Income-based inequalities in dental service utilization: A multiple mediation analysis.

OBJECTIVES: With elimination of the financial burden of dental services, one can expect an increase in utilization of dental services. This study aimed to investigate the effective mechanisms of financial barriers to the utilization of dental services in an Australian adult population. METHODS: South Australian survey data from the Dental Care and Oral Health Study (2015) were analysed. Following the flexible mediation approach, the direct effect of income and indirect effect of income through mediators (insurance, concession card and service sector) on the outcomes (visit avoidance and treatment prevention due to the cost) were calculated. RESULTS: Findings showed that around half of the low-income people and one-third of the high-income South Australians experienced a financial burden on receiving a dental visit or service. The indirect effect of income on both outcomes of financial burden was negligible, while the direct effect was significant. By changing the potential outcome distribution to their counterfactual exposure distribution and if the mediators are drawn from their counterfactual exposure (lower/higher income) distribution, the odds of visit avoidance and treatment prevention due to the cost were almost twice (Odds Ratio: 2.13, 95% CI 1.72-2.60) and 98% (Odds Ratio: 1.98, 95% CI 1.67-2.35) than in the lower-income individuals, respectively. CONCLUSIONS: It can be concluded that the level of household income, directly and regardless of insurance status, concession card ownership and whether the service sector was public or private, affected the financial burden on utilization of dental services.

The effect of education on dental service utilization patterns in different sectors: A multiple mediation analysis.

OBJECTIVE: The aim of this study was to investigate how education level affects dental service utilization patterns in the Australian adult population. This study tested how education level mediated these service patterns through behavioural mediators such as smoking, tooth brushing and oral health status and investigated these mediation effects in different dental service providers. METHOD: Following the flexible mediation approach, the direct and indirect effects of education through behavioural mediators on dental service utilization patterns (time of last dental visit, reason for last dental visit and frequency of seeking dental care) were calculated for the South Australian population from the Dental Care and Oral Health Study. RESULTS: Participants with lower educational attainment were 33% (Odds Ratio: 0.67, 95% CI 0.56-0.78) and 38% (Odds Ratio: 0.62, 95% CI 0.53-0.74), less likely than their counterparts with higher education to visit a dentist or to receive dental care in the last 12 months, respectively. Low education was associated with a 23% increase in odds of receiving emergency and treatment services (Odds Ratio: 1.23, 95% CI 1.05-1.43) compared to routine dental check-ups or examinations. CONCLUSION: Low education, regardless of oral health behaviours and status, reduces the odds of dental service utilization in terms of frequency of seeking dental care and time of last dental visit. There is more tendency towards receiving emergency and treatment services compared to routine dental check-ups or examinations in participants with lower educational attainment.

Is the association between social support and oral health modified by household income? Findings from a national study of adults in Australia.

OBJECTIVE: To investigate whether the association between social support and oral health outcomes is modified by levels of household income. METHODS: Data were from the National Study of Adults Oral Health (NSAOH 2004-06), a nationally representative study comprising n = 3619 adults in Australia. Effect measure modification (EMM) analysis was adopted to verify whether the association between social support and poor/fair self-rated oral health, lack of a functional dentition (<21 teeth) and low Oral Health Related Quality of Life (OHRQoL; measured using OHIP-14) varies according to levels of income. Poisson regressions adjusted for age, sex, education, country of birth, main language spoken at home and remoteness were used to estimate prevalence ratios (PR) for oral health outcomes for each stratum of social support (overall, family, friends and significant other) and income (effect modifier). We then computed the Relative Excess Risk due to Interaction (RERI), which represents the risk that is over what would be expected if the combination of low social support and low income was entirely additive. Sensitivity analyses for different cut-offs of household income were performed. RESULTS: Adults with lower levels of social support had a 2.1, 1.2 and 1.9 times higher prevalence of fair/poor self-rated oral health, <21 teeth and poor OHRQoL respectively. The RERIs observed were 0.98 (95% CI -0.01; 1.96) for poor/fair self-rated oral health; 0.52 (95% CI -0.06; 1.10) for lack of a functional dentition and 0.50 (95% CI -0.16; 1.15) for poor OHRQoL. For all outcomes and all individual domains of social support, the positive RERIs indicated that the joint association of low social support and low household income surpassed the sum of their separate associations with objective and subjective oral health indicators. CONCLUSION: Individuals with lower levels of social support had poorer oral health than those with high levels of social support, although this association was small for the outcome <21 teeth. The association between social support and poor oral health indicators is modified by levels of household income. Hence, the provision of social support had a stronger association with the oral health of low-income participants, suggesting that socioeconomically disadvantaged individuals would mostly benefit from a social support intervention.

