealand. Well-being was assessed using the 22-item Psychological General Well-Being Index, with a maximum score of 110 indicating good well-being. Perfectionism was assessed using the 8-item Short Almost Perfect Scale, with a maximum score of 56 and a higher score indicating perfectionism. Twenty items were used to assess professional and 7 items assessed sociodemographic factors. Associations were explored using correlation and multiple linear regression. RESULTS: There was no significant bivariate association between perfectionism and well-being. Multiple linear regression indicated a significant association between hours of undergraduate teaching and psychological well-being, after adjustment for age, gender, income and overall health. CONCLUSION: This exploratory study showed poor well-being among dentistry academics, particularly in those teaching undergraduate students for more than 6 h/week.

Derivation and validation of a risk-factor model for detection of oral potentially malignant disorders in populations with high prevalence.

BACKGROUND: Oral and pharyngeal cancers constitute the sixth most common type of cancer globally, with high morbidity and mortality. In many countries, most cases of oral cancer arise from long-standing, pre-existing lesions, yet advanced malignancies prevail. A new approach to early detection is needed. We aimed to validate a model for screening so that only high-risk individuals receive the clinical examination. METHODS: A community-based case-control study (n=1029) in rural Sri Lanka assessed risk factors and markers for oral potentially malignant disorders (OPMD) by administering a questionnaire followed by an oral examination. We then developed a model based on age, socioeconomic status and habits of betel-quid chewing, alcohol drinking and tobacco smoking, with weightings based on odds ratios from the multiple logistic regression. A total, single score was calculated per individual. Standard receiver-operator characteristic curves were plotted for the total score and presence of OPMD. The model was validated on a new sample of 410 subjects in a different community. RESULTS: A score of 12.0 produced optimal sensitivity (95.5%), specificity (75.9%), false-positive rate (24.0%), false-negative rate (4.5%), positive predictive value (35.9%) and negative predictive value (99.2%). CONCLUSION: This model is suitable for detection of OPMD and oral cancer in high-risk communities, for example, in Asia, the Pacific and the global diaspora therefrom. A combined risk-factor score of 12.0 was optimal for participation in oral cancer/OPMD screening in Sri Lanka. The model, or local adaptations, should have wide applicability.

Competitive exclusion as a mode of action of a novel Bacillus cereus aquaculture biological agent.

AIMS: To determine the contribution of potential modes of action of a Bacillus cereus aquaculture biological control agent in inhibition of the fish pathogen, Aeromonas hydrophila. METHODS AND RESULTS: When B. cereus was tested in plate well inhibition studies, no production of antimicrobial compounds was detected. Bacillus cereus had a high growth rate (0.96 h(-1)), whereas Aer. hydrophila concentration decreased by c. 70% in co-culture experiments. In nutrient limitation studies, B. cereus had a significantly higher growth rate when cultured under glucose (P < 0.05) and iron (P < 0.01) limitation in comparison with Aer. hydrophila. Bacillus cereus glucose (0.30 g l(-1) h(-1)) and iron (0.60 mg l(-1) h(-1)) uptake rates were also significantly higher (P < 0.01) than the Aer. hydrophila glucose (0.14 g l(-1) h(-1)) and iron (0.43 mg l(-1) h(-1)) uptake rates. Iron uptake was facilitated by siderophore production shown in time profile studies where relative siderophore production was c. 60% through the late exponential and sporulation phases. CONCLUSIONS: Competitive exclusion by higher growth rate, competition for organic carbon and iron, facilitated by siderophore production, could be identified as mechanisms of pathogen growth inhibition by B. cereus. SIGNIFICANCE AND IMPACT OF THE STUDY: This study is the first elucidation of the mechanism of action of our novel B. cereus biological agent in growth attenuation of pathogenic Aer. hydrophila. This study enhances the application knowledge and attractiveness for adoption of B. cereus NRRL 100132 for exploitation in aquaculture.

Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study.