Temporomandibular dysfunction experience is associated with oral health-related quality of life: an Australian national study.

BACKGROUND: There are very few studies of the association between temporomandibular dysfunction (TMD) and oral health-related quality of life (OHRQoL) in a representative sample from the Asia-Pacific region. Accordingly, we aimed to quantify the association of TMD with OHRQoL dimensions and overall measurement scores in a representative sample of Australian adults while accounting for a range of confounders, and statistically estimating whether TMD experience is meaningfully associated with OHRQoL. METHOD: Australia's National Survey of Adult Oral Health 2004-2006 data were used. The outcome variables were the Oral Health Impact Profile (OHIP-14) domains and overall scores while the main exposure was self-reported Diagnostic Criteria Question for TMD. The analysis accounted for confounders including oral health status obtained from the oral examination, demographics, socioeconomics, health behaviours and health including perceived stress subscales of the PSS-14. We conducted complex samples analysis while using Cohen's f2 effect size to estimate whether the association is meaningful. RESULTS: TMD prevalence was 9.9% (95% CI: 8.4-11.6%) among 4133 Australian adults. TMD experience was associated with impairments to the seven OHIP-14 OHRQoL domains (P < .05) with higher impairments observed in physical pain (B = 0.82, 95% CI: .45-1.20, P < .001), psychological discomfort (B = 0.68, 95% CI: .29-1.06, P = .001) and psychological disability (B = 0.52, 95% CI: .20-.84, P = .001) in adjusted multivariate analyses. The difference in the mean OHIP-14 scores for those reporting TMD (Mean = 13.1, 95% CI: 12.0-14.0) and those who did not (Mean = 6.6, 95% CI: 6.0-6.8) was significant (t = 7.51, P < .001). In an adjusted multivariable model for OHIP-14 scores, TMD experience was associated with higher OHIP-14 scores (B = 3.34, 95% CI: 1.94-4.75, P < .001) where the Cohen's f2 was .022. Further, perceived stress subscales: perceived distress and perceived control were associated with TMD experience and OHIP-14 scores (P < .05). CONCLUSION: Lower OHRQoL was observed in Australian adults who reported TMD experience but with small clinical importance which might support considering TMD in regular dental care. The higher impairments observed in physical pain, psychological discomfort and psychological disability domains of OHRQL can help clinicians and researchers focus their attention on these domains. The confounding effect exhibited by the perceived stress subscale might support their inclusion in future TMD and OHRQoL research.

The Practice of Dentistry by Australian- and Overseas-Trained Dentists in Australia: Discriminant Analysis of key Predictors.

INTRODUCTION: Overseas-trained dentists comprise at least one-fourth of the overall Australian dental workforce. This study examined characteristics and practice differences between Australian- and overseas-trained dentists to identify key predictors that best differentiate their dentistry practices. METHODS: Data for the study were from the Longitudinal Study of Dentist Practice Activity (LSDPA), a survey of a nationally representative random sample of dentists in Australia commencing in 1983-1984 and repeated every 5 years. Dentists were surveyed on a wide range of items including participant characteristics, practice patterns, practice inputs, direct demand, and productivity measures. Data were weighted to provide national estimates by age, sex, and practice type. Discriminant function analysis was used to examine the predictor variables that best distinguished between the two groups. Analysis was limited to the most recent wave of the study. RESULTS: A total of 1148 dentists (response rate = 67%) responded to the survey in 2009-2010; 648 cases were available for the discriminant analysis. The discriminant functions for the full sample and each of the 3 age groups (<35 years; 35-50 years; and 50+ years) were found effective to separate dentists into 2 groups (Australian and overseas), with the proportion of cases correctly classified being highest for the oldest age group (89.7% for 50+ years). Female gender, type of practice (working in public sector), and working in disadvantaged areas were significant predictors, with more prominence in the 35- to 50-year age group. Practice inputs, demand, and productivity measures offered less discriminative capacity between the dentists. CONCLUSION: Overseas-trained dentists contribute towards providing dental care to underserved populations, the public sector, and in rural and remote locations. This study provided basis to argue that policies to encourage overseas-trained dentists to contribute towards areas of need locations have been successful, and key productivity measures were also similar to Australian-trained dentists.

Are trust and satisfaction similar in dental care settings?

OBJECTIVES: Trust and satisfaction in dental care settings are salient constructs to operationalize the concept of dentist-patient relationships (DPR). This study aimed to compare the similarity of both constructs with regard to factor structure and revise the scales for better psychometric properties. METHODS: Data analysed in the study were collected in self-complete questionnaires from a random sample of 4011 adults living in South Australia. Trust and satisfaction were assessed using the Dentist Trust Scale and the Dental Care Satisfaction scale. Items in the scales were initially examined with a split-half sample in exploratory factor analysis and cluster analysis. Factor structures of different model designs were tested on the other half sample in confirmatory factor analysis. The final model was cross-validated on the first half sample for structural invariance. RESULTS: Exploratory factor analysis revealed a three-factor structure consisting of 'trust', 'satisfaction' and 'distrust/dissatisfaction' (60.2% of the variance explained; Cronbach's α = 0.94, 0.81, 0.73, respectively). Cluster analysis supported the factor solution with the same three major clusters except for a single-item independent branch of the 'cost' domain from the satisfaction scale. The final model was designed with two correlated but distinct factors, 'trust' and 'satisfaction', with the modification of one inter-item covariance and deleting the least associated item (GFI = 0.96, CFI = 0.98, RMSEA = 0.06). The stability of the final model was achieved through cross-validation (P = .143, ∆CFI < 0.001). CONCLUSIONS: Trust and satisfaction in dental care settings are unidimensionally different yet highly correlated factors concurrently. Demonstrating the discriminant and complementary functions of both constructs can justify the rationale to apply them together in further studies for DPR.

Use of dental services among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

BACKGROUND: This study examines last dental visit (visiting within the last 12 months, having a last visit 5 or more years ago, attending a private dental practice) and usual visit (usually visiting for a check-up, having a dentist they usually attend). METHODS: Explanatory variables include age, gender, region, income, area-based SES and dental insurance. The data were collected in the Interview in NSAOH 2017-18. RESULTS: There was a dental visiting gradient by region, with lower percentages visiting in the last 12 months in remote (44.9%) and regional areas (50.8%) than major cities (58.7%). A higher percentage of the higher-income tertile made visits (63.8%) than the middle (53.7%) and lower tertiles (49.9%). There was a visiting gradient by area-based SES, with higher percentages in the higher (63.8%) and middle SES tertiles (55.2%) than the lower tertile (50.2%). Uninsured persons had lower percentages visiting (43.3%) than insured (69.7%). CONCLUSIONS: Persons in remote locations, those with low socioeconomic status and those uninsured were disadvantaged in terms of access. They had lower percentages visiting in the last 12 months, usually visiting for a check-up, having a dentist they usually attend and higher percentages visiting 5 or more years ago.

Oral health impacts among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

BACKGROUND: This paper examines oral health impacts of toothache experience, self-rated oral health (SROH), being uncomfortable with dental appearance, and avoiding foods in the Australian adult population. METHODS: The explanatory variables include age, sex, region, income, area-based SES, dental insurance and visiting pattern. The data were collected in the interview in NSAOH 2017-18. RESULTS: There were lower percentages with: toothache in the highest (14.8%) than middle (21.2%) and lower income tertiles (25.2%); fair/poor SROH in the highest (15.8%) than middle (24.1%) and lower tertiles (34.8%); uncomfortable with appearance in the highest (29.1%) than middle (35.3%) and lower tertiles (42.2%); and food avoidance in the higher (15.3%) than middle (22.9%) and lower tertiles (34.4%). There were higher percentages with: toothache in the unfavourable (32.2%) than intermediate (23.1%) and favourable (11.7%) visiting groups; fair/poor SROH in the unfavourable (44.0%) than intermediate (27.4%) or favourable (10.2%) groups; being uncomfortable about appearance in the unfavourable (47.6%) than intermediate (39.5%) or favourable (25.8%) groups; and avoiding foods in the unfavourable (34.8%) than intermediate (26.0%) or favourable (14.5%) groups. CONCLUSIONS: Socioeconomic status and dental visiting were associated with oral health impacts. Oral health impacts were worse for those with lower income and unfavourable visiting patterns.