Government and nongovernmental organizations need national and global estimates on the descriptive epidemiology of common oral conditions for policy planning and evaluation. The aim of this component of the Global Burden of Disease study was to produce estimates on prevalence, incidence, and years lived with disability for oral conditions from 1990 to 2017 by sex, age, and countries. In addition, this study reports the global socioeconomic pattern in burden of oral conditions by the standard World Bank classification of economies as well as the Global Burden of Disease Socio-demographic Index. The findings show that oral conditions remain a substantial population health challenge. Globally, there were 3.5 billion cases (95% uncertainty interval [95% UI], 3.2 to 3.7 billion) of oral conditions, of which 2.3 billion (95% UI, 2.1 to 2.5 billion) had untreated caries in permanent teeth, 796 million (95% UI, 671 to 930 million) had severe periodontitis, 532 million (95% UI, 443 to 622 million) had untreated caries in deciduous teeth, 267 million (95% UI, 235 to 300 million) had total tooth loss, and 139 million (95% UI, 133 to 146 million) had other oral conditions in 2017. Several patterns emerged when the World Bank's classification of economies and the Socio-demographic Index were used as indicators of economic development. In general, more economically developed countries have the lowest burden of untreated dental caries and severe periodontitis and the highest burden of total tooth loss. The findings offer an opportunity for policy makers to identify successful oral health strategies and strengthen them; introduce and monitor different approaches where oral diseases are increasing; plan integration of oral health in the agenda for prevention of noncommunicable diseases; and estimate the cost of providing universal coverage for dental care.

Prevalence and severity of periodontal disease: type 2 diabetics versus non-diabetics.

OBJECTIVE: To compare the periodontal status of a group of diabetic Coloured and Black communities of South Africa with a non-diabetic group. STUDY DESIGN: Sixty-seven type 2 diabetics (mean age: 49.3 +/- 8.97) and 67 non-diabetics (mean age: 47.6 +/- 8.85) were examined. The plaque index (P1I), gingival index (GI), probing depth (PD) and clinical attachment loss (CAL) were recorded on Ramfjord index teeth or their substitutes. Previous dental care, smoking status, alcohol consumption and socio-economic status were also assessed. RESULTS: Diabetics had significantly higher mean GI (p = 0.001), PD (p = 0.031) and CAL (p = 0.022) than non-diabetics. The mean P1I (p = 0.531) was not significantly different between the two groups. CONCLUSION: This study showed that diabetics had more severe and a higher prevalence of periodontal disease. Diabetics and their health care givers should be informed of these findings so that diabetics can seek early management of periodontal disease.

Patterns and reasons for tooth extraction at the Winterveldt Clinic: 1998-2002.

BACKGROUND: Tooth extraction is the most common form of dental treatment in developing countries despite significant advances in medicine and dentistry. Dental caries, periodontitis, orthodontics, trauma and prosthodontics are the main reasons for extractions. OBJECTIVE: To determine the patterns of tooth extractions and the reasons for these extractions in a primary care dental clinic attached to a dental training institution. METHODS: A descriptive, retrospective and quantitative study design was followed. Data was gathered from 3793 patient files to record the following variables: age, gender, type of tooth extracted and reason for the extraction. RESULTS: Almost 60% of teeth extracted were lower and upper molars. The main reasons for extractions were dental caries (47.9%) and periodontitis (22.6%). CONCLUSIONS: The findings of the study show an urgent need to reverse the trends in extractions and more emphasis should be placed on primary prevention in order to reduce tooth loss.

Community-level predictors of Australian children's dental caries and injury.

BACKGROUND: Social determinants of oral health are complex and have been described by conceptual frameworks. A widely embraced model of children's oral health was published by Fisher-Owens et al. (2007), identifying theoretical constructs influencing oral health. The current study aimed to investigate community-level constructs described in the conceptual model. METHODS: The Longitudinal Study of Australian Children is a cross-sequential dual cohort study, with a representative sample (n = 10090) of Australian children. Generalized estimating equations were applied to model seven waves of carer-reported oral health and community measures. RESULTS: In the final model, children living in Queensland had a 1.48 (CI 1.35-1.62) increased odds of dental caries over time. Children in low socio-economic status (SES) areas (OR 1.32 CI 1.20-1.44) had an increased odds of caries. The state of Queensland (OR 1.24 CI 1.05-1.46) and poor neighbourhood liveability (OR 1.17 CI 1.05-1.31) were predictors of dental injury. CONCLUSION: By modelling available community measures, this study found SES and rurality were predictors of caries over childhood. Our results highlight the difficulty of applying conceptual models to oral health. The use of qualitative studies and realist reviews should be considered to complement statistical models to provide contextualized insights into funding, policy and service delivery on children's oral health.

Effect of an exponential feeding regime on the production of Rhodotorula araucariae epoxide hydrolase in Yarrowia lipolytica.