Oral hygiene behaviours among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

BACKGROUND: This paper examines oral hygiene behaviours (tooth brushing, mouthwash use and dental floss) by a range of explanatory variables. METHODS: Explanatory variables included age, sex, region, income, area-based SES, dental insurance and visiting pattern. The data reported were collected in the interview survey in NSAOH 2017-18. RESULTS: A higher percentage of females brushed with toothpaste at least daily (98.0%) and used floss in the last week (62.6%) than males (94.6% and 48.5% respectively). There was an income gradient in tooth brushing. Higher percentages brushed in the high income (96.8%) than middle (96.2%) and low-income tertiles (93.6%). A higher percentage of the high-income tertile (58.2%) flossed than the lower tertile (53.3%). Those with unfavourable visit patterns had lower percentages who brushed daily (92.7%) than the intermediate (96.7%) or favourable (98.2%) groups. There was a gradient in flossing by visiting, with a lower percentage flossing for the unfavourable visiting group (38.5%) than for the intermediate (52.8%) or favourable groups (67.6%). CONCLUSIONS: Oral hygiene behaviours were associated with gender, socioeconomic status and dental visiting. A higher percentage of women brushed and flossed than men. Lower socioeconomic status and those with unfavourable visiting patterns had lower frequencies of brushing and flossing.

The long-term influence of orthodontic treatment on dental knowledge and behaviour: An Australian cohort study.

OBJECTIVES: Fixed orthodontic treatment (FOT) typically lasts 14-33 months, with regular appointments at short intervals to monitor changes, adjust appliances, and remotivate patients to maintain excellent oral hygiene standards to prevent dental disease. Past experiences are important influencers of dental attitudes and self-care dental behaviours in adulthood. Since FOT comprises a high frequency of appointments compared to other dental visiting, we hypothesised that previous FOT enhances dental knowledge and behaviour in later life. METHODS: This cohort study followed-up 30-year-old participants who originally took part in an oral epidemiological study when aged 13-years. Participants completed a questionnaire regarding sociodemographics, dental health behaviours, dental knowledge (prevention of caries and periodontal disease, including questions about popular myths) and FOT. Data analysis comprised un/adjusted binomial logistic regression and multivariate generalised linear regression. RESULTS: Data for 448 participants (56 % female, 35 % received FOT) were analysed; adjusted models controlled for sociodemographics and baseline malocclusion severity. There was no association between FOT and regular toothbrushing (Exp B: 1.35, 95% CI: 0.87-2.10), flossing (Exp B: 1.18, 95 % CI: 0.48-2.90), dental attendance within last 2 years (Exp B: 0.96, 95 % CI: 0.62-1.49) or a non-emergency dental visit (Exp B: 1.01, 95 % CI: 0.51-1.99). Non-FOT participants placed importance on a calcium-rich diet preventing caries (Exp B: 1.99, 95 % CI: 1.14-3.50, P < 0.05), while those with a baseline definite malocclusion had higher levels of knowledge about dental visiting compared to those with minimal or more severe malocclusions (P < 0.05). CONCLUSION: Previous FOT appears to have limited impact on dental knowledge and may not affect long-term dental behaviours. CLINICAL SIGNIFICANCE: This 17-year follow-up study examined the influence of previous fixed orthodontic treatment on dental knowledge and behaviour later in life. Although patients have numerous and regular appointments during the course of orthodontic treatment, this does not seem to impact on either dental knowledge or behaviour in adulthood.

Trust in dentist-patient relationships: mapping the relevant concepts.