AIMS: To evaluate the effect of and exponential feeding regime on the production of epoxide hydrolase (EH) enzyme in recombinant Yarrowia lipolytica in comparison to a constant feed strategy. METHODS AND RESULTS: An exponential feed model was developed and fermentations were fed at six different exponential rates. A twofold increase in EH productivity and a 15% increase in volumetric EH activity was obtained by applying exponential glucose feed rates in fed-batch cultivation. These responses were modelled to obtain a theoretical optimum feed rate that was validated in duplicate fermentations. The model optimum of 0.06 h(-1) resulted in a volumetric EH activity of c. 5500 U l(-1) h(-1) and a maximum activity of 206,000 U l(-1). This correlated well with model predictions, with a variance of <10%. CONCLUSIONS: The use of an exponential feed strategy at a rate of 0.06 h(-1) yielded best results for all key responses which show a clear improvement over a constant feed strategy. SIGNIFICANCE AND IMPACT OF THE STUDY: The study was the first evaluation of an exponential feed strategy on recombinant Y. lipolytica for the production of EH enzyme. The results suggest a strategy for the commercial production of a valuable pharmaceutical enzyme.

Fissure sealants on permanent first molars--consequences of a one-year delay.

OBJECTIVE: The objective of this study was to compare the dental caries status of the occlusal surfaces of permanent first molars of Grade 2 (7-8 years of age) children who kept, and those who missed their Grade 1 (6-7 years of age) dental public health clinic appointment. DESIGN: The data were obtained from the records of schoolchildren attending the clinic for a comprehensive dental public health programme, with emphasis on fissure sealing permanent first molars. The records were grouped into those who had attended the clinic the previous year and those who did not attend. RESULTS: The permanent first molars were significantly more likely to be carious in children who missed the Grade 1 appointment compared to those who kept the appointment. CONCLUSION: A one year delay in fissure sealing the occlusal surfaces of permanent first molars substantially increased the likelihood of dental caries on these teeth.

Early-phase dental students' motivations and expectations concerning the study and profession of dentistry.

This study investigated the career choice and aspirations of early phase dental students in the four dental schools in South Africa, namely the University of the Western Cape (UWC), University of the Witwatersrand (Wits), University of Limpopo (Medunsa) and University of Pretoria (UP). Willing participants completed a self-administered questionnaire (n=184). Motivations for entering a dentistry programme were similar across race and university, with wanting a secure job most often stated as an important factor. For a third of respondents, dentistry was not a first choice. Amongst the White students, it was a first choice for 82% compared with 59% amongst Black Africans. Expected income five-years after graduation also differed significantly across race and university, with White and UP students expecting to earn considerably higher than the others. About 36% of students were concerned about the levels of personal debt related to studying, with the White and Asian students less concerned. Those who expected lower levels of income from the profession were more concerned about personal debts. Most students planned to enter general dental practice (GDP) after community service, almost all White and Wits students expressed this intention, compared with only 35% of Black Africans and 39% of Medunsa students. Orthodontics and Maxillofacial & Oral Surgery were the most popular specialities of choice. The professional attribute "Has a friendly manner and good relationship with patients" was ranked high most often. In conclusion, career advice may not need to be tailored differently for the different racial groups. There is however a need for further investigations on how to address the concerns of financial security which may be realised by the practice of dentistry, and in particular the racial disparities observed in expectations of the profession. This study further highlights the need for government financial assistance for students from under-represented groups.

A national human resources plan for oral health: is it feasible?

UNLABELLED: The South African Department of Health has prepared "A National Human Resources Plan for Health". This plan proposes that the number of dentists produced annually be decreased from 200 to 120, the number of dental therapists increased from 25 to 600 and the number of oral hygienists from 70 to 150. OBJECTIVE: To assess the feasibility of this output plan. METHODS: This paper reviewed the national oral health status and needs, as well as the National Oral Health Strategy, and then assessed the appropriateness of the plan in relation to these findings. The current numbers of students in training and expected production over the next few years was analysed and the feasibility of the proposed production outputs against the current outputs. The current distribution of oral health personnel was also investigated. RESULTS: Substantial parts of the national oral health needs and strategy can be met and implemented by any of the three oral health professionals being trained. More than 80% of oral health professionals are urban-based and in the private sector. The current production of the five dental training institutions is about 320, compared to the proposed output of almost 900 in the plan. With institutions running at near full capacity, the proposed production numbers are not feasible in the short term. However a number of issues need further investigation: which oral health professional is best suited to meet the oral health needs of the population and implement the national oral health strategy, that will make a significant impact on the oral health of the population; how many oral health professional do we require and will the plan address issues of access to services and appropriateness (evidence-based, prevention bias) of care provided? CONCLUSION: There is a need for further investigation of the plan in consultation with all stakeholders, especially its cost implications and alternative strategies to reduce the incidence of oral diseases in the country.