Trust has a central role in healthcare encounters. This review explored concepts relevant to trust in dentist-patient relationships. The findings were demonstrated by drawing visual system maps for better understanding of the inherent complexity. A pragmatic approach was employed to search for evidence. The approach was initiated with a systematised searching protocol and followed by an iterative process of drawing maps and complementing references. The analysis-synthesis process found relevant key concepts and sub-concepts presented within three frameworks: the continuum of studying trust (utilisation, measurement, and establishment); beneficiaries of trust utilisation (patients, dentists, and oral health system); and a transformational model of trust development (identification-based, knowledge-based, and deterrence/calculus-based trust). Trust in dentist-patient relationships needs to be assessed in a multidisciplinary approach for interconnectedness among relevant concepts. The findings are represented in patient-centred care and quality of care with common underlying values. Despite the centrality of trust in medical/dental contexts, empirical evidence is insufficient beyond normative suggestions from previous studies. Based on the implications of thematic analysis and interpretation of the system maps, this paper can serve as a guide and source of information for further research of trust in dentist-patient relationships.

Validation of the Health Literacy in Dentistry scale in Brazilian adults.

OBJECTIVES: To perform cross-cultural adaptation and validation of the Health Literacy Dental scale (HeLD) in Brazilian adults. METHODS: The HeLD instrument was translated and cross-culturally adapted to the Brazilian Portuguese language to create longer (HeLD-29) and shorter (HeLD-14) versions. The reliability and validity of these versions were assessed in a sample of 603 adults living near six primary care units in the city of Piracicaba, São Paulo, Brazil. RESULTS: Both versions of HeLD demonstrated high internal reliability, acceptable convergent validity and discriminant validity. However, the confirmatory factor analysis showed that only HeLD-14 demonstrated satisfactory goodness of fit. There were associations between HeLD-14 scores and social demographic characteristics, general and oral health and oral health-related behaviours. Higher scores were observed for the total HeLD-14 and/or individual components of HeLD-14 among women, ethnic white subjects, those with high educational attainment, those with higher income, those reporting toothbrushing twice or more daily, regular dental attenders, those who usually attended for dental care for a check-up, those with excellent or very good self-ratings of general health, those with excellent or very good self-ratings of oral health, and those without tooth extraction and oral health impact. CONCLUSION: The Brazilian version of HeLD-14 was demonstrated to be a reliable and valid instrument for measuring broad aspects of oral health literacy in the adult Brazilian population.

A strife of interests: A qualitative study on the challenges facing oral health workforce policy and planning.

Oral health workforce policy has often lacked systematic connections with broader health policy, and system-based reforms that would enable more effective responses to future needs of the population. The aim of the study was to better understand challenges facing oral health workforce policy and planning and identify potential solutions. In-depth interviews of 23 senior oral health leaders and/or health policy experts from 15 countries were conducted in 2016-17. Grounded theory principles using the Straussian school of thought guided the qualitative analysis. The findings identified: (i) narrow approach towards dental education, (ii) imbalances in skills, jobs and competencies, and (iii) geographic maldistribution as major challenges. An overarching theme -"strife of interests" - shed light on the tension between the profession's interest, and the needs of the population. A key aspect was the clash for power, dominance and authority within the oral health workforce and across health professions. This study argues that appreciating the history of health professions and recognising the centrality of the strife of interests is necessary in developing policies that both address professional sensitivities and are in line with the needs of the population. Integration and closer collaboration of oral health professionals with the mainstream medical and health professions has emerged as the key issue, but the solutions will be diverse and dependent on country- or context-specific scenarios.

Obesity, dietary sugar and dental caries in Australian adults.

OBJECTIVES: To determine the association of overweight/obesity, dental caries and dietary sugars in Australian adults. MATERIALS AND METHODS: The National Survey of Adult Oral Health (NSAOH) 2004-2006 provided data for analysis of dental caries experience. Self-reported body weight and height were used to calculate body mass index (BMI) for a subsample (n = 3,745, 89.8%) of the NSAOH data. A self-report questionnaire of 13 food items estimated the daily intake of added sugar, total sugars and total carbohydrate, using food composition estimates from the AUSNUT2011-2013. Bivariate analyses (Pearson's Chi-square with Rao-Scott adjustment and Student's t-tests) were used to determine the association of overweight/obesity, dental caries, sugar variables and putative confounders. Poisson regression models for the Decayed, Missing and Filled Teeth Index and individual measures of decayed, missing and filled teeth were constructed, with models containing BMI, dietary added sugar, total sugar and total carbohydrate, controlling for putative confounders. RESULTS: There was a positive association between dental caries experience and being overweight or obese compared with having normal weight or being underweight as well as between sugar consumption with all four dental caries outcome measures. When controlled for putative confounders where sugar consumption was identified as a key determinant, the statistical significance between dental caries experience and being overweight or obese disappeared. The demographic and socioeconomic factors associated with dental caries experience were age, sex, education, smoking status and usual reason for dental visit. CONCLUSION: Analysis of the relationship between dental caries and obesity must include data about sugar and carbohydrate consumption.

The long-term influence of orthodontic treatment on adults' psychosocial outcomes: An Australian cohort study.

OBJECTIVES: To assess the influence of orthodontic treatment on psychosocial outcomes in 30-year-olds. The research hypothesis tested was that participants previously treated orthodontically would have better psychosocial outcomes. SETTING AND SAMPLE POPULATION: A prospective longitudinal cohort design was used to follow-up a sample of 1859 30-year-olds from Adelaide, South Australia, who had previously participated in an oral epidemiology study. MATERIALS AND METHODS: Clinical examination in 1988-1989 recorded participants' malocclusion severity. In 2005-2006, participants were invited to complete a questionnaire collecting data on socio-demographic characteristics, dental health behaviours, receipt of orthodontic treatment and psychosocial factors. Data were analysed descriptively and by linear regression models. RESULTS: Data for 448 participants were available; 56% of participants were female. Over a third of participants had received orthodontic treatment. Higher income earners had the best psychosocial outcomes while participants with a basic level of secondary education had the lowest. Regardless of initial malocclusion severity, orthodontic treatment was not associated with better psychosocial outcomes. Instead, a pattern of better psychosocial outcome was observed amongst untreated participants, regardless of malocclusion severity, this being significant for optimism. Adjusted models controlling for socio-demographic, dental health behaviour and malocclusion severity showed no association between orthodontic treatment and self-efficacy, health competence or social support. There was, however, a strong association with optimism. CONCLUSION: There was no difference in long-term psychosocial outcomes based on orthodontic treatment. Our study does not support the contention that orthodontic treatment produces better psychosocial functioning later in life.

Area-level social development and indicators of public dental services in Southern Brazil.

OBJECTIVES: This study aimed to test associations between a municipal social development indicator and indicators of public dental services; examine differences in the achievement of public dental services goals between fluoridated and nonfluoridated municipalities; and, quantify contribution of a municipal social development indicator in estimated mean differences in the public dental services indicators between fluoridated and nonfluoridated municipalities. METHODS: A secondary analysis of data from 293 municipal dental health services records from Southern Brazil between 2010 and 2015 was conducted. Multivariable log-binomial regression models were fitted to test the associations between municipal Human Development Index (HDI) and multiple public dental services indicators (proportion of public dental health service coverage, the proportion of tooth extraction among all clinical procedures, and monthly participation in supervised tooth brushing). Cut-off points for outcomes were based on state goals for public dental services. Blinder-Oaxaca decomposition analyses were performed to quantify the relative contribution of HDI in the differences in outcomes according to the municipal water fluoridation status. RESULTS: Municipalities within the lowest tertile of HDI had 66% lower prevalence of having insufficient public dental health service coverage (less than state goals)than those in the highest tertile of HDI (PR: 0.44; 95% CI: 0.24, 0.50). Municipalities with lowest HDI had nearly 30% higher prevalence of failing the state goals regarding the proportion of extraction and supervised tooth brushing (PR: 1.30; 95% CI: 1.20, 1.40 and PR: 1.34; 95% CI: 1.23, 1.45, respectively). Mean public dental health service coverage was higher in nonfluoridated municipalities than fluoridated municipalities, and municipal HDI explained 36% of the total estimated mean difference. CONCLUSIONS: This study found associations between municipal social development and public dental services indicators in Southern Brazil. However, higher HDI was associated with lower public dental health service coverage, lower proportion of extraction and higher coverage of supervised tooth brushing [Correction added on 2 April 2019, after first online publication: In the preceding sentence, the text "but with a higher proportion of extraction and supervised tooth brushing" was changed to "lower proportion of extraction and higher coverage of supervised tooth brushing"]. Municipal HDI contributed significantly towards the gap in public dental coverage between fluoridated and nonfluoridated municipalities, favoring nonfluoridated municipalities. These findings have important policy implications for reducing oral health inequalities as it highlights the interplay between key oral health policies and their distribution according to municipal social development.

Psychosocial factors and self-reported transitions in oral and general health.

Psychosocial factors may explain variance in health beyond conventional indicators, such as behaviours. This study aimed to examine changes in health associated with perceived stress, social support, and self-efficacy, controlling for sociodemographic characteristics and health behaviour. A random sample of 45- to 54-yr-old subjects was surveyed in 2004-2005, with a follow-up 2 yr later. The outcomes were self-reported changes in oral and general health. Explanatory variables included stress, social support, and perceived health competence with covariates of income, gender, dentition status, toothbrushing, and smoking. Responses were collected from 986 persons (response = 44.4%). At the 2-yr follow-up, 25.6% reported worsening in oral health and 15.3% reported worsening in general health. Prevalence ratios (PR) from adjusted log-binomial regression showed an association between worsening oral health and higher perceived health competence (PR = 0.75, 95% CI: 0.57-0.99), and worsening general health was associated with perceived health competence (PR = 0.82, 95% CI: 0.72-0.94) and stress (PR = 1.17, 95% CI: 1.03-1.32). Worsening oral and general health were seen for male subjects (PR = 1.33, 95% CI: 1.06-1.68 and PR = 1.14, 95% CI: 1.01-1.29) and low income (PR = 1.40, 95% CI: 1.04-1.89 and PR = 1.20, 95% CI: 1.03-1.40). Health-related self-efficacy representing psychosocial resilience was associated with oral and general health, while stress was associated with general health. Psychosocial factors were independent predictors of change in health after controlling for sociodemographic characteristics and health behaviours.

The influence of orthodontic treatment on dental caries: An Australian cohort study.

OBJECTIVE: To assess the influence of orthodontic treatment on long-term caries experience in 30-year-old South Australians. The research hypothesis that was tested was that those with previous orthodontic treatment would have lower caries experience. METHODS: In 2005-2006, a sample of 1859 30-year-olds from Adelaide, South Australia, who comprised 47% of participants who had previously taken part in an oral epidemiology study in 1988-1989, were traced from the Australian electoral roll and invited to participate in a cross-sectional study investigating long-term dental health outcomes. Participants completed a questionnaire that collected information on socio-demographic characteristics, dental health behaviours and receipt of orthodontic treatment. This was followed by clinical examination. The outcome variables were the summed decayed, missing and filled teeth (DMFT) score, and its individual components. Data were analysed using negative binomial regression. RESULTS: The response rate for the questionnaire was 34% (n = 632). There were no systematic differences between those who were followed up and those who were not followed up. Clinical data for 448 participants were available for analyses, representing 24% of the originally contacted individuals. By the age of 30, over a third of participants had received orthodontic treatment. Regardless of initial malocclusion classification, orthodontically treated participants had a lower DMFT score at age 30 but this did not reach statistical significance. Adjusted models controlling for socio-demographic, dental health behaviour and malocclusion status showed no associations between orthodontic treatment and decayed (Exp B: 1.00, 95% CI: 0.72-1.40), missing (Exp B: 1.00, 95% CI: 0.59-1.69), or filled teeth (Exp B: 1.18, 95% CI: 0.93-1.51) or overall DMFT (Exp B: 1.12, 95% CI: 0.88-1.41). CONCLUSION: There was no difference in the long-term caries experience of South Australians aged 30 years based on past orthodontic treatment. Our study does not support the contention that those treated orthodontically have better dental health later in life.